Suture material in cosmetic cutaneous surgery.

Optimal cosmetic surgical results are dependent, in part, on the chosen suture material. Given the importance of sutures in wound healing, it is imperative for the esthetic physician to choose the correct suture material. There are a wide variety of suture materials available and each material presents advantages and disadvantages. An ideal suture material has great strength and knot security while remaining elastic with minimal tissue reactivity. Given that there is no single suture material that is ideal for all situations, the cosmetic physician must decide which material is best suited for the particular closure. This review will address the major properties of common suture materials and describe their advantages and disadvantages.     

Laser therapy for vascular lesions

The use of lasers to treat vascular lesions began in the late 1960s with the introduction of argon laser. More recently pulsed laser and intense pulsed light techniques have further improved results and reduced side effects. Their function is based on the principle of selective photothermolysis. Simultaneous application of cooling methods (contact cooling, cold air, cryogen spray) has become standard procedure for these types of therapy, whose most important indications are port-wine stain, hemangioma, and telangiectasia. A persistent difficulty is their limited penetration, resulting in limited or no effect on deeper dermal layers. New approaches therefore include combinations with bipolar radio frequency or the use of two different laser systems, e.g., dye and Nd:YAG lasers. The different lasers are described along with their effectivity, limitations and indications.     

Laser abrasion for cosmetic and medical treatment of facial actinic damage

Previous studies have shown the carbon dioxide (CO2) laser to be effective in the treatment of actinic cheilitis. After CO2 laser abrasion, normal skin and marked cosmetic improvement of the lip were noted. In our study, twenty-three patients were treated with CO2 laser abrasions for cosmetic improvement of facial lines and actinic changes. Pre- and postoperative histopathologic examinations were made on two patients. Preoperative examination of specimens from actinically damaged skin showed atypical keratinocytes in the basal layer of the epidermis, with overlying dense compact orthokeratosis and parakeratosis. Abundant solar elastosis was seen in the papillary dermis. Postoperative histologic specimens showed a normal-appearing epidermis with fibrosis in the papillary dermis and minimal solar elastosis (about four weeks after laser treatment). At present, various modalities are available for the regeneration of the aged skin, including chemical peels and dermabrasion. Significantly fewer complications were noted with CO2 laser abrasion than with these methods. Thus, CO2 laser abrasion can be useful in the cosmetic and medical treatment of the aged skin. Marked clinical and histologic improvement has been demonstrated.     

The horizon for treating cutaneous vascular lesions

Dermatologists encounter a wide range of cutaneous vascular lesions, including infantile hemangiomas, port-wine stain birthmarks, arteriovenous malformations, venous malformations, Kaposi sarcomas, angiosarcomas, and angiofibromas. Current treatment modalities to reduce these lesions include topical and/or intralesional steroids, laser therapy, surgical resection, and endovascular therapy. However, each method has limitations owing to recurrence, comorbidities, toxicity, or lesion location. Photodynamic therapy, antiangiogenic therapy, and evolving methods of sclerotherapy are promising areas of development that may mitigate limitations of current treatments and offer exciting options for patients and their physicians.     

肿瘤相关的皮肤血管损害

肿瘤相关的皮肤血管损害包含副肿瘤性血管损害及皮肤肿瘤直接导致的血管损伤.概述目前肿瘤相关的皮肤血管损害的发病情况、可能的发病机制、分类和临床特点,了解不同皮肤血管损害与肿瘤之间可能存在的关系.在诊治皮肤血管疾患的过程中,对于血管损害慢性持续存在,常规血管炎的治疗抵抗,伴有体重减轻、发热、贫血等全身体征,尤其是老年患者,应及时进行相关肿瘤的筛查.此类疾病的预后多与其对应的肿瘤种类相关,应早期针对病因进行治疗.     

Long-term patient satisfaction with cosmetic outcome of minor cutaneous surgery

We evaluated our patients' own assessment of the cosmetic outcome of minor dermatological surgery procedures. A postal questionnaire was sent to patients who had undergone surgery between 12 and 18 months previously. Patient satisfaction was correlated with variables, including age, sex, lesion size and site, indication for excision, histological diagnosis and operator. Two hundred and seven excisional procedures were identified in 193 patients. Seventy-nine per cent of the questionnaires (163/207) were returned. Seventy per cent of patients reported that the scar was invisible or better than expected and 9% rated it to be worse than expected. Ninety per cent of patients said they would undergo the procedure again. Patient dissatisfaction was associated significantly and independently with excisions from the back, younger age and benign histology.     

Laser therapy for cutaneous hyperpigmentation and pigmented lesions

ABSTRACT: Selective treatment of pigmented lesions can be accomplished as a result of the recent technologic advancements made in cutaneous laser surgery. Melanin-specific, high-energy, pulsed lasers are being used successfully to remove most benign epidermal and dermal pigmented lesions, including lentigines, café-au-lait macules, melanocytic and blue nevi, drug-induced and infraorbital hyperpigmentation, Becker's nevus, and nevus spilus. These acquired and congenital cutaneous pigmented lesions can be lightened and even permanently eradicated after a series of outpatient laser treatments, with minimal risk of permanent sequelae, such as scarring, skin atrophy, or pigmentary irregularities. Because of the enhanced cosmetic effect of these lasers and their relative ease of use, they are becoming the mainstay of treatment for a variety of pigmented lesions and pigmentary disorders.     

A diagnostic trap for the dermatopathologist: granulomatous reactions from cutaneous microimplants for cosmetic purposes

We present a case of late granulomatous reactions from silicone that first appeared in a site different from that of the injection causing an incorrect diagnosis of liposarcoma in the beginning. The histological picture was a cystic-macrophagic granuloma in both the injection site (upper lip) and the migrating site (paranasal regions). We think that the foreign body has undergone an antigravity migration from the upper lip to the right paranasal region. To our knowledge, such a phenomenon has not been yet reported in literature.     

Cutaneous manipulation of vascular growth factors leads to alterations in immunocytes, blood vessels and nerves: Evidence for a cutaneous neurovascular unit

Background

Skin cells produce soluble factors which influence keratinocyte proliferation, angiogenesis, nerve innervation and immunocyte response.

Objective

To test the hypothesis that epidermal-dermal interactions influence neural outgrowth, vascular survival, immunocyte recruitment and keratinocyte proliferation.

Methods

We genetically manipulated the epidermis to express excess vascular endothelial growth factor (VEGF) and/or angiopoietin-1 (Ang1) and then examined the epidermal and dermal phenotypes. We compared these findings with those occurring following overexpression of the Ang1 receptor Tie2 in endothelial cells or keratinocytes.

Results

Keratinocyte-overexpression of Ang1 resulted in increased epidermal thickness compared to control littermates. Keratinocyte-specific overexpression of Ang1 or VEGF increased dermal angiogenesis compared to control animals and combined Ang1-VEGF lead to further increases. Cutaneous leukocyte examination revealed increases in CD4⁺ T cell infiltration in mice with keratinocyte-specific overexpression of Ang1, VEGF and Ang1-VEGF combined; in contrast only keratinocyte-specific Ang1 overexpression increased cutaneous F4/80⁺ macrophage numbers. Interestingly, combined keratinocyte-derived Ang1-VEGF overexpression reduced significantly the number of F4/80⁺ and Cd11c⁺ cells compared to mice overexpressing epidermal Ang1 alone. Endothelial cell-specific Tie2 overexpression increased dermal angiogenesis but failed to influence the epidermal and immune cell phenotypes. Keratinocyte-specific Tie2 expressing mice had the highest levels of CD4⁺, CD8⁺ and CD11c⁺ cell numbers and acanthosis compared to all animals. Finally, increases in the number of cutaneous nerves were found in all transgenic mice compared to littermate controls.

Conclusion

These findings demonstrate that change to one system (vascular or epidermal) results in change to other cutaneous systems and suggest that individual molecules can exert effects on multiple systems.     

Port-wine-stain-associated dermatitis: implications for cutaneous vascular laser therapy

Abstract:  Port-wine stains are congenital vascular malformations affecting 0.3% to 0.5% of infants. Dermatitis occurring exclusively or most severely within port-wine stains has been described in the literature. Traditionally, topical corticosteroid therapy has been used for the treatment of dermatitis, while pulseddye laser treatment is considered a safe and effective means of lightening the appearance of congenital port-wine stains. To describe the development of port-wine stain-associated dermatitis as well as a rational treatment approach to these patients, we studied three children with facial, limb, or truncal port-wine stains who developed dermatitis within the congenital vascular malformation either prior to or during treatment with pulseddye laser. Laser therapy of dermatitis-affected areas was subsequently deferred pending resolution of the dermatitis with topical corticosteroid or topical calcineurin inhibitor treatment. While pulseddye laser therapy is an effective means of lightening port-wine stains and achieving lasting resolution of any associated dermatitis, this therapy to dermatitis-affected areas should be postponed until the inflammation resolves to minimize the risk of laser-associated adverse effects.     

Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias

Background Cosmetic changes are to be expected after radiotherapy for skin tumours. Objectives This study aimed to answer the questions: How frequent are cosmetic changes after soft X‐ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field? Methods In total, 2474 examinations of 1149 irradiated fields were performed. Results Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X‐ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time–dose–fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews. Conclusions Cosmetic changes after soft X‐ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.     

Laser therapy of vascular lesions

Since the first construction of a laser by Maiman in 1960 and the first clinical application of a laser in the therapy of skin lesions by Leon Goldman, laser therapy has become an important therapeutic modality in dermatology. Various lasers can be used for the treatment of different vascular and non-vascular lesions. According to our results, vascular lesions constitute the most important indication for laser therapy in dermatology.     

Laser treatment of vascular lesions

Lasers and other light sources have been developed that remove or improve many vascular lesions that were previously untreatable. Port-wine stains are the most notable example. Vascular lasers and light sources represent a major advance in dermatology for cosmetic and non-cosmetic applications. This article reviews the common vascular conditions amenable to laser therapy and the approaches and devices used.     

Laser treatment of vascular lesions

Laser treatment of vascular lesions remains one of the more common applications of lasers in dermatology. In fact, lasers have largely become the treatment of choice for vascular birthmarks such as hemangiomas and port-wine stains and the definitive treatment of the telangiectatic form of rosacea. The range of congenital and acquired vascular lesions effectively treated with lasers continues to expand.