Melissa A. Bogle

Clinical long-term in vivo evaluation of poly(L-lactic acid) porous conduits for peripheral nerve regeneration

distal nerve. At 8 months the number of axons/mm2 was significantly lower in the isograft compared to the midconduit experimental group (p = 0.006). The number of axons/mm2 in the distal nerve and the nerve fiber density in the midconduit and distal nerve were not significantly different between the two groups. The study confirmed our initial hypothesis that PLLA conduits are a viable scaffold for clinical long-term nerve gap replacement. We are critically aware however that longer evaluation of polymer degradation is warrented. Further studies on these individual nerve components are continuing, with the ultimate goal being the fabrication of a bioactive conduit that meets or exceeds the functional results of isografts.

The role of soft tissue reconstruction after melanoma resection in the head and neck.

Reconstruction after wide local excision of melanomas in the head and neck can be formidable. Many tumors lie close to vital structures, and excision must carefully balance preservation of form and function. For small defects, primary closure or skin grafting is satisfactory. However, it has become increasingly evident that more advanced reconstructive procedures can improve the outcome in terms of both function and aesthetics. This study was undertaken to determine the effectiveness of flap closure after wide local excision of melanomas in the head and neck and to develop a set of surgical recommendations on the basis of our experience.

Severe radiation dermatitis is related to staphylococcus aureus

Acute radiation dermatitis commonly occurs following local radiation therapy for various cancers and, when severe, may necessitate disruption of treatment. Intense inflammatory reaction may result in a breakdown of the skins barrier function and accompanying bacterial colonization. Bacterial superantigens may exacerbate inflammation through activation of T-cells and subsequent cytokine release. We report six cases of severe radiation dermatitis in cancer patients. Four of the six grew pathogenic bacteria, and three had psoriasiform or eczematous reactions at distant sites. Both the radiation dermatitis and the distant cutaneous reactions resolved rapidly on a combination of topical steroids and oral plus topical antibiotic therapy. We suggest that staphylococcal superinfection of acute radiodermatitis intensifies the inflammatory process and hinders repair of the epidermal barrier. Patients with acute radiation dermatitis should be investigated for secondary infection. We emphasize the importance of including topical and oral antibiotic therapy in conjunction with topical corticosteroids to eradicate infection as well as hasten repair of the skins barrier function. These cases are presented to call attention to the role of Staphylococcus aureus in the pathogenesis of severe radiation dermatitis and the need to include appropriate antibiotic therapy based on culture in the management of acute radiation dermatitis.

Wrinkles and Acne Scars: Ablative and Nonablative Facial Resurfacing

Fully ablative carbon dioxide (CO2) laser resurfacing is the traditional gold standard for the treatment of moderate-to-severe rhytides and acne scars. It offers the most dramatic results but can have extensive downtime of 2 or more weeks. The Erbium:YAG laser, Erbium:YSGG laser, and plasma skin regeneration were developed to improve photoaging and textural abnormalities without the prolonged recovery time of traditional CO2 resurfacing. Clinical efficacy is generally not as impressive; however, there are less recovery time and an improved side-effect profile. The term “nonablative resurfacing” encompasses a wide range of treatments aimed at tissue remodeling and skin rejuvenation. The results vary depending on the laser or light source that is used. The goal of nonablative resurfacing is to induce selective injury of the dermis while keeping the overlying epidermis intact. Nonablative resurfacing devices include infrared lasers, visible light lasers, intense pulsed light, and light-emitting diode (LED) technology.

Klassisches Resurfacing und Subsurfacing: Lasertherapie

Das ablative Resurfacing kann in Abhängigkeit vom verwendeten Gerät zu weitreichenden Verbesserungen bei Aknenarben, tiefen Falten im Gesicht und Pigmentstörungen führen. Dabei werden die beschädigte Epidermis sowie die obere (papilläre) Dermis durch neues Gewebe ersetzt. Nichtablatives Resurfacing umfasst eine große Bandbreite an Behandlungen zum Remodelling und zur Verjüngung der Haut. Das Ziel ist eine selektive Schädigung der Dermis bei gleichzeitiger Schonung der darüberliegenden Epidermis. Im Allgemeinen erzielt das nichtablative Laserresurfacing weniger deutliche Ergebnisse als das ablative Resurfacing, ermöglicht aber geringere Ausfallzeiten.

Klassisches Resurfacing und Subsurfacing

Vollstandig ablatives Resurfacing mit dem CO2-Laser ist bisher der Goldstandard fur die Behandlung von masigen bis tiefen Falten und Aknenarben. Es erzielt im Vergleich zu anderen Laserverfahren die besten Ergebnisse, kann aber zu Ausfallzeiten von bis zu 2 und mehr Wochen fuhren. Der Erbium:YAG-Laser, Erbium:YSGG-Laser sowie die Plasmaskinregeneration wurden entwickelt, um lichtbedingte vorzeitige Hautalterung und Texturveranderungen mit kurzeren Ausfallzeiten als beim traditionellen CO2-Resurfacing zu behandeln. Das klinische Ergebnis ist nicht ganz so eindrucksvoll, dafur bieten diese Laser eine kurzere Abheilungszeit und ein verbessertes Sicherheitsprofil als der CO2-Laser. Der Begriff ″nichtablatives Resurfacing″ umfasst eine grose Bandbreite an Behandlungen zur Gewebeumbildung und Verjungung der Haut. Die Ergebnisse variieren je nach verwendeter Laser- oder Lichtquelle. Das Ziel beim nichtablativen Resurfacing ist eine selektive Schadigung der Dermis bei gleichzeitiger Schonung der daruberliegenden Epidermis. Zu den fur das nichtablative Resurfacing verwendeten Geraten zahlen Infrarotlaser, Laser, die sichtbares Licht emittieren, IPL-Gerate sowie die lichtemittierende Diodentechnologie (LED).