Biomedical subjects
G M Marrero
Publications and source records attributed to G M Marrero.
The use of the SMAS to close Mohs defects invading the parotid gland.
BACKGROUND: Plastic surgery literature reports the use of the superficial musculoaponeurotic system (SMAS) in reconstruction after parotidectomies to prevent the complications of Frey's Syndrome and fistula formation. However, there is scant information in the dermatologic literature regarding the use of the SMAS when closing Mohs defects overlying the parotid gland. OBJECTIVE: Our purpose is to introduce to the dermatologic surgery literature the need for plication of the SMAS prior to closure of the overlying tissues when repairing surgical defects which invade the integrity of the parotid gland. METHODS: We describe a patient with a large basal cell carcinoma located in the right preauricular region. Using text and photographs, we detail our closure of this large defect which invaded the parotid gland. RESULTS: Closure of the SMAS over the parotid gland before suturing the overlying tissues provided our patient with an excellent functional and cosmetic result, without the formation of a fistula, sialocele, or Frey's Syndrome. CONCLUSION: We propose that the essential first step in the ideal closure of surgical wounds which penetrate the parotid gland involves the isolation and plication of the SMAS. This will create a barrier to the accumulation of parotid secretions which, in turn, may lead to the development of a sialocele and fistula formation. Such a barrier will also prevent the formation of Frey's Syndrome. Furthermore, plication of the SMAS serves to improve cosmesis by contributing soft tissue bulk to the wound and avoiding a concave deformity.
The new fluor-hydroxy pulse peel. A combination of 5-fluorouracil and glycolic acid.
BACKGROUND: Chemical peels have become an increasingly popular method to treat a myriad of benign skin disorders. Individually, glycolic acid (GA) and 5-fluorouracil (5-FU) have been proven efficacious in the treatment of actinically damaged skin. However, to our knowledge the literature lacks a study examining the synergistic effects of these two agents in the treatment of actinic keratoses (AKs) and solar damage. OBJECTIVE: The aim of the study was to determine if a combination of 5-FU and 70% GA, when delivered in pulse doses, would have greater efficacy than using GA alone in destroying precancerous AKs and improving the cosmetic appearance of the skin. METHODS: A prospective randomized controlled study was designed with 18 subjects who had clinically apparent facial AKs. Each patient was treated with the combination of 5-FU and GA to one half of the face, while GA alone was applied to the other half, in a randomized fashion. A before-treatment count of the number of AKs present on each half of the face was recorded and pretreatment photographs were taken. The solutions were applied weekly to all patients for an 8-week period. A posttreatment count of AKs on each half of the face along with posttreatment photographs followed at 6 months. RESULTS: The combination of 5-FU and GA cleared 91.94% of AKs at a 6-month follow-up period as compared with 19.67% clearing by GA alone. There were no significant side effects reported with the combination peel. CONCLUSION: The fluor-hydroxy pulse peel applied in a pulse dose regimen not only provides cosmetic improvement, but more importantly, has a therapeutic effect on ablating premalignant AKs. This therapeutic effect occurs without the usual morbidity associated with using 5-FU alone in a nonpulsed dosage. Additionally, it is evident that the superficial peeling induced by alpha hydroxy acids may improve cosmesis of actinically damaged skin, but the GA alone cannot destroy a significant number of AKs.
Seasonal presentation of keratoacanthomas in Rhode Island.
Seasonal presentation of skin cancers has been previously described, but the seasonal presentation of keratoacanthomas is less well documented. Pathology reports and dermatology clinic visits were examined from the Roger Williams Medical Center, the major dermatopathology service in Rhode Island, U.S.A., from 1990 to 1992. Seasonal presentation was defined as the ratio of keratoacanthomas during the summer months (June-September) to the number diagnosed during the winter months (December-March). A peak incidence of keratoacanthomas was noted in the summer and early autumn months. The summer/winter ratio (1-38) was statistically significant (P = 0.002). The summer/winter ratio of office visits was smaller at 1.12, but also significant (P < 0.001). There appears to be a seasonal presentation of keratoacanthoma in southern New England. This suggests that ultraviolet radiation has an acute effect on the development of keratoacanthoma.
An intraoperative skin-stretching device to close wounds in Mohs defects.
BACKGROUND: A skin-stretching device takes advantage of the viscoelastic properties of the skin by exerting incremental traction to aid in closing complex wounds. OBJECTIVE: To evaluate the effectiveness of a skin-stretching device and determine the cosmetic results available when this device is used in Mohs surgery. METHODS: We applied a skin-stretching device to seven patients, each of whom had a large, complex wound defect following Mohs surgery. All of the patients had basal cell carcinomas. In one patient the carcinoma was on an upper extremity, and in the others the carcinoma was located on broad facial surfaces, including the temple and forehead. RESULTS: Complete primary closure was accomplished in six patients. A maximum of three cycles of tissue stretching were applied during the period of tissue processing between Mohs layers. In one patient the defect was reduced in size by more than 75%, with final healing by secondary intention. In two patients minor complications developed: focal wound dehiscence occurred in one patient and in the second patient, an inconsequential hypertropic scar developed. In both cases, the problems resolved with acceptable cosmetic results. The remaining patients experienced no complications and the cosmetic results were excellent. CONCLUSION: The skin-stretching device accomplishes effective primary closure of large skin defects by dramatically reducing the size of the defect. It allows a simpler closure where a full-thickness graft or local flap would have otherwise been utilized. The device is convenient to use with minimal complications, reduces operative time, and aids greatly in preserving tissue integrity.