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Schwenk L, Graf J, Kofler K, Häfner HM, Kofler L. Surgical Therapy of Congenital Nevi in the First Year of Life-Psychological Impact on Parents. J Cutan Med Surg 2023; 27:608-613. [PMID: 37735715 PMCID: PMC10714692 DOI: 10.1177/12034754231199750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The birth of a child with a congenital melanocytic nevus (CMN) can lead to distress in the parents. Surgical treatment of CMN can begin in infancy. OBJECTIVES To provide insight into the perspective of parents of children with CMN regarding their experienced psychological burden and motivation to undergo surgery as well as their satisfaction. METHODS Retrospective analysis of patient data of infants (< 1 year of age), who were surgically treated by power stretching for CMN using subcutaneous infiltration anesthesia (SIA) from 01/01/2020 to 08/31/2021. To evaluate the parent's motivation and psychological burden during the surgical treatment of their child, a questionnaire was designed to interview them in a standardized telephone-based interview. RESULTS Out of 45 interviewed parents, 62.2% indicated "severe" or "very severe" distress at the time of their child's birth. Distress was mostly reduced by information about diagnosis and treatment (n = 34) and treatment-progress (n = 27). Stigmatization was experienced by 35.6% of parents. 84,5% of parents were highly satisfied with early initiation of surgical therapy. 69% felt "very satisfied" or "satisfied" with the outcome of surgery. Motivation for surgical therapy was concern about malignant transformation of the, possible stigmatization of the child due to the nevus, while most of the parents (73.3%) mentioned both. CONCLUSIONS Surgical treatment of CMN by power stretching in SIA in infancy is associated with high levels of satisfaction among the children's parents. Early initiation of surgical therapy and education about the diagnosis can reduce the psychological burden of the parents and can prevent psychosocial problems in affected children.
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Affiliation(s)
- Lena Schwenk
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Johanna Graf
- Internal Medicine VI Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Psychooncology Section, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
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Kofler K, Häfner HM, Forchhammer S, Kofler L. [Surgical treatment of nevi in children in a dermatological surgery center : Histopathology and complications]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05147-0. [PMID: 37119200 DOI: 10.1007/s00105-023-05147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The indication for surgical management and histological diagnosis of melanocytic nevi in children is a major challenge in clinical routine. In consultations with children and parents, the exclusion of malignant findings, on the one hand, and the risk of complications, on the other hand, are important. PATIENTS AND METHODOLOGY Included were 946 children under the age of 10 years who underwent surgery with a suspected diagnosis of melanocytic nevus at the University Department of Dermatology, Tübingen, Germany, between 2008 and 2018. Dermatohistopathologic findings and postoperative complications were recorded. RESULTS A clinical diagnosis of melanocytic nevus was histologically confirmed in 93.2% (882/946) of cases, whereby there were 41 Spitz nevi and 18 pigmented spindle cell tumors. Melanoma was diagnosed in 2 of the children (0.2%). In another 6.6%, non-melanocytic findings (e.g., nevus sebaceous, epidermal nevi) were diagnosed. The complication rate was low at 3%. The most common complication was the occurrence of postoperative wound infection in 1.7%. CONCLUSION It is possible to take a biopsy or surgically remove congenital nevi of different sizes even in infants. Serial excision of congenital nevi is an important tool for this purpose. In the investigated cohort, the complication rate was low. Histological confirmation is essential in case of clinically suspicious or atypical findings.
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Affiliation(s)
- Katrin Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a.d.R., Deutschland.
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Stephan Forchhammer
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a.d.R., Deutschland
- Zentrum für Seltene Hauterkrankungen/Kongenitale Nävi, Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
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Kofler K, Häfner HM, Kofler L. Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life. J Eur Acad Dermatol Venereol 2023; 37:1215-1220. [PMID: 36807362 DOI: 10.1111/jdv.18989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. METHODS All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. RESULTS Overall, a cumulative total area of 38.65 cm2 could be removed on average within the first year of life (trunk: 67 cm2 , head: 21.2 cm2 , legs: 21.6 cm2 , arms: 13.2 cm2 ). A cumulative maximum area reduction of 406.9 cm2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5 months (0.46-10.7 months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesia-related complications occurred. CONCLUSION We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.
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Affiliation(s)
- Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Center for Skin Diseases skin+more MVZ, Biberach a.d.R., Germany
- Center for Rare Skin Diseases, Eberhard Karls University, Tuebingen, Germany
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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Eckardt J, Ghoreschi FC, Häfner HM, Scheu A. Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer. J Eur Acad Dermatol Venereol 2023; 37:65-74. [PMID: 36152007 DOI: 10.1111/jdv.18588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. OBJECTIVES The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. METHODS Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. RESULTS In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1-102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old-old group (≥75-84 years) included 491 patients and the oldest-old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow-up period was 4.9 days (range 1-28 days). 92.0% (719/782) suffered from pre-existing comorbidities. Systemic complications occurred in 10.2% (80/782; old-olds: 8.6%, oldest-olds: 13.1%). Hypertensive crisis (>180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life-threatening complications directly related to tumescent local anaesthesia were found. CONCLUSIONS Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre-existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high-tumescent concentrations or volume quantities.
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Affiliation(s)
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | | | - Julia Eckardt
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Saur A, Stenger F, Pfefferle V, Häfner H, Kofler L. Operative Therapie kongenitaler Nävi mittels
Power‐Stretching
‐Technik an der Stirn. J Dtsch Dermatol Ges 2022; 20:1526-1529. [DOI: 10.1111/ddg.14868_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Saur A, Stenger F, Pfefferle V, Häfner H, Kofler L. Surgical therapy of congenital nevi using power‐stretching technique on the forehead. J Dtsch Dermatol Ges 2022; 20:1527-1529. [DOI: 10.1111/ddg.14868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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7
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Eckardt J, Häfner HM, Kofler K, Mroz G, Scheu A, Schulz C, Kofler L. Postoperativer Verlauf von 150 Patienten nach Wächterlymphknotenbiopsie in Tumeszenz‐Lokalanästhesie. J Dtsch Dermatol Ges 2021; 19:536-544. [PMID: 33861008 DOI: 10.1111/ddg.14351_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Julia Eckardt
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | | | - Katrin Kofler
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Gabi Mroz
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Alexander Scheu
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Claudia Schulz
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
| | - Lukas Kofler
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen
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8
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Roerden A, Neunhoeffer F, Götz A, Häfner HM, Kofler L. Vorteile, Sicherheit und Nebenwirkungen der Tumeszenz‐Lokalanästhesie bei dermatologischen Operationen an Säuglingen. J Dtsch Dermatol Ges 2021; 19:352-358. [PMID: 33709604 DOI: 10.1111/ddg.14340_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022]
Abstract
Die Tumeszenz-Lokalanästhesie (TLA) spielt bei dermatochirurgischen Eingriffen eine wichtige Rolle. Die TLA bietet etliche Vorteile, wie lang anhaltende Betäubung, reduzierte Blutung während der Operation und Vermeidung möglicher Komplikationen einer Vollnarkose. Einfache Durchführung, günstiges Risikoprofil und breites Indikationsspektrum sind weitere Gründe dafür, dass TLA zunehmend auch bei Säuglingen eingesetzt wird. Es gibt nicht nur viele Indikationen für chirurgische Exzisionen im Säuglingsalter, wie angeborene Naevi, sondern es hat auch erhebliche Vorteile, wenn diese Exzisionen in einem frühen Alter durchgeführt werden. Dazu zählen die geringere Größe der Läsionen sowie die unproblematische Wundheilung und Geweberegeneration im Säuglingsalter. Dennoch müssen hinsichtlich der Anwendung der TLA bei Säuglingen einige Aspekte berücksichtigt werden, darunter die Dosierung, eine veränderte Plasmaproteinbindung und die Notwendigkeit einer adäquaten und lang anhaltenden Schmerzkontrolle.
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Affiliation(s)
- Alisa Roerden
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland)
| | - Felix Neunhoeffer
- Department of Pediatrics, University Hospital Tübingen, Germany, (Klinik für Kinderheilkunde, Universitätsklinikum Tübingen, Deutschland)
| | - Angelika Götz
- Department of Anesthesiology, University Hospital Tübingen, Germany, (Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Deutschland)
| | - Hans-Martin Häfner
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland)
| | - Lukas Kofler
- Department of Dermatology, University Hospital Tübingen, Germany, (Hautklinik, Universitätsklinikum Tübingen, Deutschland).,Center of Rare Skin Diseases, University Hospital Tübingen, Germany, (Zentrum für seltene Hauterkrankungen, Universitätsklinikum Tübingen, Deutschland)
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Roerden A, Neunhoeffer F, Götz A, Häfner HM, Kofler L. Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants. J Dtsch Dermatol Ges 2021; 19:352-357. [PMID: 33576159 DOI: 10.1111/ddg.14340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long-lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia-associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long-lasting pain control.
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Affiliation(s)
- Alisa Roerden
- Department of Dermatology, University Hospital Tübingen, Germany
| | | | - Angelika Götz
- Department of Anesthesiology, University Hospital Tübingen, Germany
| | | | - Lukas Kofler
- Department of Dermatology, University Hospital Tübingen, Germany.,Center of Rare Skin Diseases, University Hospital Tübingen, Germany
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10
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Eckardt J, Häfner HM, Kofler K, Mroz G, Scheu A, Schulz C, Kofler L. Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia. J Dtsch Dermatol Ges 2021; 19:536-543. [PMID: 33565235 DOI: 10.1111/ddg.14351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. PATIENTS AND METHODS We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. RESULTS 32 % of the patients reported post-operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA. CONCLUSIONS SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.
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Affiliation(s)
- Julia Eckardt
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Hans-Martin Häfner
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Katrin Kofler
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Gabi Mroz
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Alexander Scheu
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Claudia Schulz
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Lukas Kofler
- Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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11
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Cao L, Zhu F. Comparison of tumescent local anesthesia vs normal anesthesia technology in upper blepharoplasty in Asian women. J Cosmet Dermatol 2020; 20:2264-2269. [PMID: 33217779 DOI: 10.1111/jocd.13855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blepharoplasty is the most common type of plastic surgery, used to improve most of the eyelid skin sag caused by aging. In the past, local infiltration anesthesia was widely used in blepharoplasty. Tumescent local analgesia (TLA) is safe and reliable method for anesthesia, even children can use this method. AIMS This research aimed to systematically compare the differences between conventional local infiltration anesthesia and TLA in blepharoplasty. PATIENTS/METHODS One hundred and seventy-eight bilateral upper blepharoplasty patients participated in this research. Visual analog scale (VAS) was employed to evaluate the postoperative pain in the patients. Periorbital appearances are based on light photography and judged by both medical and nonmedical panel. RESULTS The use of TLA decreased the surgery duration but had no influence on the other surgery characteristics of upper blepharoplasty. Using TLA for anesthesia in bilateral upper blepharoplasty generated less pain than using local infiltration anesthesia. At day 7 after upper blepharoplasty, the rate of generation of both ecchymosis and erythema in normal anesthesia (NA) side were higher than in TLA side. The satisfaction of patients after upper blepharoplasty was not influenced by the use of different anesthesia methods. CONCLUSION Compared with the normal anesthesia technology, the use of TLA in the upper blepharoplasty shortened the surgery duration, alleviated the postoperative pain, and mitigated the generation of ecchymosis and erythema. So, TLA is suitable for the performance of anesthesia in blepharoplasty.
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Affiliation(s)
- Lin Cao
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Plastic Surgery, The Hefei Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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12
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Zargham H, Khachemoune A. Systematic review of Mohs micrographic surgery in children: Identifying challenges and practical considerations for successful application. J Am Acad Dermatol 2020; 85:152-161. [PMID: 33011324 DOI: 10.1016/j.jaad.2020.09.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few data exist to guide the application of Mohs micrographic surgery (MMS) in the pediatric population. OBJECTIVE We sought to summarize the clinical characteristics of children undergoing MMS, identify challenges that limit the use of MMS in this population, and examine how these challenges can be overcome. METHODS A systematic review of PubMed and EMBASE, from inception of databases to November 2, 2019, identified all cases of pediatric skin lesions treated with MMS. RESULTS A total of 111 patients were included. The median patient age was 11 years (range 6 weeks to 17 years). The most commonly treated tumor was dermatofibrosarcoma protuberans (n = 62), followed by basal cell carcinoma (n = 30). The most common location was the head and neck (n = 34), followed by the trunk (n = 28) and the extremities (n = 23). The most commonly cited challenges in the application of MMS in children included patient cooperation, concerns for the safety of prolonged general anesthesia, availability of a MMS service in the pediatric setting, and access to a histopathology laboratory experienced in MMS sectioning. LIMITATIONS Many articles did not report specific patient characteristics. CONCLUSION Multiple obstacles limit the application of MMS in pediatric patients. This review describes practical methods to circumvent these obstacles to facilitate the appropriate use of MMS in children.
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Affiliation(s)
- Hanieh Zargham
- Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada; Department of Dermatology, University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, New York
| | - Amor Khachemoune
- Division of Dermatology, McGill University Health Center, Montreal, Quebec, Canada; Department of Dermatology, University of New York Downstate and Veterans Affairs Medical Center, Brooklyn, New York.
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13
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Risk of General Anesthesia in Pediatric Skin Procedures with Projection on Tumescent Anesthesia. Dermatol Res Pract 2020; 2020:9327152. [PMID: 32550845 PMCID: PMC7277072 DOI: 10.1155/2020/9327152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful. Aim The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures. Methods We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability. Results A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00). Conclusion Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.
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Volc S, Götz A, Breuninger H, Häfner H. Management von kongenitalen Riesennävi beim Säugling durch Exzisionen in Lokalanästhesie. J Dtsch Dermatol Ges 2020; 18:396-399. [DOI: 10.1111/ddg.14061_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Angelika Götz
- Universitätsklinik für Anästhesiologie und IntensivmedizinUniversitätsklinikum Tübingen
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15
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Volc S, Götz A, Breuninger H, Häfner H. Management of giant congenital nevi in infants by excision under local anesthesia. J Dtsch Dermatol Ges 2020; 18:396-399. [DOI: 10.1111/ddg.14061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Sebastian Volc
- Department of DermatologyUniversity Medical Center Tübingen Germany
| | - Angelika Götz
- Department of Anesthesiology and Intensive Care MedicineUniversity Medical Center Tübingen Germany
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Breuninger H, Häfner H. Serial excision with power stretching for large and giant melanocytic nevi of the trunk. J Dtsch Dermatol Ges 2019; 17:852-855. [DOI: 10.1111/ddg.13903] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Helmut Breuninger
- Department of DermatologyTübingen University Medical Center Tübingen Germany
| | - Hans‐Martin Häfner
- Department of DermatologyTübingen University Medical Center Tübingen Germany
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17
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Breuninger H, Häfner H. Powerdehnung bei der seriellen Exzision großer und riesiger melanozytärer Nävi am Rumpf. J Dtsch Dermatol Ges 2019; 17:852-855. [DOI: 10.1111/ddg.13903_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Volc S, Maier JCP, Breuninger H, Hund V, Häfner HM, Kofler L. Manufacture and use of tumescence solution meeting hospital-required hygiene conditions - practical implications. J Eur Acad Dermatol Venereol 2019; 33:e434-e435. [PMID: 31220369 DOI: 10.1111/jdv.15754] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Affiliation(s)
- S Volc
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - J C P Maier
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - H Breuninger
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - V Hund
- University Pharmacy, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - H-M Häfner
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - L Kofler
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
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Crisan D, Scharffetter-Kochanek K, Kastler S, Crisan M, Manea A, Wagner K, Schneider LA. Dermatochirurgie bei Kindern: Gegenwärtiger Stand zu Indikation, Anästhesie, Analgesie und potentiellen perioperativen Komplikationen. J Dtsch Dermatol Ges 2018. [PMID: 29537145 DOI: 10.1111/ddg.13451_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HINTERGRUND Anders als Erwachsene benötigen Kinder bei dermatochirurgischen Eingriffen besondere Aufmerksamkeit; die Anwendung verschiedener Analgetika, Anästhetika oder Sedativa erfordert eine gründliche Kenntnis von Pharmakokinetik und -dynamik der Medikamente. Außerdem können Medikamente zur Sedierung/Allgemeinanästhesie bei operierten Kindern zu Anästhesie- oder Analgesie-bedingten Komplikationen einschließlich Störungen der geistigen Entwicklung führen. ZIEL: Auf Basis unserer klinischen Erfahrung und einer Literaturübersicht stellen wir die gängigsten in der pädiatrischen Dermatochirurgie verwendeten Analgetika, Anästhetika und Sedativa dar und diskutieren Risiken und Komplikationen nach dermatochirurgischen Eingriffen. ERGEBNISSE Topische Anästhetika können bei Kindern für oberflächliche dermatologische Eingriffe oder vor einer Infiltrationsanästhesie eingesetzt werden. Die Berechnung der empfohlenen Maximaldosen auf Basis des Körpergewichts ist erforderlich, um eine Überdosierung von Lokalanästhetika zu vermeiden. Die Allgemeinanästhesie gilt bei der Dermatochirurgie als sicher und hat eine geringe Nebenwirkungsrate. Allerdings ist bei Kindern im ersten Lebensjahr aufgrund potentieller langfristiger neurologischer Nebenwirkungen Vorsicht angebracht. NSAR und Opioide spielen bei der Analgesie von Kindern eine bedeutende Rolle. SCHLUSSFOLGERUNGEN Dieser Artikel gibt eine Übersicht über die derzeit verfügbaren Daten zu Analgesie, Anästhesie und Komplikationen, die im Rahmen der pädiatrischen Dermatochirurgie auftreten können. Diese Daten können dabei helfen, die Sicherheit und Qualität der Versorgung zu optimieren und die Beratung der Eltern zu verbessern.
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Affiliation(s)
- Diana Crisan
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
| | | | - Sabine Kastler
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Ulm
| | - Maria Crisan
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Rumänien
| | - Avram Manea
- Department of Face Mouth Jaw Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Rumänien
| | - Katja Wagner
- Klinik für Anästhesiologie, Universitätsklinikum Ulm
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Crisan D, Scharffetter-Kochanek K, Kastler S, Crisan M, Manea A, Wagner K, Schneider LA. Dermatologic surgery in children: an update on indication, anesthesia, analgesia and potential perioperative complications. J Dtsch Dermatol Ges 2018; 16:268-276. [PMID: 29431909 DOI: 10.1111/ddg.13451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children undergoing dermatosurgical procedures require, unlike adults, particular attention; the administration of various analgesics, anesthetics or sedatives requires a thorough knowledge of drug pharmacokinetics and pharmacodynamics. Furthermore, there are concerns that drugs used for sedation/general anesthesia may result in anesthetic/analgesic complications in children undergoing surgery, with a risk of impaired mental development. OBJECTIVES Based on our clinical experience and a literature review, we illustrate the most commonly used analgesic, anesthetic and sedative drugs in pediatric dermatosurgery, and identify risk factors and complications following dermatosurgical procedures. RESULTS Topical anesthetics can be used in children for superficial dermatologic procedures or prior to infiltration anesthesia. Maximum recommended doses based on body weight should be calculated in order to avoid overdosage of local anesthetics. General anesthesia in dermatosurgery is considered safe and has a low rate of side effects. However, caution is advised in children under the age of one due to potential long-term neurological side-effects. NSAIDs and opioids play a significant role in analgesia for children. CONCLUSIONS This article reviews currently available data on analgesia, anesthesia and complications that may arise in pediatric dermatosurgery. These data may be useful in optimizing the safety and quality of care and in improving parent counseling.
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Affiliation(s)
- Diana Crisan
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | | | - Sabine Kastler
- Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany
| | - Maria Crisan
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Avram Manea
- Department of Face Mouth Jaw Surgery, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Katja Wagner
- Department of Anesthesiology, University Clinic Ulm, Germany
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