Jason D. Marquart

Fractional Thermoablation Using an Erbium‐Doped Yttrium Aluminum Garnet Fractionated Laser for the Treatment of Pulsed Dye Laser–Resistant Port Wine Stain Birthmarks

Port-wine stain (PWS) birthmarks are relatively common vascular malformations, affecting 3 out of 1,000 individuals at birth. The exact etiology of these vascular lesions remains uncertain, but the presence of ectatic dilation of otherwise normal vessels in the papillary and mid-dermis is well established. Although these malformations can occur anywhere on the body, they most commonly present on the face. Involvement of an exposed area such as this often leads to significant psychological distress, with the patient anxious to find treatment options.

Secondary Intention Healing and Purse-String Closures.

BACKGROUND Secondary intention healing and purse-string closures are simple but extremely useful methods for the dermatologic surgeon to master. OBJECTIVE To review the literature on the use of these two types of closures and offer recommendations based on our collective experiences. METHODS A literature review was performed using the terms “secondary intention healing” and “purse-string closure.” The evidence and recommendations from the resultant references were summarized in our article and synthesized with our own experiences. RESULTS Twenty-eight sources were cited overall with fifteen related to secondary intention healing, eleven pertaining to purse-string closures, and one randomized, blind clinical trial comparing the two modalities. CONCLUSION The art of dermatologic surgery often requires a tailored approach to the patient and can involve a spectrum of closures, from the simplest to most complex. This variety not only provides more reconstruction options, but are also necessary to keep dermatologic surgery cost-effective. Certain locations or situations are more amenable for these two types of closures than others. The use of secondary intention healing, either alone or in conjunction with purse-string closures, should be in every dermatologic surgeons armamentarium.

Repair of an unwanted navel piercing.

The authors describe the use of a guidewire punch technique for piercing correction, with a modification for sites that do not allow for complete removal of the tract. Specifically, in this case, the site is the navel. Body piercing for cosmetic reasons has increased in prevalence in recent years. A 2004 study of randomized phone calls nationwide looked at the prevalence of piercings in 500 men and women, aged 18 to 50 years. In this study, 35% of participants reported that they had body piercings, of which, 18% had navel piercings. Known complications specific to navel piercings include delayed healing, jewelry migration, frictional irritation secondary to clothing, and, rarely, bacterial endocarditis in individuals with risk factors. Whether due to medical, personal, or professional reasons, patients often seek assistance in the repair of the tract left by these piercings.

Patient Preferences Comparing Linear Versus Purse String Closures in Dermatologic Surgery Utilizing a Novel Simulator-Based Educational Tool.

BACKGROUND Patients often query in regard to cosmetic outcomes after cutaneous surgery. This study provides information on this topic by surveying preference on 2 skin closure methods, purse and linear. The authors used a novel method to poll opinions by incorporating simulated skin within the context of the survey. OBJECTIVE To determine patients preference for linear or purse string closure. Additional outcomes were to survey patients opinions regarding which scar characteristics have the highest cosmetic impact, the cosmetic importance of a scar, and the utility of simulators, and patient photographs as methods of understanding closure techniques. MATERIALS AND METHODS Participants were prospectively recruited to complete a survey. Data outcomes were analyzed using descriptive statistics and the chi-square test of association. RESULTS About half of the participants (54.7%) preferred linear closure. Preference was independent of gender (p = .90) or having a prior linear or purse string closure (p = .17). Patient photographs were the most influential for determining preference according to 86.2% of participants; however, 88% of the participants found simulator devices useful for educational purposes. CONCLUSION The methods in this survey may represent a venue for educating patients and incorporating their preferences into the choices they will make regarding dermatologic procedures, which they will undergo.

Modification of the Running Suture to Avoid Wound Edge Protrusion

The running closure is a suture technique often used in cutaneous surgery because it is easy to perform and efficient. One common pitfall seen when implementing the traditionally taught running external closure is protrusion of one wound edge over the other at the initiation and termination points. We propose a novel method for preventing this that still ensures good wound edge approximation and eversion throughout the entire length of the superficial closure and prevents formation of dog ears.