Biomedical subjects
Publications and source records attributed to Amy Stanway.
SUMMARY Local infiltration of anaesthetic in the ala of the nose is very uncomfortable for most patients. This is an area frequently operated on by dermatosurgeons under local anaesthesia as it is a common site for non-melanoma cutaneous malignancies. A simple method is described of providing more pleasant local anaesthesia for patients undergoing alar surgery by using nerve blocks prior to local infiltration.
BACKGROUND: Skin cancer surgery involving the nasal tip and dorsum sometimes results in exposure of underlying bone or cartilage. We describe a simple method of providing a vascular bed for the defect using the superficial nasalis musculoaponeurotic system (SNAS) of the nose, which allows full-thickness skin graft reconstruction of the defect and an acceptable cosmetic outcome. OBJECTIVE: The utility of nasalis flaps to provide a vascular bed for grafting has not been specifically addressed in the dermatology literature. Our experience with 26 SNAS flaps is outlined to demonstrate the utility of this closure in the appropriate situations. METHODS: A discussion of the relevant anatomy is followed by an outline of the surgical technique. RESULTS: SNAS flaps provide a reliable vascular bed and contour for defects of the bridge and distal nose. Complications have been few. CONCLUSIONS: The SNAS flap and graft are simple to perform and provide a reliable alternative to interpolated nasolabial or forehead flaps when the defect exposes significant bare cartilage or bone.
AIM: This audit was designed to compare current referral practice with the Ministry of Health elective services National Access Criteria for first Specialist Assessment (ACA) guidelines, to identify specific problems, and (if possible) to improve the use of acute dermatology services. METHOD: Information regarding referral source, information provided, urgency and diagnostic accuracy, time interval between referral and consultation date, and follow-up arrangements was collected via data sheet on each referral received. We confined the audit to acute referrals--ie, 'immediate and urgent cases' from general practitioners (GPs) that had been discussed with the dermatologist by phone, and internal referrals when an urgent consultation had been requested. RESULTS: More acute referrals came from other hospital departments (74%) than from general practitioners (26%). Acute referrers, especially hospital teams, tended to overestimate the urgency with which a dermatological condition needed to be seen. Information about inpatients was often considered inadequate for triage. GP referrals contained more useful information. GP referral diagnostic accuracy is in keeping with other studies (approximately 50%) but the diagnostic accuracy of hospital doctors is well below this level. All acute referrals were seen within the recommended timeframe. Follow-up patterns were similar (whether referrals came from general practitioners or hospital teams) but for both groups there was a relatively high failure to attend rate. CONCLUSIONS: Inappropriate referrals are time-consuming and reduce our capacity for seeing community patients on the waiting list. To improve referral triage, we recommend that a referral letter that clearly specifies the information that should be provided. The majority of acute referrals did not comply with the ACA guidelines. We recommend applying the ACA guidelines to internal acute dermatology referrals (as well as those from GPs) to reduce unnecessary inpatient reviews, and to provide a better urgent service for those persons who truly require it.
An 83-year-old woman presented with primary multifocal cutaneous B-cell lymphoma, presenting as discrete nodules on the right pinna and nail-bed of the left middle finger, diffuse swelling and erythema of several other nail-beds of the fingers and toes, with associated pincer nail deformity and rhinophyma. Because of the involvement of several sites not amenable to radiotherapy, she was treated with oral cyclical chlorambucil with good result.
A 55-year-old woman with severe, chronic, treatment-resistant ulcerating necrobiosis lipoidica of the shins was commenced on oral cyclosporin at a dose of 2.5 mg/kg/day. Improvement started within 1 week of commencing treatment, and the lesions healed completely over 8 months. Further ulceration occurred 3 months after discontinuing cyclosporin, with improvement on reintroduction of cyclosporin. There have been four previous case reports of healing of treatment-resistant ulcerating necrobiosis lipoidica with cyclosporin.