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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Huynh J, Ghoreschi FC, Häfner HM, Scheu A. Tumeszenz-Lokalanästhesie bei geriatrischen Patienten mit Hauttumoren im Kopf-Hals-Bereich - Eine retrospektive Studie an 782 Patienten: Tumescent local anesthesia in geriatric patients with head and neck skin cancer - a retrospective study of 782 patients. J Dtsch Dermatol Ges 2024; 22:210-222. [PMID: 38361199 DOI: 10.1111/ddg.15287_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/28/2023] [Indexed: 02/17/2024]
Abstract
ZusammenfassungHintergrund und ZielsetzungAufgrund ihrer Morbidität werden dermatochirurgische Eingriffe bei älteren Patienten vorzugsweise in Tumeszenz‐Lokalanästhesie durchgeführt. Allerdings ist die Datenlage hierzu begrenzt. Ziel der Arbeit war es, die Tumeszenz‐Lokalanästhesie für Hautkrebsoperationen bei älteren Patienten mit dem Fokus auf klinische Vorteile (Behandlungsprozesse, Schmerzmanagement) und dem lokalen postoperativen Komplikationsrisiko zu evaluieren.Patienten und MethodikUntersuchung von Patienten ≥75 Jahren mit stationär durchgeführten Hautkrebsoperationen im Kopf‐Hals‐Bereich unter Tumeszenz‐Lokalanästhesie.Ergebnisse2940 Eingriffe bei 782 Patienten (Durchschnittsalter 83,3 Jahre) mit dem Ziel einer vollständigen Tumorresektion während des stationären Aufenthaltes wurden durchgeführt. 3,8 (Bereich: 1–20) Eingriffe erfolgten über einen Zeitraum von durchschnittlich 4,9 Tagen (Bereich: 1–28). 43,2% benötigten keine postoperative Analgesie. 53,5% erhielten NSAID, 3,3% Opioide. Wundinfektionen (13,6%) waren die häufigste lokale postoperative Komplikation. Chirurgische Interventionen aufgrund von Nachblutungen waren in 2,8% der Fälle erforderlich. Keine der Blutungen waren hämoglobinrelevant oder lebensbedrohlich. Nahtdehiszenzen und Nekrosen waren selten (0,6%).SchlussfolgerungenDie Tumeszenz‐Lokalanästhesie ist für Hautkrebsoperationen bei älteren Menschen eine effektive Anästhesiemethode. Durch den Verzicht auf eine Vollnarkose können die Behandlungsabläufe optimiert und anästhesiologische Risiken minimiert werden. Lokale postoperative Komplikationen treten eher selten auf und sind gut behandelbar. Die langanhaltende Analgesie führt zu einem geringeren Analgetikabedarf und selteneren Medikamenteninteraktionen.
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Affiliation(s)
| | - Claus Garbe
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
| | | | - Vincent Walter
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
| | | | - Julia Huynh
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin
| | | | | | - Alexander Scheu
- Universitäts-Hautklinik, Eberhard Karls Universität Tübingen
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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Huynh J, Ghoreschi FC, Häfner HM, Scheu A. Tumescent local anesthesia in geriatric patients with head and neck skin cancer - a retrospective study of 782 patients. J Dtsch Dermatol Ges 2024; 22:210-221. [PMID: 38243888 DOI: 10.1111/ddg.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/28/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND OBJECTIVES Due to frailty, dermatosurgery in the elderly is preferably performed under tumescent local anesthesia, but data is limited. The aim was to evaluate tumescent local anesthesia for skin cancer surgery in the elderly with focus on clinical benefits (treatment processes, pain management) and local postoperative complication risk. PATIENTS AND METHODS Investigation of patients ≥ 75 years with inpatient head and neck skin cancer surgery under tumescent local anesthesia. RESULTS 2,940 procedures in 782 patients (mean age 83.3 years) were performed with the aim of complete tumor resection during the inpatient stay. 3.8 (range: 1-20) interventions were done over an average of 4.9 days (range: 1-28). 43.2% did not require any postoperative analgesia. 53.5% received NSAIDs, 3.3% opioids. Infection (13.6%) was the most common local postoperative complication. Surgical intervention due to bleeding was required in 2.8%. None was hemoglobin relevant or life-threatening. Suture dehiscence and necrosis were rare (0.6%). CONCLUSIONS Tumescent local anesthesia is an effective method for skin cancer surgery in the elderly. By avoiding general anesthesia, treatment processes can be optimized and anesthesiologic risks minimized. Local postoperative complications are still low and well treatable. The long-lasting analgesia results in a reduced need for analgesics and drug interactions.
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Affiliation(s)
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | | | - Julia Huynh
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Bataraga E, Matuzala A, Eisendle K. Accessory axillar breast tissue-Newest member of BLEND TAN EGG family-BLEND TAN EGG MA. J Eur Acad Dermatol Venereol 2023; 37:e1412-e1413. [PMID: 37458531 DOI: 10.1111/jdv.19342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Elga Bataraga
- Department of Dermatology and Venereology, Rīga Stradiņš University, Rīga, Latvia
| | | | - Klaus Eisendle
- Department of Dermatology and Venereology, Rīga Stradiņš University, Rīga, Latvia
- Department of Dermatology and Venerology, Central Teaching Hospital Bolzano/Bozen, Bolzano, Italy
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Siegelmayer D, Gradner G. Reading man flap in four dogs: a case series. BMC Vet Res 2023; 19:159. [PMID: 37715165 PMCID: PMC10503179 DOI: 10.1186/s12917-023-03723-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The reading man flap is a novel technique in human medicine for the closure of cutaneous circular defects. To the best of our knowledge, no recent clinical studies have described this procedure in small animals. CASE PRESENTATION In this case series, we present four dogs in which neoplasms were reconstructed using the reading man procedure, which is a double-advancement transposition subdermal flap. The reading man flap was applied in wound revision after surgical removal of a neoplasm in two dogs and in the closure following the excision of a neoplasm in another two dogs. Successful tension-free closure of the lesion site was achieved in all four patients. The postoperative period was uneventful in all patients, and there was no flap necrosis or surgical site infection, although surgical site infection preceded in two cases. Minor complications included partial suture dehiscence in one dog and seroma formation in two dogs. Only one dog required a second anesthesia to insert an active drainage system. The follow-up examination of all four dogs revealed no further complications with the reading man flap at time of the latest wound reevaluation conducted by the surgeon. CONCLUSION The reading man flap is a well-vascularized fasciocutaneous flap that provides tension-free closure owing to its asymmetrical Z-plasty. It is a simple-to-use option for the closure of circular skin lesions in dogs.
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Affiliation(s)
- Desiree Siegelmayer
- University Clinic for Companion Animals of Vienna, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Gabriele Gradner
- Diplomate of European College of Veterinary Surgeons, University Clinic for Companion Animals of Vienna, Veterinärplatz 1, 1210, Vienna, Austria
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5
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Schnabl SM, Garbe C, Breuninger H, Walter V, Aebischer V, Eckardt J, Ghoreschi FC, Häfner HM, Scheu A. Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer. J Eur Acad Dermatol Venereol 2023; 37:65-74. [PMID: 36152007 DOI: 10.1111/jdv.18588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. OBJECTIVES The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. METHODS Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. RESULTS In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1-102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old-old group (≥75-84 years) included 491 patients and the oldest-old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow-up period was 4.9 days (range 1-28 days). 92.0% (719/782) suffered from pre-existing comorbidities. Systemic complications occurred in 10.2% (80/782; old-olds: 8.6%, oldest-olds: 13.1%). Hypertensive crisis (>180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life-threatening complications directly related to tumescent local anaesthesia were found. CONCLUSIONS Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre-existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high-tumescent concentrations or volume quantities.
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Affiliation(s)
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Helmut Breuninger
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
| | | | - Julia Eckardt
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Carola Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tuebingen, Germany
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Yadlapati S, Kaul S, Jakhar D. Liposomal bupivacaine infiltration as an effective option for postoperative pain management after Mohs surgery. Int J Dermatol 2022; 61:e472-e473. [PMID: 34791645 DOI: 10.1111/ijd.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/24/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sujitha Yadlapati
- HCA Corpus Christi Medical Center-Bay Area Dermatology Residency Program, McAllen, TX, USA
| | - Subuhi Kaul
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL, USA
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Martínez de Espronceda Ezquerro Í, Azcona Rodríguez M, Sarriugarte Aldecoa-Otalora J, Iglesias Zamora M. Colgajo del lector como alternativa reconstructiva en regiones sometidas a movimientos de flexoextensión. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.ad.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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8
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Martínez de Espronceda Ezquerro Í, Azcona Rodríguez M, Sarriugarte Aldecoa-Otalora J, Iglesias Zamora M. The Reading Man Flap: An Alternative for Reconstructing Defects in Areas of Flexion and Extension. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Eisendle K, Puviani M, Pagani A, Thuile T. Unterlidrekonstruktion mit modifizierter Tenzel‐Plastik nach Resektion eines Lentigo‐maligna‐Melanoms. J Dtsch Dermatol Ges 2020; 18:1338-1342. [PMID: 33251735 DOI: 10.1111/ddg.14260_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Klaus Eisendle
- Academic Teaching Department of Dermatology Venereology and Allergology, Central Hospital Bolzano/Bozen, Italy.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, College of Healthcare Professions Claudiana, Bolzano/Bozen, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST
| | - Mario Puviani
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST.,Unit of Dermatology and Surgical Dermatology Sassuolo Hospital, Sassuolo, Modena, Italy
| | - Andrea Pagani
- Academic Teaching Department of Dermatology Venereology and Allergology, Central Hospital Bolzano/Bozen, Italy
| | - Tobias Thuile
- Academic Teaching Department of Dermatology Venereology and Allergology, Central Hospital Bolzano/Bozen, Italy
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10
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Eisendle K, Puviani M, Pagani A, Thuile T. Eyelid reconstruction with modified Tenzel flap after lentigo maligna melanoma resection. J Dtsch Dermatol Ges 2020; 18:1338-1342. [DOI: 10.1111/ddg.14260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Klaus Eisendle
- Academic Teaching Department of Dermatology Venereology and Allergology Central Hospital Bolzano/Bozen Italy
- IMREST Interdisciplinary Medical Research Center of South Tyrol College of Healthcare Professions Claudiana Bolzano/Bozen Italy
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology SIDeMaST
| | - Mario Puviani
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology SIDeMaST
- Unit of Dermatology and Surgical Dermatology Sassuolo Hospital Sassuolo Modena Italy
| | - Andrea Pagani
- Academic Teaching Department of Dermatology Venereology and Allergology Central Hospital Bolzano/Bozen Italy
| | - Tobias Thuile
- Academic Teaching Department of Dermatology Venereology and Allergology Central Hospital Bolzano/Bozen Italy
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11
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Carriere C, Baier S, Campana LG, Puviani M, Eisendle K. Palliative intralesional tumescent methotrexate for recurrent locally advanced periocular cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 2020; 18:1063-1066. [PMID: 32909317 DOI: 10.1111/ddg.14262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cinzia Carriere
- Academic Teaching Department of Dermatology Venereology and Allergology, Central Hospital Bolzano/Bozen, Italy
| | - Susanne Baier
- Department of Oncology, Central Hospital Bolzano/Bozen, Italy
| | - Luca Giovanni Campana
- Surgical Oncology Unit, Department of Surgical Oncological and Gastroenterological Sciences DISCOG, University of Padova, Padova, Italy
| | - Mario Puviani
- Unit of Dermatology and Surgical Dermatology, Sassuolo Hospital, Sassuolo, Modena, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST, Brescia, Italy
| | - Klaus Eisendle
- Academic Teaching Department of Dermatology Venereology and Allergology, Central Hospital Bolzano/Bozen, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST, Brescia, Italy.,IMREST, Interdisciplinary Medical Research Center of South Tyrol, College of Healthcare Professions Claudiana, Bolzano/Bozen, Italy
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12
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Carriere C, Baier S, Campana LG, Puviani M, Eisendle K. Intraläsionale Tumeszenz‐Infiltration von Methotrexat zur palliativen Behandlung eines lokal fortgeschrittenen kutanen Plattenepithelkarzinoms. J Dtsch Dermatol Ges 2020; 18:1063-1066. [DOI: 10.1111/ddg.14262_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Cinzia Carriere
- Akademische Lehrstation für Dermatologie Venerologie und Allergologie Zentralkrankenhaus Bozen Italien
| | - Susanne Baier
- Abteilung Onkologie Zentralkrankenhaus Bozen Italien
| | - Luca Giovanni Campana
- Arbeitsgruppe Operative Onkologie Abteilung für operative onkologische und gastroenterologische Wissenschaften DISCOG Universitär Padua Italien
| | - Mario Puviani
- Abteilung Dermatologie und Dermatochirurgie Krankenhaus Sassuolo Modena Italien
- Arbeitsgruppe Dermatochirurgie der italienischen Gesellschaft für Dermatologie und Venerologie SIDeMaST Brescia Italien
| | - Klaus Eisendle
- Akademische Lehrstation für Dermatologie Venerologie und Allergologie Zentralkrankenhaus Bozen Italien
- Arbeitsgruppe Dermatochirurgie der italienischen Gesellschaft für Dermatologie und Venerologie SIDeMaST Brescia Italien
- IMREST Interdisziplinäres medizinisches Forschungszentrum Südtirol Institut für medizinische Berufe Bozen Italien
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Eisendle K, Thuile T, Deluca J, Pichler M. Surgical Treatment of Pyoderma Gangrenosum with Negative Pressure Wound Therapy and Skin Grafting, Including Xenografts: Personal Experience and Comprehensive Review on 161 Cases. Adv Wound Care (New Rochelle) 2020; 9:405-425. [PMID: 32320362 DOI: 10.1089/wound.2020.1160] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Significance: Pyoderma gangrenosum (PG) is a rare debilitating autoinflammatory ulcerative skin disease. No gold standard has been established for the treatment of PG. The role of surgical interventions and negative pressure wound therapy (NPWT) was discussed controversially until recently as these procedures might pose a trigger to further aggravate the condition. Recent Advances: Recent advances confirm the paradigm change that a surgical approach of PG with split thickness skin grafting (STSG) secured by NPWT is a safe and valuable treatment if performed under adequate immunosuppression. We elaborate this on the hand of a broad literature search retrieving 101 relevant articles describing 138 patients complemented with our personal experience on 23 patients, including 2 patients treated with a porcine xenodressing. Critical Issues: A wide range of surgical approaches have been reported, including xenografts. Treatment was finally successful in 86%, including the xenotransplant cases. Ten percent improved and failures were mainly reported without immunosuppression. Despite halting the inflammatory process, NPWT alone, without skin grafting, does not much accelerate healing time. The best surgical approach appears to be STSG fixed with NPWT as this leads to higher skin graft take. There remains the problem of the chronic nature of PG and the recurrence after tapering of immunosuppression or trauma; therefore, a sustained immunosuppressive treatment is suggested. Future Directions: While surgical treatment is supported by the published data, the exact immunosuppression is still evolving. Due to deeper insights into pathogenesis and growing clinical reports, a broader utilization of biologic treatments and a shift from tumor necrosis factor (TNF)-alpha to interleukin (IL)-12/23 or IL-23 antibodies alone are predictable, as IL-12/23 antibodies show good clinical responses with fewer side effects. The positive results with porcine xenodressings might be due to immunological effects of the xenomaterial; they appear promising, but are preliminary and should be confirmed in a larger patient collective.
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Affiliation(s)
- Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
- IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italy
| | - Tobias Thuile
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Jenny Deluca
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Maria Pichler
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
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Puviani M, Monari P, Gualdi G, Eisendle K. Verschiebelappen durch Spaltung der Ohrhelix für Läsionen des Helixrandes und der benachbarten Haut. J Dtsch Dermatol Ges 2019; 17:90-93. [PMID: 30615285 DOI: 10.1111/ddg.13719_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mario Puviani
- Unit of Dermatology and Surgical Dermatology, Sassuolo Hospital, Sassuolo, Modena, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST
| | - Paola Monari
- Department of Dermatology, A.O. Spedali Civili, University of Brescia, Brescia, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST
| | - Giulio Gualdi
- Department of Dermatology, A.O. Spedali Civili, University of Brescia, Brescia, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Italy.,IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italy.,Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology, SIDeMaST
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15
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Puviani M, Monari P, Gualdi G, Eisendle K. Split ear helix advancement flap for lesions of the ear involving the helical rim and adjacent skin. J Dtsch Dermatol Ges 2018; 17:90-93. [DOI: 10.1111/ddg.13719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mario Puviani
- Unit of Dermatology and Surgical Dermatology; Sassuolo Hospital; Sassuolo Modena Italy
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology; SIDeMaST
| | - Paola Monari
- Department of Dermatology; A.O. Spedali Civili; University of Brescia; Brescia Italy
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology; SIDeMaST
| | - Giulio Gualdi
- Department of Dermatology; A.O. Spedali Civili; University of Brescia; Brescia Italy
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology; SIDeMaST
| | - Klaus Eisendle
- Department of Dermatology; Venereology and Allergology; Academic Teaching Department of Medical University Innsbruck; Central Hospital Bolzano/Bozen; Italy
- IMREST Interdisciplinary Medical Research Center South Tyrol; Claudiana; College of Health-Care Professions; Bolzano/Bozen Italy
- Dermatologic Surgery Workgroup of the Italian Society of Dermatology and Venereology; SIDeMaST
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16
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Thuile T, Larcher L, Gatscher B, Schwaiger K, Deluca J, Fallaha A, Tappeiner L, Puviani M, Eisendle K. Spalthauttransplantation zur Defektdeckung am Ohr: eine statistische Analyse. J Dtsch Dermatol Ges 2018; 16:163-173. [PMID: 29418093 DOI: 10.1111/ddg.13415_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
Abstract
HINTERGRUND UND ZIELE Die Rekonstruktion nach Entfernung ausgedehnter maligner Hauttumoren am Ohr ist eine Herausforderung. Verschiedene Methoden der Defektdeckung wurden beschrieben. Lappenplastiken, längere Anästhesiezeiten, geringe Compliance und Antikoagulation stellen bei den oft älteren Patienten zusätzliche Risiken dar. Eine rasch, effizient und unkompliziert durchführbare Methode der Defektdeckung ist daher wünschenswert. Ziel der Studie war die Beurteilung des ästhetischen Resultats, des Heilungsprozesses, der Komplikations- und Rezidivrate nach Transplantation ungenetzter Spalthaut (SPHT) zur Defektdeckung nach knorpelerhaltender Resektion maligner Tumoren am Ohr. PATIENTEN UND METHODIK 32 Patienten wurden nach Entfernung von Hauttumoren am Ohr einer Defektdeckung mittels SPHT unterzogen. ERGEBNISSE Die durchschnittliche Defektgröße betrug 8,0 cm2 . Eine vollständige Einheilung des Transplantates erfolgte in allen Fällen innerhalb von zwei Wochen. Wesentliche Komplikationen traten nicht auf. Das ästhetische Resultat wurde sowohl von den Patienten als auch von einem Dermatochirurgen und zwei plastischen Chirurgen als gut bewertet. SCHLUSSFOLGERUNGEN Die SPHT am Ohr ist eine zuverlässige Methode zur Deckung ausgedehnter Hautdefekte. Selbst bei großen Tumoren des äußeren Ohres ist der Ohrknorpel nicht immer infiltriert. Eine knorpelschonende Tumorresektion mit anschließender Defektdeckung mittels SPHT ist eine ausgezeichnete und rasch durchführbare Technik mit hoher Patientenzufriedenheit.
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Affiliation(s)
- Tobias Thuile
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien
| | - Lorenz Larcher
- Abteilung für plastische, rekonstruktive und ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Barbara Gatscher
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien
| | - Karl Schwaiger
- Abteilung für plastische, rekonstruktive und ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Jenny Deluca
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien
| | - Amgiad Fallaha
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien
| | - Lukas Tappeiner
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien
| | - Mario Puviani
- Abteilung für Dermatologie und Dermatochirurgie, Sassuolo Hospital, Sassuolo, Modena, Italien
| | - Klaus Eisendle
- Abteilung für Dermatologie, Venerologie und Allergologie. Lehrabteilung der Medizinischen Universität Innsbruck, Zentrales Krankenhaus Bolzano/Bozen, Italien.,IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italien
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Insull EA, Joganathan V, Norris JH. The "reading man" flap for reconstruction of large periorbital defects. Orbit 2018; 37:303-305. [PMID: 29333949 DOI: 10.1080/01676830.2017.1423088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The "reading man" flap (RMF), a double advancement transposition cutaneous flap named for its appearance, has been described in the reconstruction of various circular skin defects, particularly in the malar region. We describe two cases where this flap was used to reconstruct the lower eyelid/periorbital region. METHODS Two oculoplastic patients with lower eyelid basal cell carcinomas underwent Mohs micrographic excision resulting in a large skin defects. In both cases, reconstruction was performed using the RMF. RESULTS At 6 months, both patients achieved good cosmetic results with no case of secondary eyelid malposition. CONCLUSION The RMF is a useful adjunct to the armamentarium of the oculoplastic surgeon for the reconstruction of large periorbital defects.
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Thuile T, Larcher L, Gatscher B, Schwaiger K, Deluca J, Fallaha A, Tappeiner L, Puviani M, Eisendle K. Split-thickness skin grafting for reconstruction of auricular skin defects: a statistical analysis. J Dtsch Dermatol Ges 2018; 16:163-173. [PMID: 29328534 DOI: 10.1111/ddg.13415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical reconstruction following the removal of large malignant auricular lesions is challenging. While many options for defect closure have been described, in the elderly population usually affected flap surgery, long anesthesia times, patient compliance, and anticoagulant therapy pose additional risks. An alternative quick, simple, and effective method of defect closure is therefore highly desirable. The objective of the present study was to assess the aesthetic outcome, healing process, complications, and recurrence rates associated with unmeshed split-thickness skin grafts (STSGs) used for covering large auricular skin defects following cartilage-sparing skin cancer removal. PATIENTS AND METHODS Under local tumescent anesthesia, 32 patients received STSGs for defect closure following the removal of malignant cutaneous neoplasms of the ear. RESULTS The average defect size was 8.0 cm². In all cases, complete healing of the recipient site occurred within two weeks. There were no major complications. The aesthetic outcome was rated highly by patients as well as by the dermatosurgeon involved and two independent plastic surgeons. CONCLUSIONS STSGs are a valid option for closing large auricular skin defects. Even large cutaneous tumors of the external ear do not necessarily infiltrate the cartilage. Thus, cartilage-sparing tumor resection with subsequent defect closure using a STSG is an excellent and quick method associated with high patient satisfaction.
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Affiliation(s)
- Tobias Thuile
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Lorenz Larcher
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Barbara Gatscher
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Karl Schwaiger
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jenny Deluca
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Amgiad Fallaha
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Lukas Tappeiner
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Mario Puviani
- Unit of Dermatology and Surgical Dermatology, Sassuolo Hospital, Sassuolo, Modena, Italy
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology. Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy.,IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italy
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Kato M, Kimura S, Okochi M, Ueda K, Watanabe S, Watanabe A, Kono T. Intraoperative local flap transforming (iLoFT) method; from hachet to reading-man flap. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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A Double-Lobe Flap Design Combined Nasolabial Advancement and Infraorbital Rotation for Reconstruction of Infraorbital Defect. J Craniofac Surg 2017; 27:e389-90. [PMID: 27213736 DOI: 10.1097/scs.0000000000002654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Various adjacent flaps have been designed to close infraorbital defect, and each of them is trying to get an aesthetic outcome and meanwhile circumvent eyelid retraction, ectropion, and functional disability. Here, the authors report an adjacent double-lobe flap, which took advantage of nasolabial advancement and infraorbital rotation of the 2 lobes, combinatorially closed a pentagon infraorbital defect by removal of 2 small skin paddles as donor sites, and finally yielded an acceptable aesthetic and functional outcome. This flap may be a new option for closure of polygon infraorbital defects.
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Pichler M, Larcher L, Holzer M, Exler G, Thuile T, Gatscher B, Tappeiner L, Deluca J, Carriere C, Nguyen VA, Moosbrugger-Martinz V, Schmuth M, Klein GF, Eisendle K. Surgical treatment of pyoderma gangrenosum with negative pressure wound therapy and split thickness skin grafting under adequate immunosuppression is a valuable treatment option: Case series of 15 patients. J Am Acad Dermatol 2016; 74:760-5. [PMID: 26979359 DOI: 10.1016/j.jaad.2015.09.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/01/2015] [Accepted: 09/06/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Maria Pichler
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Lorenz Larcher
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital of St. John of God Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Holzer
- University Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerald Exler
- Department of Dermatology, Hospital of Elisabethinen, Linz, Austria
| | - Tobias Thuile
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Barbara Gatscher
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Lukas Tappeiner
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Jenny Deluca
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Cinzia Carriere
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy
| | - Van Anh Nguyen
- University Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Matthias Schmuth
- University Department of Dermatology and Venereology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg F Klein
- Department of Dermatology, Hospital of Elisabethinen, Linz, Austria
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Teaching Hospital Bolzano/Bozen, Bolzano/Bozen, Italy; IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano/Bozen, Italy.
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Acute pain management in dermatology. J Am Acad Dermatol 2015; 73:543-60; quiz 561-2. [DOI: 10.1016/j.jaad.2015.04.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/02/2023]
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