George J. Hruza

Refinements of nasalis myocutaneous flap.

During the last 3 years, we have applied the nasalis myocutaneous island flap for reconstruction of nasal defects following excision of skin basal cell carcinoma and melanoma in 19 patients. By refinements with Z plasty, early dermabrasion, and placement of a bolster, we could minimize the trapdoor deformity, obvious scars, and blunting of the alar groove. No patients required revisional surgery, and flap survival was 100%. On the basis of our experience, the nasalis myocutaneous island flap is the solution for reconstruction of moderate-sized distal nasal defects in terms of reliability, aesthetics, and simplicity.

Management of a young patient with xeroderma pigmentosum.

Abstract: Xeroderma pigmentosum is a group of rare autosomal recessive disorders with defective DNA repair that provide insight into the basic mechanism of carcinogenesis. It is the best human model linking clinical abnormalities and neoplasla to carcinogen exposure. We describe a patient with xeroderma pigmentosum and numerous basal cell carcinomas, squamous cell carcinomas, and melanomas treated with radiation therapy, Mohs micrographic surgery, dermabrasion, and isotretinoin prophylaxis.

The frontonasal flap: utility for lateral nasal defects and technical refinements

This report details the experience with 27 patients over a 5-year period who had nasal reconstruction using a frontonasal flap. The frontonasal flap procedure is a useful method for the repair of relatively large post-Mohs micrographic surgery defects of the lower, upper, lateral and central nose. Our modified method has been extended (1) to resurface lateral as well as central defects of the caudal one-third of the nose; (2) the scar can be shortened so it does not extend into the forehead; (3) the flap can be combined with the island nasalis flap, or nasolabial flaps to resurface large (3-4 cm) defects; (4) early dermabrasion has improved the scars in sebaceous skin.

Health Care Overutilization in the United States

In Reply: Dr Sinnott and Mr Joseph have listed additional measures a physician could take to remove his or her Web presence and to anonymize Web surfing habits. Some of these suggestions are straightforward to implement, such as using a post office box and blocking caller ID, but others require advanced knowledge of server configuration and are cumbersome to execute. Although these tools may be useful for some physicians, cultivating an awareness of a person’s Internet presence may be more broadly useful than executing specific countermeasure strategies. In addition to the nearly impossible technical challenges associated with total removal of an individual’s digital information, focusing on such measures may result in a missed opportunity to shape and enhance a physician’s Web identity. Given the vastness and increasing ubiquity of personal data online, it is important to have a strategy for moving forward. We offer these steps as general guidelines for clinicians: 1. Know your Web presence. Every physician should search for data about herself or himself to have an idea of what patients may find. 2. Remove slanderous information. Be aggressive in removing slanderous information posted about you or about someone who might be confused for you. 3. Isolate personal data. Use the privacy settings on social network sites such as Facebook. 4. Build your professional Web identity. By creating a Web page or blog, a physician has the ability to put forth the kind of professional identity that he or she would want a patient to see. By making available on the Web appropriate contact information, practice information, curriculum vitae, licensing and board certification information, and academic interests, a physician can use the Internet in a constructive manner and embrace it as a tool to enhance digital identity.