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Biomedical subjects

R E Fitzpatrick

Publications and source records attributed to R E Fitzpatrick.

At least 19 recordsLinked to original sources
PubMed2001

Resurfacing of photodamaged skin on the neck with an UltraPulse((R)) carbon dioxide laser.

BACKGROUND AND OBJECTIVE: Successful treatment of facial wrinkles with carbon dioxide or erbium laser resurfacing brings about a more youthful appearance of the skin on the face. A variable degree of contrast with the untreated skin on the neck prompts many patients to request treatment for photodamaged skin on the neck. The objective is to investigate the feasibility of resurfacing photodamaged skin on the neck with the UltraPulse((R)) carbon dioxide laser. SUDY DESIGN/MATERIALS AND METHODS: The study was carried out in two phases. During the first phase, a small area on the upper neck was tested with three different parameters. The best parameter was then used to treat the neck area in a single pass in 10 cases in the second phase. Patients were then evaluated at 3-6 months. RESULTS: The three parameters tested were 200 mJ at CPG settings of pattern 3, size 9, density 6, 300 mJ at CPG 3-9-5, and 300 mJ at CPG 3-9-6. The latter seemed to achieve the best results, and there were no complications at any test sites. This setting was used to treat the whole anterior and anterolateral part of the neck with a single pass, wiping away the resultant epidermal debris. Moderate improvement in color and texture, but no improvement in wrinkling, were observed at 3-6 months. However, a mild degree of patchy hypopigmented scarring in the lower neck was encountered in three cases, as well as one other case of patchy hypopigmentation without textural changes. CONCLUSIONS: Despite some obvious improvements, the risk of scarring and hypopigmentation with the tested parameters out-weighs the potential benefits. The lower part of the neck responded very differently from the upper part. Alternative strategies to achieve better results are discussed.

Aged↗
PubMed2000

Successful treatment of treatment-resistant laser-induced pigment darkening of a cosmetic tattoo.

BACKGROUND AND OBJECTIVE: Cosmetic tattoo removal has a reported risk of immediate pigment darkening when treated with a high energy, nanosecond pulsed-laser system. Surgical treatment options for this reaction are limited and carry significant risk of scarring and permanent pigment alterations. This report describes the response of a resistant Q-switched ruby laser-induced cosmetic tattoo ink darkening to multiple treatments with the Q-switched alexandrite laser and Q-switch Nd:YAG laser and textural improvement with the UltraPulse CO(2) laser. STUDY DESIGN/MATERIALS AND METHODS: A woman with Q-switched ruby laser-induced pigment darkening of a cosmetic tattoo of the upper lip resistant to four further treatments with the ruby laser and two chemical peels received a total of 26 treatments with the Q-switched alexandrite and Nd:YAG lasers and a single treatment with the UltraPulse CO(2) laser, most treatments being done at monthly intervals. RESULTS: Treatment of the affected areas with the Q-switched alexandrite and Nd:YAG lasers resulted in complete clearing of the pigment without scarring, but revealed some preexisting textural changes. Use of the UltraPulse CO(2) laser smoothed the surface irregularities. CONCLUSION: The Q-switched pigment lasers are a useful modality for treating this pigment darkening reaction. As in this case, multiple treatment sessions with the laser may be necessary but the pigment can be expected to clear eventually without scarring. Any textural changes may be blended with the UltraPulse CO(2) laser with further improvement.

Adult↗
PubMed2000

Collagen tightening induced by carbon dioxide laser versus erbium: YAG laser.

BACKGROUND AND OBJECTIVE: Pulsed CO2 laser resurfacing improves photodamage and acne scarring by ablation of abnormal tissue with subsequent regeneration and remodeling of collagen and through heat induced collagen contraction. Whether collagen contraction persists long-term and helps maintain the skin tightening observed after resurfacing is debated. One possible mechanism of long-term clinical tightening is that of wound contracture that occurs as part of normal wound healing. If normal wound contracture, and not heat induced collagen contraction, is responsible for maintaining the initial skin tightening seen in CO2 laser resurfacing, then equal results would be expected from resurfacing with either CO2 or erbium lasers. The study was performed to determine whether there is a difference in skin tightening secondary to thermally mediated collagen contraction versus that which occurs secondary to tissue contraction of wound healing. The persistence of these changes over 6 months and the histologic characteristics were studied as well. STUDY DESIGN/MATERIALS AND METHODS: Nine patients had four tattoo dots applied to the upper eyelids, with horizontal axis measuring 18-20 mm and the vertical axis 6-10 mm. One month later, one eyelid was treated with three passes of the UltraPulse CO2 laser and the other eyelid with an erbium laser to the end point of early pinpoint bleeding. Three patients were treated with additional passes after pinpoint bleeding was encountered. The total number of pulses used per patient was recorded. Measurements of the vertical and horizontal distances were made after each pass and monthly for 6 months. The treated skin was then excised in performance of an upper lid blepharoplasty and the tissue submitted for histologic analysis. RESULTS: In the vertical plane, the UltraPulse CO2 laser induced an average of 43% tightening intraoperatively and this gradually diminished to an average of 34% by 6 months, whereas the wound contracture of erbium resurfacing was not seen until 1 month postoperatively, at which time 42% tightening was seen, gradually diminishing to 36% at 6 months. Three patients with erbium resurfacing had scarring present. These were the three patients treated most aggressively and also the three patients with the most significant wound contracture. Scarring was not seen on the CO2 treated side in any patients. In the horizontal plane, the CO2 laser caused 31% intraoperative tightening, decreasing to 19% at 6 months. In this plane, the erbium laser induced wound contracture was 12% at 1 month which remained stable and unchanged. CONCLUSIONS: Although wound contraction secondary to tissue healing may result in nearly the same tissue tightening as heat-induced collagen contraction, the two processes are very different and variable, with increased risk of scarring seen with wound contracture, compared with heat-induced collagen tightening. The tissue tightening seen with thermally induced collagen contraction is long-lasting, if not "permanent."

Blepharoplasty↗
PubMed2000

Treatment of facial skin using combinations of CO2, Q-switched alexandrite, flashlamp-pumped pulsed dye, and Er:YAG lasers in the same treatment session.

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.

Acne Vulgaris↗
PubMed2000

Laser skin resurfacing of the face with a combined CO2/Er:YAG laser.

BACKGROUND: A combined, dual-wavelength CO2/Er:YAG laser system having the ability to deliver both clean ablation of skin with the erbium wavelength and a simultaneous deeper penetrating subablative thermal pulse of CO2 was developed for full-face resurfacing. The CO2 component can be pulsed from 1 to 100 msec at a power of 1-10 W with the Er:YAG component pulsed at 350 microsec at 1.7 J/cm2 through either a computer pattern generator with 3 mm diameter spot size or through a noncollimated spot ranging from 0.2 to 8 mm in diameter. Our previous study using this laser on the neck using a 4-8 mm diameter spot with Er:YAG fluence at 1.7 J and the CO2 at 5 W with a 50 msec pulse at a frequency of 10 Hz showed a higher degree of overall patient satisfaction, as well as improvement in skin texture and skin color, compared to patients treated with an Er:YAG laser alone. OBJECTIVE: This study evaluated the CO2/Er:YAG laser treatment modality in facial resurfacing. METHODS: Ten patients were treated with four passes at 1.7 J with a 4 mm diameter spot and the CO2 at 5 W with a 50-msec pulse at a frequency of 10 Hz. Photoaging scores as well as thermal damage and new collagen formation were compared immediately before and after treatment as well as at 2 weeks and 3 months postoperatively. RESULTS: The average pretreatment periorbital score was 6.2 The average posttreatment periorbital scores were 4.2 (P =.0239) at 2 weeks postoperatively (32% improvement) and 3.8 (P =.0028) at 3 months postoperatively (38% improvement). The average pretreatment perioral score was 5.9. The average posttreatment perioral scores were 3.0 (P =.0001) at 2 weeks postoperatively (49% improvement) and 3.3 (P =.0009) at 3 months postoperatively (44% improvement). The average pretreatment cheek score was 4.7. The average posttreatment cheek scores were 2.7 (P =.0066) at 2 weeks postoperatively (43% improvement) and 3.8 (P =. 0152) at 3 months postoperatively (36% improvement). The average pretreatment forehead score was 4.7. The average posttreatment forehead scores were 3.8 (P =.0340) at 2 weeks postoperatively (33% improvement) and 3.6 (P =.0147) at 3 months postoperatively (37% improvement). The average depth of collagen measured in the dermis pretreatment was 29 microm. The average depth of collagen 3 months posttreatment was 54 microm. This is an average increase of 25 microm or an 86% increase in collagen (P =.006). The average thermal damage immediately after treatment was 20 microm. CONCLUSION: The CO2/Er:YAG laser utilized with four passes at the above-mentioned parameters results in a similar degree of improvement as other forms of laser resurfacing with high-energy, short-pulsed CO2 lasers.

Adolescent↗
PubMed2000

Laser hair transplantation II.

BACKGROUND: Micrografting has revolutionized hair transplantation, resulting in far more natural results than have been achieved prior to this technique. Operative problems including bleeding, graft compression, and ease of graft insertion have been alleged to be decreased with the use of a high-energy pulsed CO2 laser for creation of recipient sites. However, because of thermal injury to surrounding tissue, diminished hair growth and slower wound healing also have been seen. OBJECTIVE: A new laser handpiece, designed to minimize tissue thermal damage to hair recipient sites was tested in comparison to 18-gauge needle recipient sites in the same patients. Hair growth counts at 6 months as well as various measurements of operative problems were compared. METHODS: Two hundred laser grafts were performed on one scalp side and compared to 200 needle grafts on the opposite side. Hair counts preoperatively and at 6 months were performed. Biopsies for depth and surrounding tissue damage were taken intraoperatively. Time for completion of various stages of the procedure for each side were recorded, as well as the incidence of side effects per side. RESULTS: Hair growth was equal for each side. Bleeding and operative time were significantly reduced and ease of graft insertion was increased on the laser side. Graft compression and scarring were not seen. CONCLUSIONS: Laser hair transplantation is faster than using conventional techniques and results in equal hair growth, and should be considered as a viable alternative technique.

Alopecia↗
PubMed2000

Laser treatment of imipramine-induced hyperpigmentation.

BACKGROUND: Blue or slate-gray hyperpigmentation is seen with a variety of medications, including imipramine. We describe a patient with significant imipramine-induced pigmentation. OBJECTIVE: The purpose of this study was to describe an effective laser treatment resulting in improvement of imipramine-induced hyperpigmentation, without discontinuing the medication. METHODS: The patient underwent treatment with carbon dioxide, erbium, alexandrite, and ruby lasers to hyperpigmented areas. Tissue biopsy specimens taken before treatment, immediately after treatment with the alexandrite laser, and at clearing were analyzed by light microscopy. RESULTS: The Q-switched alexandrite and ruby lasers resulted in clinical improvement in the patient's hyperpigmentation and a decrease in pigment granules on light microscopy. CONCLUSION: Both the Q-switched alexandrite and ruby lasers are effective treatments for imipramine-induced hyperpigmentation. The improvement is progressive with successive sessions.

Aged↗
PubMed1999

Cutaneous laser resurfacing.

UNLABELLED: Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.) LEARNING OBJECTIVE: At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.

Anesthesia↗
PubMed1999

Depth of vaporization and the effect of pulse stacking with a high-energy, pulsed carbon dioxide laser.

BACKGROUND: Laser resurfacing of photodamaged skin has become popular, but questions regarding its safety with regard to the risks of scarring have arisen. OBJECTIVE: This study was designed to investigate the depth of vaporization and residual thermal necrosis of single-pulse vaporization and multiple passes versus pulse-stacking and multiple passes. The potential significance of operator technique and laser parameters is considered. METHODS: Skin samples from surgical excisions were treated by means of a Coherent Ultrapulse carbon dioxide laser at 250 mJ per pulse and 500 mJ per pulse with a 3 mm collimated beam and a repetition rate of 10 Hz. A total of 70 treatment areas were performed. Blinded analysis of the histologic effects of single-pulse, double-pulse, and triple-pulse vaporization after 1 through 10 passes was undertaken. RESULTS: A plateau of vaporization was observed after 3 passes at both 250 and 500 mJ whether single-, double-, or triple-pulse vaporization was used. This plateau occurs at approximately 100 to 250 microm from the skin surface. Thermal necrosis is well controlled only with single-pulse vaporization. There is a direct linear increase in the depth of thermal necrosis both with the number of pulses stacked and the number of passes. CONCLUSION: Pulsed carbon dioxide laser resurfacing is a safe and self-limited procedure if a pulse width of less than 1 msec is used with single-pulse vaporization and fluences of 3.5 J/cm2 and 7.0 J/cm2. There appears to be little justification for performing more than 3 or 4 passes. Pulse stacking may significantly increase residual thermal necrosis, thereby increasing the risk of scarring. Operator technique may be significant in avoidance of this occurrence.

Cicatrix↗
PubMed1999

Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin.

BACKGROUND: Laser resurfacing has been used for treatment of photoaged facial skin since late 1993. Very few long-term follow-up studies regarding the effectiveness and side effects of this procedure have been reported. METHOD: Patients who received carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec 17, 1993, to Nov 30, 1996, were followed up with clinical evaluation and patient questionnaires. Histologic study was also performed in 10 representative patients who had had preoperative biopsies. All treatments were performed by 2 experienced laser surgeons (R. E. F. and M. P. G.). RESULTS: One hundred four patients were examined and interviewed with an average 24-month postoperative follow-up (range 12 to 44 months). We observed high patient satisfaction ratings and significant persistence of wrinkle score improvement. Long-term histologic features confirmed the long-lasting nature of the clinical improvement and demonstrated continuing, progressive improvement in solar clastosis deep in the dermis for an average follow-up period of 2 years. Prolonged use of topical tretinoin (retinoic acid) postoperatively may contribute to continued improvement. The incidence of long-term side effects, including pigmentary changes and scarring, was generally very low and these side effects were usually not noticed by the patients. CONCLUSION: Improvement from cutaneous laser resurfacing has persisted for an average 24-month postoperative period with a low incidence of side effects. Hypopigmentation is the most common long-term side effect and appears to be related to the degree of pre-existing photodamage as it contrasts with the newly healed undamaged skin.

Biopsy↗
PubMed1999

Prophylactic antibiotics in patients undergoing laser resurfacing of the skin.

BACKGROUND: Carbon dioxide (CO2) laser resurfacing produces a superficial second-degree burn that needs to be protected from bacterial and fungal infections. OBJECTIVE: We investigated the effects of various systemic and topical antimicrobial regimens. METHODS: Four different regimens using oral ciprofloxacin, topical antibiotics (intranasal mupirocin ointment and otic solution), oral ketoconazole, and oral fluconazole were tested in four time periods. The frequency and types of the infections with various regimens was compared. RESULTS: The study included 356 sequential patients who underwent facial CO2 laser resurfacing. Infections occurred in 27 patients (7.6%). Without antibiotic prophylaxis, 8.2% of patients had bacterial infections from days 3 to 12 after the procedure (average, day 5). With prophylactic ciprofloxacin only, 4.3% of patients had bacterial infections; these occurred almost exclusively after ciprofloxacin was discontinued. For 7 months, patients were randomly assigned to either receive or not receive mupirocin intranasally. All Staphylococcus aureus infections that occurred were seen in patients who had used intranasal mupirocin. Yeast infections were seen in 6 patients (1.7%), but mostly occurred more than 10 days after the procedure. Yeast infections were of approximately equal occurrence in the ciprofloxacin group (2.2%) and in the non-ciprofloxacin group (1.8%). No yeast infections occurred in patients who had undergone antifungal prophylaxis. CONCLUSION: Post-CO2 resurfacing infections are not rare but can appear subtly and might only be noticeable in the second postoperative week. Prophylactic intranasal mupirocin is ineffective, but ciprofloxacin is effective in preventing infection with both gram-positive and gram-negative bacteria. Oral ketoconazole and fluconazole are effective in preventing yeast infections.

Anti-Bacterial Agents↗
PubMed1999

Comparison of the Q-switched alexandrite, Nd:YAG, and ruby lasers in treating blue-black tattoos.

BACKGROUND: A new generation of highly selective short-pulsed lasers has emerged in recent years for the treatment of tattoos. Several studies (including reports by the present investigators) have proven the efficacy of each of the three commercially available, FDA approved devices; namely, the Q-switched alexandrite, Q-switched Nd:YAG and Q-switched ruby lasers. Considerable differences among the three have been reported in relation to the rate of clearing of the tattoo ink particles, tissue effects, beam profile, wound healing, and side effects. OBJECTIVE: This study was primarily conducted to examine and compare the clinical response of patients with blue-black tattoos simultaneously treated with three different Q-switched lasers (alexandrite, Nd:YAG, ruby) with a focus on the percentage of tattoo lightening/clearance and the occurrence or non-occurrence of pigmentary change as a side effect. METHODS: A total of forty-two blue-black tattoos seen at two laser centers (Massachusetts General Hospital Dermatology Laser Center and Laser and Skin Surgery Center of La Jolla) were simultaneously treated with three types of Q-switched lasers: a Candela Q-switched alexandrite laser (755nm 50-100 nanoseconds, 3.0 mm spot size, 6-8 J/cm2); a Continuum Biomedical Q-switched Nd:YAG laser (1064nm, 10-20 nanoseconds, 3.0 mm spot size, 5-10 J/cm2); and a Spectrum Q-switched ruby laser (694 nm, 25-40 nanoseconds, 5.0 mm spot size, 4-10 J/cm2). Paired t-tests and McNemar tests were used to compare the treatment outcome and pigmentation side effects between sites per tattoo, with each site representative of one of the three lasers. The statistical significance level was set at p < .05. RESULTS: Overall, the Q-switched ruby laser had a significant difference in tattoo lightening versus the Q-switched Nd:YAG and Q-switched alexandrite lasers. An increase in the number of treatments paralleled a statistically significant increase in tattoo clearance for all three Q-switched lasers. CONCLUSION: The Q-switched ruby laser had the highest clearance rate in blue-black tattoos and the highest incidence of long-lasting hypopigmentation. The Nd:YAG had no incidence of hypopigmentation.

Adolescent↗
PubMed1999

Treatment of inflamed hypertrophic scars using intralesional 5-FU.

BACKGROUND: Hypertrophic scars and keloids may complicate wound healing secondary to trauma or surgery. A variety of treatment regimens have been used with a range of success. OBJECTIVE: The purpose of this paper is to report the use of 5-fluorouracil (5-FU) intralesionally in treatment of inflamed hypertrophic scars, both as an individual agent as well as in conjunction with low-dose intralesional corticosteroids plus pulsed dye laser therapy. METHODS: The author's 9-year experience in the use of this agent in treating hypertrophic scars is summarized, and case reports are used to demonstrate its efficacy at 50 mg/cc as well as mixed with Kenalog (1 mg/cc) plus concomitant use of the pulsed dye laser. RESULTS: Frequent initial injections (once to thrice weekly) were found to be more efficacious with decreasing frequency (weekly to monthly) during a period of stabilization and resolution of the scars. The combination of 5-FU and Kenalog appeared to be more effective and less painful. The addition of the pulsed dye laser treatments simultaneous with injection therapy was found to be most effective. CONCLUSION: The use of 5-FU intralesionally for treatment of hypertrophic scars appears to be both effective and safe. Further study is warranted.

Acne Vulgaris↗
PubMed1999

Laser resurfacing of the neck with the Erbium: YAG laser.

BACKGROUND: Laser resurfacing of the face is widely used to correct the effects of photoaging. The neck also develops a similar degree of photoaging, but is not usually treated because a higher incidence of adverse effects can occur with laser treatment. OBJECTIVE: To present a new method for treating photoaged skin of the neck with an erbium:yttrium aluminum garnet (Er:YAG) laser. METHODS: Twenty patients underwent Er:YAG laser resurfacing of the neck with one of two methods. Method 1 consisted of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of 8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to 10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of treating the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at identical settings was made on the upper half of the neck with a more defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the lower half of the neck. Patients were evaluated by two nontreating physicians as to overall satisfaction and improvement in skin texture and color. RESULTS: Overall, 51% of patients were satisfied with their results. Skin texture improved an average of 39%. Method 1 produced a 28% improvement, Method 2 a 48% improvement. Skin color improved an average of 37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement. CONCLUSION: Photoaged skin of the neck can be effectively treated with the Er:Yag laser with minimal adverse effects.

Female↗
PubMed1997

Laser resurfacing of rhytides.

A discussion of the pathologic findings found with aging and photodamage is used to formulate a rational preoperative regimen, treatment technique, and maintenance regimen. Details of laser treatment technique, anesthesia, and postoperative care are given. Possible contraindications are discussed, as are the pros and cons of early versus late treatment.

Anesthesia, General↗
PubMed1997

Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin.

BACKGROUND: With proper technique and instrumentation, laser resurfacing for facial wrinkles has been found to be highly effective and relatively safe. Most, if not all, of the noninfectious complications such as pigmentary changes, scarring, and persistent erythema can either be avoided or managed with appropriate therapy. Postoperative infections, on the other hand, may develop despite proper technique and instrumentation. Without proper management, they may cause significant physical morbidity and psychological distress defying the expected benefit of the procedure. OBJECTIVE: To quantify the incidence and to study the characteristics of infections arising after laser resurfacing for facial wrinkles with pulsed carbon dioxide laser treatment. METHOD: A retrospective study was carried out by reviewing the records of all patients undergoing laser resurfacing for facial wrinkles from January 1, 1995 to April 30, 1996. An infection is defined as a positive culture in the presence of signs or symptoms of an infection. RESULTS: Over 16 months, 395 procedures were performed and 17 cases of culture-proven infection recorded, an incidence of 4.3%. All patients had symptoms starting between days 2 and 10 after the operation. Over half of the patients had multiple infections with two to three microorganisms. Pseudomonas aeruginosa was the most common causative agent, found in 41% of all infected cases, followed by Staphylococcus aureus (35%), S. epidermidis (35%), and Candida species (24%). Multiple drug-resistant, gram-negative bacteria were found in four cases, implicating the possibility of hospital-acquired infections. Almost all isolates of gram-positive bacteria were resistant to both erythromycin and penicillin, but not oxacillin. With proper treatment, most patients healed normally. Only one patient had persistent, multiple atrophic scars due to locally disseminated herpes simplex infection despite proper prophylaxis and treatment. CONCLUSIONS: Postoperative infection is uncommon and manageable with early recognition and proper treatment. The types of infectious agents being found are very similar to those reported in burn patients. This complication has been found to be much more common in patients undergoing full face resurfacing and those using a bio-occlusive dressing postoperatively. With comprehensive preventive and management measures, it is likely that this type of uncommon, yet distressful, complication can be avoided and more successfully treated. Recommendations are made for prevention and management of suspected postoperative infections.

Candidiasis↗