Michael L. Ramsey

The Chondrocutaneous Helical Rim Advancement Flap of Antia and Buch

background The cutaneous surgeon commonly encounters defects of the helix, as 2–4% of all skin cancers occur at this site. objective We report our experience with 47 patients using the chondrocutaneous helical rim advancement flap of Antia and Buch. methods Incisions are made from the defect inferiorly into the lobule and, when necessary, superiorly along the helical sulcus into the helical crus. The postauricular skin is extensively undermined to allow maximal movement of the resulting broad‐based, well‐vascularized flap(s). results We experienced very favorable results using this technique with our patients. No necrosis due to ischemia occurred in any of our cases. Hematomas formed postoperatively in two patients, but healing proceeded uneventfully after removal of coagulated blood. conclusion This technique is an excellent method of repairing many defects of the helical rim. Its advantages include technical simplicity, little risk of tip necrosis, patient convenience, and superior cosmesis.

Alar Rotation Flap for Small Defects of the Ala

Background. Surgical defects of the alar lobule can be difficult to repair with aesthetically pleasing results. Full‐thickness skin grafts are often smoother than the sebaceous skin of the ala. Random patterned flaps from the cheek or proximal nose usually bridge and obliterate the supra‐alar crease and may cause nasal valve malfunction. Objective. We describe and illustrate a technique to repair subtotal alar lobule defects within the cosmetic unit of the alar lobule. Methods. Twenty‐three consecutive alar lobule rotation flaps for repair of Mohs surgical defects were reviewed by patient examination and interview. Results. Twenty‐one of 23 patients were contacted. Patients rated cosmetic results as excellent (18), good (2), or fair (1), and no patients graded their results as poor. Six patients reported “a little” breathing difficulty in the postoperative period that resolved within 6 months. Anesthesia reported by 11 of 21 patients resolved within 5 years in 8 of 9 patients available for follow‐up. Conclusion. Rotation of the ala combined with cheek advancement is a cosmetically pleasing and functional method to repair deep defects of the ala.

Managing friction blisters of the feet

In brief Active people often develop friction blisters on their feet. Although such blisters rarely create significant medical problems, they can be quite painful and can hinder athletic performance. People can decrease the chance of blister formation by wearing properly fitting shoes, doubling up on socks, and applying dressings or lubricants. If lesions do develop, conservative treatment will speed healing and lessen pain and disability.

Transposition island pedicle flaps in the reconstruction of nasal and perinasal defects

Nasal and perinasal defects provide the dermatologic surgeon a challenge. It is necessary that the dermatologic surgeon assess each defect and patient individually for optimal repair. Many reconstructive options exist. This report demonstrates the technique of the transposition island pedicle flap which may be useful for reconstruction of post-Mohs surgery defects on or near the nose.

Surgical Pearl: Delayed intranasal knot tying for composite grafts of the ala

From the Geisinger Medical Center, Section of Dermatologic Surgery. Reprint requests: Michael L. Ramsey, MD, PennState Geisinger Health System, Geisinger Medical Center, Section of Dermatologic Surgery, Danville, PA 17822-1406. J Am Acad Dermatol 1998;39:787-8. Copyright

Plantar warts : choosing treatment for active patients

In brief Plantar warts can be difficult to brief treat. Many eventually resolve without treatment, but patients may want therapies that will quickly return them to pain-free activity. And though seemingly countless remedies have been concocted, no cure exists. Treatment options include chemical, immunologic, and surgical techniques. Physicians must take care to select therapy that does not cause discomfort, loss of function, or long-term problems.

Minimizing Corns and Calluses

In brief: Calluses can be advantageous to some athletes but painful to others, while corns are characteristically painful. Corns and calluses, which may be confused with plantar warts, can be differentiated by gentle paring with a scalpel. This will reveal soft, granular, elongated mounds of dermis projecting up into the epidermis if the abnormality is a wart. Treatment of corns and calluses includes relieving the cause of pressure or friction. Properly fitting shoes and corn/callus pads can help prevent or minimize these common skin disorders.

Athlete's Foot: Clinical Update

In brief: Athletes are particularly prone to athletes foot because they are generally more exposed than others to conditions that encourage fungal growth, eg, communal showers and locker rooms. Diagnosis of athletes foot rests on clinical suspicion and laboratory testing. Treatment may consist of topical antifungal agents and, for more resistant cases, oral griseofulvin. Preventive measures include keeping the feet dry, wearing nonocclusive leather shoes or sandals and absorbent cotton socks, and applying talcum or antifungal powder at least twice daily.

Foot odor: how to clear the air.

Foot odor is seldom discussed around the water cooler. But many people suffer from this embarrassing and at times frustrating problem, particularly active people whose feet sweat a lot. Fortunately, foot odor can usually be controlled with simple measures (table 1).

How I Manage Jock Itch.

In brief Jock itch, an extremely common skin infection, is caused by dermatophytic fungi. Usually the condition is easily diagnosed and responds well to treatment. Therapy consists of administering antifungal medications and keeping the warm, moist environment of the groin area as cool and dry as possible. After the skin disturbance clears, measures should be taken to prevent recurrent infection.