Biomedical subjects
Publications and source records attributed to M J Auletta.
The common blue nevus is a benign, localized collection of dermal melanocytes. To date, removal required excisional surgery to eliminate pigment that usually extends into the reticular dermis. We report the successful long-term elimination of common blue nevi on the nasal skin of two patients whose lesions were treated with the laser emission of 694 nm energy from the Q-switched ruby laser.
Knowledge of local anesthesia is critically important to perform dermatologic surgery. The objective of this article is to provide an updated review of local anesthesia. The principles of local anesthesia as it pertains to dermatologic surgery are reviewed. New methods of delivering local anesthesia are also presented. Local anesthetics are safe, effective drugs that provide transient insensibility to pain in a limited area of skin. There are a variety of methods of inducing local anesthesia which can be tailored to the requirements of the contemplated procedure. Local anesthetics allow dermatologists to perform a range of procedures safely. Recent developments in topical anesthetics and in tumescent local anesthesia have provided the dermatologic surgeon other methods of delivering local anesthesia.
BACKGROUND: Immediate tissue expansion has been reported to expand skin sufficiently to permit primary closure of large facial defects up to 5 cm in diameter. OBJECTIVE: We wished to evaluate and compare skin hooks with foley catheters in producing tissue expansion. METHODS: Seven patients with post-Mohs surgery defects measuring 3.0 to 5.5 cm in diameter and located on scalp, temple, or forehead skin were treated with immediate tissue expansion. RESULTS: Immediate tissue expansion provided a 16 to 36% increase in the tissue available for closure, over and above what was achieved by undermining alone. In each case, adequate stretching of skin was achieved to permit primary closure relatively easily, which was not possible with undermining alone. Skin hooks were found to be equivalent to foley catheters in their ability to produce tissue expansion. At the one year follow-up visit, some spreading of the scar was noted, ranging from 1 to 7 mm, which appears in part to be related to the degree to which the skin was expanded. CONCLUSION: These findings support the concept that immediate tissue expansion is a separate and distinct process from undermining, which provides additional tissue for reconstructive surgery.
Protein C, when activated, is a vitamin K-dependent serine protease that has anticoagulant and profibrinolytic activities. An increased risk of thrombotic disease is associated with deficiency of this enzyme. A neonate developing purpura fulminans with internal thrombotic complications and congenital absence of protein C is described. Family studies showed partial protein C deficiency in the subject's symptom-free parents and two of three siblings. Clinically and histopathologically similar lesions are also seen in two acquired conditions in which there is a thrombotic tendency: coumarin necrosis and purpura fulminans of childhood, both of which are probably the result of transient protein C deficiency. We conclude that purpura fulminans can represent a cutaneous marker of acquired or congenital protein C deficiency.
With the growth of dermatologic surgery the appropriate use of local anesthesia is becoming an important issue. Thoughtful use of local anesthesia can improve the patient's experience and facilitate the surgical procedure. In this review we discuss historical and pharmacologic aspects of local anesthetic agents. Emphasis is placed on clinical considerations, including contraindications, toxic reactions, and detailed descriptions of anesthetic use.
Venous ulceration, a relatively common manifestation of venous hypertension, is often difficult to treat. This article reports the authors' experience with a new wound-healing technology using a bilayered, culture-derived human skin equivalent (HSE, Apligraf) for treatment of venous ulcers. In the patients studied, HSE appeared to promote wound healing in three ways: 1) apparent graft "take"; 2) temporary wound closure (persistence of HSE with subsequent wound re-epithelialization from wound margins); and 3) stimulation of host healing without temporary persistence by acting as a biologic dressing. The demonstrated efficacy of HSE suggests that it will prove useful for promoting the healing of venous ulcers.