New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal

Successful skin healing without any graft reconstruction after scalpel blade paring of huge rhinophyma: a case report and review of literature

Rhinophyma is considered as a benign tumor of the exterior of the nose. It is a disfiguring soft tissue hypertrophy of the nasal skin, predominantly seen in older, white men. It is believed to be the final stage of acne rosacea. The main presentation of the patients with rhinophyma is the cosmetic disfigurement, although it may also cause nasal obstruction and visual disturbance. The rhinophyma is mainly treated by surgical intervention, which exists in different forms, but all will provide almost similar cosmetic results. Our presentation constitutes one case of rhinophyma treated by paring with a sharp scalpel. The case showed satisfied cosmetic results with a complete healing of the raw area without any skin graft reconstruction.

Severe rhinophyma treated by shave excision and electrocautery

Rhinophyma is a rare disease, causing disfiguring soft-tissue hypertrophy of the nose. Various medical and surgical treatment modalities have been tried, with limited success. We report a case of a 76-year-old man, where shave excision of the rhinophymatous tissue was done with satisfactory cosmetic outcome.

Use of the microdebrider in the surgical management of rhinophyma

Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities-including scalpel surgery, dermabrasion, CO₂ laser ablation, and electrocautery-have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients-a 65-year-old man and a 74-year-old man-who presented with rhinophyma. The instrument we used was the Medtronic Straightshot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option.

Management of haemostasis in surgery: sealant and glue applications

Blood loss has always been a sensitive issue in surgery. Traditional techniques, such as suturing and electrocautery, have drastically reduced operatory bleeding. Unfortunately, wound edges and point application devices are frequently characterized by bleeding and infections. Over the past 20 years, haemostatic agents and tissue sealants have been developed and now are currently used, along with classic suture in various surgical specialties. Their fluid nature allows management of blood loss along any point of the wound and tissue repair. This review presents an overview of the most diffused haemostatic sealants, focusing on their main use in surgery and their adverse effects.

Coblation of rhinophyma

INTRODUCTION

Rhinophyma is a disfiguring hypertrophy of the skin of the tip of the nose.

OBJECTIVE

To assess the new technique of coblation of rhinophyma.

STUDY DESIGN

Case series of six patients.

RESULTS

All patients had a good cosmetic result. Comparison with existing techniques showed advantages due to the lower tissue temperature involved.

CONCLUSION

Coblation of rhinophyma is an effective treatment with few side effects.

Rhinophyma: Excision and Reconstruction with Local Nasolabial Flap

Rhinophyma is a rare disease which causes disfiguring soft tissue hypertrophy of the nose. Various medical and surgical treatment modalities have been proposed and tried with varying degree of success. We report a case where we adopted excision of the rhinophymatous tissue and reconstructed with the local nasolabial flap. The result was cosmetically good enough and the procedure technically simple.

Interventions for rosacea

BACKGROUND

Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective.

OBJECTIVES

To assess the evidence for the efficacy and safety of treatments for rosacea.

SEARCH STRATEGY

We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted.

SELECTION CRITERIA

Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded.

DATA COLLECTION AND ANALYSIS

Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus.

MAIN RESULTS

The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study.

AUTHORS' CONCLUSIONS

The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.