Biomedical subjects
Publications and source records attributed to David J Leffell.
This article reviews the indications and techniques for performing a bilobed flap for reconstruction of surgical wounds. Various examples of surgical defects where a bilobed flap can be used are shown. Possible complications and pitfalls are also reviewed.
Mohs micrographic surgery is a surgical technique that seeks to ensure the clearance of cutaneous tumors while maximizing normal tissue conservation. This is accomplished through the sequential removal of thin layers of tissue in which the entire peripheral and deep margins are examined for residual tumor. This approach appears to be superior to conventional surgical excision in the treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common cancers of the skin. Its efficacy in treating BCC and SCC has led clinicians to explore the role of Mohs micrographic surgery in the management of less common cutaneous neoplasms, such as melanoma, Merkel cell carcinoma, dermatofibrosarcoma protuberans, extramammary Paget's disease, and microcystic adnexal carcinoma.
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OBJECTIVE: To evaluate the scientific evidence for the efficacy of devices for nonablative photorejuvenation of the skin. DATA SOURCES: All studies published between January 1996 and June 2002 in the dermatology literature listed in the MEDLINE database. Search terms included nonablative and photoaging or skin aging. STUDY SELECTION: All studies that presented data on human clinical trials that were designed to test the efficacy of nonablative light sources in reducing fine lines and wrinkles due to photodamage. DATA EXTRACTION: Data presented in the studies were reviewed and evaluated from the perspective of study design and validity of conclusions. DATA SYNTHESIS: Eleven studies were reviewed. Five different light sources were used, each with varying parameters. Ten different clinical end point scales and methodologies were used. No 2 studies used the same clinical end point standards. The majority of the studies provided no statistical analysis of data. CONCLUSIONS: The studies reviewed failed to present consistent data on the efficacy of nonablative photorejuvenation to improve or eliminate rhytids. The field is early in development, and continued improvement and standardization of study design are needed to determine the efficacy of these interventions.
BACKGROUND: Immediate reconstruction after removal of skin cancer by Mohs micrographic surgery (MMS) may not be feasible in patients unwilling or unable to undergo an extensive procedure. Human cadaveric allograft (HCA) may offer a useful alternative to granulation. OBJECTIVE: To examine the usefulness of HCA in resurfacing nasal defects after extirpation of basal cell carcinoma (BCC) by MMS. METHODS: Case histories of seven patients treated with HCA were reviewed with respect to primary skin cancer histology, defect size, medical status, healing time, and cosmesis. RESULTS: Five of seven tumors were infiltrative BCCs. Defects ranged from 2.7 to 20 cm2. Average healing times for wounds with and without exposed cartilage were 42 and 35 days, respectively. There were no wound infections. Hypergranulation tissue was noted in three patients and had no effect on cosmesis, which was adequate in five patients and poor in two patients. CONCLUSION: HCA may be a useful alternative to granulation following MMS for treatment of skin cancers involving the nose.
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