Matteo C. LoPiccolo

Vitamin D in health and disease.

Background/purpose: Investigations have revealed that vitamin D plays an important role in many areas of health and disease. Questions over whether sun avoidance and sunscreen use will decrease vitamin D levels may concern clinicians when counseling patients at risk for vitamin D insufficiency. A review of the role of vitamin D in health and disease, the impact of photoprotection and skin type on vitamin D levels, and recommendations for adequate vitamin D intake is provided to aid clinicians in counseling patients regarding these issues.

Silicone Granulomas After Soft-Tissue Augmentation of the Buttocks: A Case Report and Review of Management

&NA; The authors have indicated no significant interest with commercial supporters.

Subcuticular Incision Versus Naturally Sourced Porcine Collagen Filler for Acne Scars: A Randomized Split-Face Comparison

BACKGROUND Subcuticular incision is performed to release fibrotic bands beneath acne scars and to stimulate neocollagenesis. Naturally sourced porcine collagen has been approved for filling moderate to deep facial wrinkles and nasolabial folds. To our knowledge, naturally sourced porcine collagen filler has not yet been tried as a treatment for correcting atrophic acne scars. OBJECTIVE To objectively assess and directly compare the efficacy and safety of subcuticular incision versus naturally sourced porcine collagen dermal filler in correcting atrophic and rolling acne scars. MATERIALS AND METHODS We performed a prospective, randomized, split‐face, single‐blind study to evaluate intermediate long‐term efficacy of subcision and collagen dermal filler on 20 unilateral faces. Patients and blinded physicians evaluated results. RESULTS Patients rated subcision as superior to collagen dermal filler at 3 months (p=.03). At 6 months, subcision had a slightly higher rating than collagen dermal filler (p=.12). Blinded evaluators leaned toward subcision at 3 months (p=.12) and at 6 months showed no preference (p=.69). CONCLUSION Subcuticular incision and naturally sourced porcine collagen dermal filler appear to be efficacious for improving atrophic and rolling acne scars. Patients may prefer subcuticular incision over collagen dermal filler. Blinded evaluators found no significant difference between the treatments. The authors indicate no significant interest with commercial supporters.

Guidelines for the use of local anesthesia in office-based dermatologic surgery

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.

Rotation Flaps-Principles and Locations.

BACKGROUND The rotation flap is a classic method of tissue rearrangement. It is a simple yet effective tool for recruiting tissue from areas of laxity and redirecting vectors of tension to reconstruct wounds not amenable to primary closure. OBJECTIVE This article presents the basic design principles and specific applications of the rotation flap in dermatologic surgery. METHODS A Medline search of articles describing rotation flaps published prior to April 1, 2015 was performed, and several prominent texts in dermatologic surgery were reviewed. RESULTS Information gathered from the above sources is combined with the clinical experience of the author and editors to present surgeons with a guide for planning and executing various rotation flaps. CONCLUSIONS Mastering the technique of the rotation flap will allow a surgeon to repair a wide variety of cutaneous defects.

Mohs Micrographic Surgery for the Treatment of Cellular Neurothekeoma and Review of Its Use in Surgical Management of Benign Tumors

&NA; The authors have indicated no significant interest with commercial supporters.

Safety Precautions in Mohs Micrographic Surgery for Patients with Known Blood-Borne Infections: A Survey-Based Study

Purpose A survey‐based study was conducted to gather expert experience on safety procedures used when performing Mohs micrographic surgery (MMS) on patients with known infectious hepatitis or human immunodeficiency virus (HIV). Methods Six hundred eighty‐four fellowship‐trained Mohs surgeons were surveyed to examine the types of safety protocols used when treating patients with known infectious hepatitis or HIV and the frequency of exposure injuries to laboratory and surgical personnel from these patients. Results One hundred eighty‐eight (27.5%) surveys were collected; 64.7% of respondents reported at least one exposure injury to surgical or laboratory personnel in the past year, and 4.8% reported exposure from a patient with known hepatitis or HIV infection. Risk of reporting at least one injury from a patient with known infection within the past year was significantly less when also reporting disposal of the ink applicator after each use (relative risk [RR] = 0.109) and greater when employing laboratory personnel with no medical education or background (RR = 3.857). No exposures were reported from respondents using blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply, or 24‐hour formalin fixation. Conclusion Although firm associations cannot be made from this study, the data suggest that certain measures may help to reduce the rate of exposure injuries in MMS.

Comparing Ablative Fractionated Resurfacing, Photodynamic Therapy, and Topical Imiquimod in the Treatment of Trichoblastomas of Brooke-Spiegler Syndrome: A Case Study

&NA; Graceway Pharmaceuticals, Bristol, Tennessee, provided the imiquimod cream used in this study.

Bilateral Peri-Alar Advancement Flap to Close a Midline Upper Lip Defect

An 80-year-old Caucasian woman presented with a basal cell carcinoma on the mid-upper cutaneous lip. Definitive removal of the tumor using Mohs micrographic surgery required eight stages and resulted in a 2.11.1-cm defect of the dermis and subcutaneous fat extending from the right-mid vermilion inferiorly to the medial left nasal sill superiorly (Figure 1). The underlying musculature was not compromised. How would you reconstruct this defect?

Evaluation of Orbicularis Oculi Muscle Stripping on the Cosmetic Outcome of Upper Lid Blepharoplasty: A Randomized, Controlled Study

Background Many variations in the surgical treatment of upper eyelid blepharoplasty have been described, including orbicularis oculi muscle stripping. There is no evidence in the literature to support the efficacy of this technique in improving the aesthetic results of the procedure. Objectives To conduct a single‐blind, randomized, controlled, split‐face pilot study to evaluate the effects of orbicularis oculi muscle stripping on upper lid blepharoplasty. Methods Ten subjects were randomized to receive upper lid blepharoplasty with orbicularis oculi muscle stripping on one side and skin‐only blepharoplasty on the other. Patients and two blinded physicians evaluated the aesthetics of the eyelids at 1‐, 3‐, and 17‐month follow‐up visits. Results Blinded physician evaluation failed to show a difference in the overall cosmetic appearance of the eyelids between the control and treatment sides at any time point. Analysis of the composite of all patient scores showed a trend favoring the control side at 3 months (p = .28) and the treatment side at 17 months (p = .50), but neither difference was significant. Conclusion Based on the data from this pilot study, orbicularis oculi muscle stripping appears to have no affect on the aesthetic outcome of upper lid blepharoplasty.