Ronald J. Siegle

Facial cutaneous reconstructive surgery: General aesthetic principles

The performance of cutaneous reconstructive surgery requires understanding and application of many important principles. This article reviews the critical factors to consider in the management of surgical wounds by second-intention healing, primary closure, skin grafting, and repair with local flaps. For certain defects, reconstruction with local flaps offers several advantages over other alternatives. Key concepts useful in flap choice and implementation are discussed, and surgical techniques that maximize the aesthetic outcome of reconstructive surgery are reviewed.

Use of α-hydroxy acids in the therapy for photoaged skin

We chose to investigate a commercially available, low-concentration α-hydoxy acid lotion (Lac-Hydrin, 12% ammonium lactate lotion) to determine what, if any, effects it had on the combined changes of aging and photodamage.

Facial cutaneous reconstructive surgery: Facial flaps

Basic principles of aesthetics and function important for successful facial cutaneous reconstructive surgery with local flaps include the use of appropriate tissue donor sources, knowledge of the mechanisms, dynamics, and effects of tissue movement, and techniques for scar camouflage. Useful flaps for defects in each of the facial cosmetic units are reviewed with these principles used as guidelines.

Effects of topical clindamycin on intestinal microflora in patients with acne

Thirty-two patients with acne completed a randomized, double-blind study using topical 1% clindamycin phosphate or its vehicle applied twice daily for 8 weeks for a study of its effects on the intestinal microflora. Two clindamycin patients and one vehicle patient had Clostridium difficile in stools prior to therapy. Of the remaining twenty-nine patients, four of nineteen patients who used clindamycin and none of ten patients who used vehicle had C. difficile detected during treatment; the difference was not statistically significant. There was no diarrhea in the clindamycin group, even though clostridial cytotoxin was found transiently in two patients. Self-limited diarrhea occurred in one vehicle-treated patient, whose stool culture was negative but whose stool specimen showed a positive reaction for C. difficile cytotoxin. With the use of a bioassay, clindamycin was not detected in urine or stool of any patient. No significant changes in Bacteroides fragilis counts in stools were observed in either group.