Oren Goldan

The use of video capture virtual reality in burn rehabilitation: the possibilities.

We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy™ is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy™ as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for the patient to immerse himself or herself in an alternate reality while undergoing treatment, thereby reducing the pain and discomfort he or she experiences. This simple, affordable technique may prove to heighten the level of patient cooperation and therefore speed the process of rehabilitation and return of functional ability.

A new modality in the treatment of actinic cheilitis using the Er:YAG laser.

Background. Cheilitis is a precancerous skin lesion most often affecting the lower lip. We describe a technique in which this disorder can be treated using Er:YAG laser vaporization. The Er:YAG laser wavelength at 2940 nm lies in a very strong water absorption peak; tissue interaction results mainly in vaporization with minimal heat conduction to adjacent tissue. Objective. To evaluate the efficacy and outcome of a new modality in the treatment of actinic cheilitis with the Er:YAG laser. Methods. Between 2002 and 2005, 12 patients with actinic cheilitis were treated at our institute with the Er:YAG laser. All patients were cured with no recurrence to date, and none suffered postoperative complications. Results: Patients were men and women aged between 37 and 71 years. The healing duration varied from 7 to 30 days (mean 22.33±6.91 days) and the follow‐up ranged from 8 months to 3 years (mean 23.16±9.48 months). No recurrences were detected in our study. Conclusion. Using the Er:YAG laser provides accurate tissue ablation, giving a very satisfactory cosmetic result, with a short healing period, no lip deformity and no sensation loss.

Stensen duct rupture (sialocele) and other complications of the Aptos thread technique.

Background: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. Methods: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. Results: The authors present two major complications, a rare case of Stensens duct laceration and a case of chronic inflammation mandating surgical treatment. Conclusions: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

Treatment of Postdermabrasion Facial Hypertrophic and Keloid Scars with Intralesional 5-Fluorouracil Injections

Hypertrophic and keloid scarring is a known complication of dermabrasion facial resurfacing, although only a very small fraction of patients experience it. Treatment with intralesional corticosteroid injections and flashed pumped vascular dye laser is recommended in the literature. The treatment of keloid and hypertrophic scars using intralesional 5-fluorouracil (5-FU) injections has been well described, but there is no literature regarding use of the same treatment for postdermabrasion hypertrophic and keloid scars. In this case report, we describe a 67-year-old woman with persistent postdermabrasion facial hypertrophic and keloid scars that were treated at our scar clinic using intralesional 5-FU injections.

Expanded reverse abdominoplasty for reconstruction of burns in the epigastric region and the inframammary fold in female patients.

We report the use of expanded reverse abdominoplasty in three female patients with postburn scars involving the entire epigastric region in which the inframammary folds were effaced, resulting in distortion of breast contour. In two of the patients, tissue expanders were used, and subsequently, reverse abdominoplasty was performed, thus re-creating the inframammary fold. The third patient reported to be pregnant after expanders were placed; therefore, smaller volumes of inflation for tissue expansion were necessary. We believe that this procedure is an optimal solution, both aesthetically and functionally, in respect to other reconstructive techniques in female patients with normal skin inferior to epigastric burns. The surgical technique and results are discussed.

A comparison between CO2 laser surgery with and without lateral fold vaporization for ingrowing toenails

Background: An ingrowing toenail is an excessive lateral nail growth into the nail fold. It acts as a foreign body and exerts a local pressure sore‐like effect, which may result in inflammation and granulation. Several treatment modalities exist, including chemical ablation and different surgical procedures. Here we describe and compare a simple and effective method of partial matricectomy using the CO2 laser (group A) versus a similar method with the addition of lateral nail fold vaporization (group B). Objective: Outcome evaluation of a modified laser treatment modality for ingrowing toenails and determination of the role of lateral fold vaporization in reducing the recurrence of symptoms. Methods: Forty patients (mean age 32.45 years) were treated with CO2 laser ablation of toenails between 1999 and 2005 by four physicians. One physician implemented a method that includes lateral nail fold vaporization and resection of the nail segment with its nail bed from 1999 to 2005. Three physicians implemented a similar technique but without lateral fold vaporization between 1999 and 2003, and added lateral fold vaporization to the performed procedure starting in 2004. Results: The recurrence rate was 37.5% in group A and 6.2% in group B. The overall average disease‐free follow‐up period was 42.2 months. Conclusion: The use of CO2 laser in the treatment of ingrowing toenails offers an effective modality. We demonstrate the importance of lateral fold vaporization with the CO2 laser both in improving efficacy and in decreasing recurrence rates over a long follow‐up period.

Late-onset facial abscess formation after cosmetic soft tissue augmentation with bio-alcamid.

Bio-Alcamid (BA) (polyalkylimide) was introduced in Europe in 2001. It is a nonresorbable injectable filler for soft tissue augmentation, indicated for a wide variety of clinical applications in reconstructive and cosmetic surgery in conditions where subcutaneous volumetric compensation is required. Although BA biocompatibility was approved by a European Union Certificate (CE), the substance is not a natural component of biologic tissues, and thus inflammation and infection are still potential risks. The authors present a case of BA infection after minor trauma 3 years after bilateral injections to the malar regions in a 43-year-old woman, causing an abscess that required surgical drainage and parenteral antibiotics.

Epidermoid Inclusion Cysts After APTOS Thread Insertion: Case Report with Clinicopathologic Correlates

The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57-year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood.

Medicinal leech fixation in precarious locations.

Successful use of the medicinal leech Hirudo medicinalis in the salvage of microvascular free flaps has been widely described. The potent anticoagulant hirudin injected by the leech reduces venous engorgement nonsurgically by improving blood drainage from the flap. Potential risks include local infection (mainly by Aeromonas hydrophila), sepsis, blood loss, and leech migration. A method described by Granzow et al employs limiting the movement of medicinal leeches from the surgical site by affixing one end of a surgical suture to the leech and tying the free end to a firm object or dressing. The following case description reports a modification of this technique by suturing a leech to the skin close to an engorged composite graft at the nasal columella. An otherwise healthy 61-year-old woman presented with a large lesion involving the right nostril floor and columella. Tissue biopsy revealed a Morpheus-type basal cell carcinoma. A Mohs procedure was performed excising the nasal columella, the right vestibular mucosa on the septum, the lining mucosa of the right nostril, and the right septal mucosa. Several composite grafting procedures were needed to achieve acceptable structural results. After the last of these operations, the graft appeared to be congested (Fig. 1), and the patient was readmitted to undergo medicinal leech treatment. The proximity of the graft to the nasal orifice posed a therapeutic challenge, as the risk of leech translocation into the nostril and to the mouth was high. This obstacle was overcome by placing a suture piercing through the middle of the leech and fastening it to the underlying tissue using a connective buttonhole, thus preventing migration into the nasal cavity (Fig. 2). The medicinal leech Hirudo medicinalis has been successfully used in the salvage of congested microsurgical flaps by creating an alternative outflow for engorged blood in a flap compromised by poor venous drainage. Attachment is achieved by manipulation of the leech toward the designated area, both physically and chemically by creating a feeding substrate such as a sucrose solution or fresh blood by needle pricking the target tissue. Once sated, the leech will spontaneously detach, at which point arises the risk of translocation. Traditional methods of gauze application surrounding the treatment site may not be applicable in areas anatomically proximal to apertures such as the nose, ears, mouth, and genital orifices. Transmigration into virtually every bodily cavity has been described, posing an impending risk of internal bleeding. The emotional apprehension associated with leech therapy at any site is further heightened when applied near these challenging sites. These factors warrant the conception

Lacrimal Fistula 10 Years After Closed Cosmetic Rhinoplasty: Case Report

Lateral osteotomies performed during cosmetic rhinoplasty can be associated with several complications. Due to the proximity of the lacrimal drainage system to the site of lateral osteotomies, the lacrimal system may be injured during this procedure. This type of injury is very rare, with few reports in the literature. The authors describe a 31-year-old woman who underwent a cosmetic rhinoplasty and experienced postoperative recurrent conjunctivitis with purulent discharge and epiphora. A lacrimal fistula developed 10 years after the procedure.