Steven S. Greenbaum

The Treatment of Chondrodermatitis Nodularis Chronica Helicis with lnjectable Collagen

Chondrodermatitis nodularis chronica helicis (CNCH) consists of a painful, erythematous, often crusted, papule most commonly found on the helical rim of the ear of white men over the age of 40 years old (Fig. 1). It is seen less commonly in women and younger individuals, where the anatomic locations may vary to include the antihelix, antitragus, and other areas on the external ear. Over the years there have been many treatments for this disorder. We present the use of injectable collagen implants as a conservative, effective, and practical method for treatment of this disorder.

Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients

background. The short pulse duration high‐energy carbon dioxide (CO2) lasers have been used in the past for treating cutaneous pathology and more recently for cosmetic improvements of rhytids, photo‐aging, and acne. objective. This study was undertaken to determine the benefits of CO2 laser resurfacing on the severe peri‐oral rhytidosis commonly seen in patients with systemic scleroderma. methods. Three patients were studied and evaluated for satisfactory wound healing, improved cosmetic result, and lack of complications. results. All three patients experienced significant improvement following laser resurfacing. conclusion. The study demonstrated the safe and effective treatment for peri‐oral rhytidosis in patients with generalized scleroderma utilizing CO2 laser resurfacing.

The 585 nm flashlamp-pumped pulsed dye laser for the treatment of telangiectases in patients with scleroderma

penis, and hirsutis papillary corona of the penis. 9 Tyson suggested that these lesions were a source of smegma and others considered them a nervous system organ (cited in Magid and Garden6). It is now known that neither of these hypotheses is correct. Normally the lesions are asymptomatic and appear to have no functional significance. There are some reports of an increased incidence in uncircumcised men compared with circumcised men (22% vs 12%).3, 9 The papules should be differentiated from condyloma acuminamm or ectopic sebaceous glands. Several therapeutic modalities have been used, including circumcision, podophyllin, electrodesiccation and curettage, and, more recently, the carbon dioxide laser. Only the carbon dioxide laser and electrodesiccation and curettage were successful.6, 10

Stellate Purse-String Closure

Background. There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. Objective. We describe the stellate modified purse‐string closure, a novel flap modification. Method. Report of an illustrated case. Result. A patient with vertex scalp defect was reconstructed using the stellate purse‐string flap. Conclusion. Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. Advantages of this modification are discussed.

Intraoperative tissue expansion in eyelid reconstruction

OBJECTIVE Chronic tissue expansion is a well-accepted modality for increasing available tissue for reconstructive surgery. In rapid intraoperative tissue expansion (RITE), a tissue expander is used intraoperatively to increase the available tissue area for defect closure. The use of the ubiquitous and inexpensive Foley catheter has previously been reported as a tissue expander in RITE. In this paper, the authors examine the application of the Foley catheter for RITE in oculoplastic surgery. DESIGN Case series. PARTICIPANTS Twenty-six patients (ages 50 to 87) with eyelid defects from various causes underwent reconstruction using RITE. INTERVENTION Using this technique, the tip of a #14 French Foley catheter is trimmed, keeping the balloon intact. The balloon is inserted under a skin-muscle flap. Counter traction is applied, and the balloon is filled with saline until the flap blanches. The balloon is inflated twice for 5 minutes with a 1- to 2-minute rest period between expansions. This provides increased tissue area for reconstruction of periocular defects. MAIN OUTCOME MEASURES The linear extent of the eyelid defect was measured prior to and after expansion with RITE. A comparison was made between the two measurements. RESULTS The linear extent of the eyelid margin defect decreased by 36% after RITE. CONCLUSIONS Rapid intraoperative tissue expansion with a Foley catheter is a means of providing increased tissue area for reconstructive surgery of the eyelids and periorbital region. This technique provides excellent tissue match for color, texture, and thickness. The technique decreases the size of the incised and undermined skin-muscle flap and the tension needed for wound closure.

Modified Burow's Wedge Flap for Upper Lateral Lip Defects

Background. There are fundamental concepts we use in managing surgical defects. Whether planning a primary closure or a local flap, we frequently modify the basic design to maximize aesthetic outcomes, taking into consideration a number of factors including the location of the defect and tissue availability. Objective. We describe a modified Burows wedge flap for upper lateral lip defects. Method. Report of an illustrated case. Result. A patient with an upper lip defect was successfully reconstructed using the modified Burows wedge flap, where the Burrows wedge is placed on the mucocutaneous lip. Conclusion. Certain modifications of commonly used reconstructive techniques can be utilized in specific situations to enhance cosmesis. For the Burows wedge flap, the dermatologic surgeon has several options in placing the Burows triangle. This is an example of how alternatives in a closure can be used depending on the laxity of the skin and the size of the defect. Advantages and disadvantages of this alternative placement of the Burows triangle are discussed.

Multiple painful keratoacanthomas

7. Eng RH, Bisburg E, Smith SM. Cryptococcal infections in patients with the acquired immune deficiency syndrome. AmJ Med 1986; 81:19-23. 8. Iacobelhs EW, Jacobs Ml, Cohen RP. Primary cutaneous cryptococcosis. Arch Dermatol 1979; 115:984-985. 9. Rico MJ, Penneys NS. Cutaneous cryptococcosis resembhng molluscum contagiosum in a patient with AIDS. Arch Dermatol 1985; 121:901-902. 10. Jimenez-Acosta E, Casado M, Borbujo J. Cutaneous cryptococcosis mimicking molluscum contagiosum in a haemophiliac with AIDS. Clin Exp Dermatol 1987; 12: 446-450. 11. Miller SJ. Cutaneous cryptococcosis resembling molluscum contagiosum in a patient with acquired immunodeficiency syndrome. Cutis 1988; 41:411-412. 12. Concus APM, Helfand RF, Imber MJ. Cutaneous cryptococcosis mimicking molluscum contagiosum in a patient with AIDS. J Infect Dis 1988; 158:897-898. 13. Picon L, Vaillant T, Lorette G. Cutaneous cryptococcosis resembling molluscum contagiosum: a first manifestation of AIDS. Acta Derm Venereol (Stockh) 1989; 69: 365-367. . 14. Manrique P, Mayo J, Alvarez JA. Polymorphous cutaneous crytococcosis: nodular, herpes-like, and molluscum-like lesions in a patient with the acquired immunodeficiency syndrome. J Am Acad Dermatol 1992; 26:122-124.

Use of a deep polypropylene suture during earlobe repair: a method to provide permanent reinforcement in the prevention of recurrent earlobe tract elongation.

Background Cosmetic repair of elongated or lacerated earlobe tracts is a commonly encountered dermatologic procedure. For esthetic purposes, patients may choose to repierce the repaired lobe over the original site. Subsequent piercing within a scarred area potentially increases the risk of recurrent tract elongation secondary to the reduced tensile strength of the scar. Objective To strengthen a damaged earlobe by incorporating a nonabsorbable, dermal polypropylene suture during earlobe repair. Methods The technique is described within the text. Results A deep polypropylene suture placed within a repaired earlobe tract provides a permanent barrier above which repiercing can be performed. Conclusion Permanent reinforcement of the repaired earlobe serves to reduce the possibility of recurrent elongation of the earlobe tract. The technique is relevant when repeat piercing is desired over the original site.