Search

// Josef Haik 1,2,3 , Gil Nardini 1 , Noga Goldman 4 , Gilli Galore-Haskel 5 , Moti Harats 1 , Isaac Zilinsky 1 , Oren Weissman 1 , Jacob Schachter 3,5 , Eyal Winkler 1,3 and Gal Markel 2,3,5 1 Department of Plastic Surgery, Tel Aviv University, Tel Aviv, Israel 2 Talpiot Medical Leadership Program, Tel Aviv University, Tel Aviv, Israel 3 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 4 Department of General Surgery C, Tel Aviv University, Tel Aviv, Israel 5 Ella Institute of Melanoma, Sheba Medical Center, Ramat Gan, Israel Correspondence to: Gal Markel, email: // Keywords : burns, immune suppression, natural killer, lysis receptors, MICB, Immunology and Microbiology Section, Immune response, Immunity Received : September 26, 2015 Accepted : December 23, 2015 Published : December 29, 2015 Abstract Immune suppression following major thermal injury directly impacts the recovery potential. Limited data from past reports indicate that natural killer cells might be suppressed due to a putative soluble factor that has remained elusive up to date. Here we comparatively study cohorts of patients with Major and Non-Major Burns as well as healthy donors. MICB and ULBP1 are stress ligands of NKG2D that can be induced by heat stress. Remarkably, serum concentration levels of MICB and ULBP1 are increased by 3-fold and 20-fold, respectively, already within 24h post major thermal injury, and are maintained high for 28 days. In contrast, milder thermal injuries do not similarly enhance the serum levels of MICB and ULBP1. This kinetics coincides with a significant downregulation of NKG2D expression among peripheral blood NK cells. Downregulation of NKG2D by high concentration of soluble MICB occurs in cancer patients and during normal pregnancy due to over production by cancer cells or extravillous trophoblasts, respectively, as an active immune-evasion mechanism. In burn patients this seems an incidental outcome of extensive thermal injury, leading to reduced NKG2D expression. Enhanced susceptibility of these patients to opportunistic viral infections, particularly herpes viruses, could be explained by the reduced NKG2D expression. Further studies are warranted for translation into innovative diagnostic or therapeutic technologies.

Background The Burns Specific Health Scale-Brief (BSHS-B) questionnaire is a suitable measurement tool for the assessment of general, physical, mental, and social health aspects of the burn survivor. Aim To translate, culturally adapt and validate the BSHS-B to Hebrew (BSHS-H), and to investigate its psychometric properties. Methods Eighty-six Hebrew speaking burn survivors filled out the BSHS-B and SF-36 questionnaires. Ten of them (11.63%) completed a retest. The psychometric properties of the scale were evaluated. Internal consistency, criterion validity, and construct validity were assessed using interclass correlation coefficient, Cronbach's alpha statistic, Spearman rank test, and Mann–Whitney U test respectively. Results BSHS-H Cronbach's alpha coefficient was 0.97. Test–retest interclass coefficients were between 0.81 and 0.98. BSHS-H was able to discriminate between facial burns, hand burns and burns >10% body surface area (p < 0.05). BSHS-H and SF-36 were positively correlated (r2 = 0.667, p < 0.01). Conclusions BSHS-H is a reliable and valid instrument for use in the Israeli burn survivor population. The translation and cross-cultural adaptation of this disease specific scale allows future comparative international studies.

The goal of this literature review is to review and combine case studies of accidental burns to the breast, following mastectomy and immediate breast reconstruction with autologous tissue, implants, or tissue expanders.The authors searched PubMed and Cochrane Library and reviewed cases of burns of reconstructed breasts after mastectomy from July 1985 to May 2015. Only studies in the English language were included in their search. They also report 5 new cases of burns in patients with burns to the breast, which were either reconstructed with implants or tissue expanders at Sheba Medical Center (Ramat Gan, Israel).The authors found 21 publications regarding burns after breast reconstruction dating from 1985 to 2014, which equaled 59 cases of reported burns in the 21 included publications. The most common causes of burns were due to heat conduction (37/59) followed by solar radiation (19/59) and heat convection (3/59). The majority of the cases were treated by a conservative approach. The 5 new cases added were all due to thermal radiation (5/5). Two of these cases were treated conservatively (2/5), and 3 underwent surgery (3/5).The removal of thermoregulatory capabilities of the skin and the thickness of the remaining tissue in the mastectomy procedure are key to understanding the cause of burns to reconstructed breasts.

In recent years the acellular dermal matrix (ADM) has gained popularity in prosthetic breast reconstruction. These procedures involve placement of a closed suction drain in the reconstructed breast. Although it is now widely accepted that ADM has an overall positive effect on the outcome of breast reconstruction, data regarding its effect on postoperative drain secretions is lacking. This study was designed to quantitatively evaluate the influence of ADM on postoperative drain secretions in the setting of immediate prosthetic breast reconstruction (IPBR). This is a prospective, comparative controlled study. Two groups of 16 patients each underwent skin sparing mastectomies (SSM) and IPBR with or without ADM. Closed suction drains were left in all the reconstructed breasts and daily secretion volumes were recorded and compared. Postoperative complications were also noted. Patients in the ADM group showed higher daily and overall secretion volumes compared with patients in the control group (p = 0.014) and the time for removal of the drains was higher by an average of 5 days (13 compared with 8 days, respectively; p = 0.004). There was no correlation between ADM and infection. This study provides the first objective evidence that ADM contributes to elevated and prolonged drain secretions when used for IPBR. This might affect possible prosthesis-related complications (e.g., rotation and malposition, capsular contraction, seroma formation, and infection). This study also noted erythema of the post-mastectomy skin flaps in selected patients, which may be attributable to a local inflammatory reaction to the ADM rather than infection.

Suction-assisted lipoplasty (SAL; liposuction) is an established aesthetic procedure in plastic surgery. The main parameters differentiating one method of lipoplasty from another are safety, consistency of results, and other more technical parameters. Due to the recent popularity of lipotransfer, the quality of extracted fat has become a relevant parameter. We compare the viability of extracted adipocytes after dry SAL, hyper-tumescent PAL (power-assisted lipoplasty), and water-assisted lipoplasty (WAL). We used fluorescent microscopy to differentiate viable from necrotic/apoptotic cells after liposuction using each of the mentioned methods. The ratio of living cells between the three methods was significantly different with dry liposuction yielding inferior ratios (p = 0.011). When omitting extreme results, we found that the body-jet technique (WAL) yielded higher ratios of living cells than the hyper-tumescent technique (p

The treatment of tinea capitis using radiotherapy was introduced at the beginning of the twentieth century. In Israel, between 1949 and 1960, approximately 17,000 children underwent radiotherapy treatments for tinea capitis (actual numbers are probably higher due to irradiation in countries of origin as a prerequisite for immigration). Skin cancer presents a major problem for patients who underwent irradiation for the treatment of tinea capitis [aggressive biological behavior, multiple basal cell carcinomas (BCCs), up to 40 lesions in a single patient, with no predisposing condition such as Gorlin's or Bazex's syndromes]. There are ample data in the literature concerning the molecular changes in ultraviolet (UV) radiation-induced BCCs. However, similar data regarding ionizing radiation-induced BCCs are scarce. One work found higher rates of p53 and PTCH (both are tumor suppressor genes whose alterations are associated with BCC formation and frequency, but not biological behavior) abnormalities in post ionizing radiation BCCs. The absence of documented differences in gene expression that would account for a different biological behavior of radiotherapy-related BCCs, coupled with the aggressive and recurrent nature of these lesions, has propelled us to examine these differences by comparing gene expression in BCCs of the scalps of patients who were previously irradiated for tinea capitis in their childhood and of the scalps of patients who were not.Tissue samples of excised scalp BCCs from seven previously irradiated patients (five male, two female) and seven not previously irradiated patients (six male, one female) were frozen upon excision and genetically analyzed using DNA microarray chips.No correlation was found between previous ionizing irradiation and gene expression.The negative results of this study, coupled with the observation of aggressive biological behavior of BCCs in previously irradiated patients merit further attention. Other explanations for the aggressive biological behavior of radiotherapy-induced BCCs come to mind. One such explanation could be that the difference between the groups lies not in the tumor itself, but in the host, who is more susceptible to the local destruction caused by the tumor due to changes in the surrounding tissue (e.g., impaired blood supply due to radiation, structural damage in seemingly healthy skin). This hypothesis will be the focus of further research.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Many women have a dwindled ptotic breast. The surgical solution for these two concurring problems has two separate procedures: augmentation and mastopexy. Combining these two procedure into one surgery is considered unpredictable and avoided by many physicians. This study presents a revised mastopexy-augmentation technique found to be safer and more simple, enabling these two procedures to be performed together. A retrospective review of 60 patients who underwent surgery by a single surgeon is presented. The presented method has yielded a relatively low reoperation rate of 10% and a high satisfaction rate.

It was previously shown that CEACAM1 on melanoma cells strongly predicts poor outcome. Here, we show a statistically significant increase of serum CEACAM1 in 64 active melanoma patients, as compared to 48 patients with no evidence of disease and 37 healthy donors. Among active patients, higher serum CEACAM1 correlated with LDH values and with decreased survival. Multivariate analysis with neutralization of LDH showed that increased serum CEACAM1 carries a hazard ratio of 2.40. In vitro, soluble CEACAM1 was derived from CEACAM1(+), but neither from CEACAM1(-) melanoma cells nor from CEACAM1(+) lymphocytes, and directly correlated with the number of CEACAM1(+) melanoma cells. Production of soluble CEACAM1 depended on intact de novo protein synthesis and secretion machineries, but not on metalloproteinase function. An unusually high percentage of CEACAM1(+) circulating NK and T lymphocytes was demonstrated in melanoma patients. CEACAM1 inhibited killing activity in functional assays. CEACAM1 expression could not be induced on lymphocytes by serum from patients with high CEACAM1 expression. Further, expression of other NK receptors was impaired, which collectively indicate on a general abnormality. In conclusion, the systemic dysregulation of CEACAM1 in melanoma patients further denotes the role of CEACAM1 in melanoma and may provide a basis for new tumor monitoring and prognostic platforms.

Terror attacks have changed in the past decade, with a growing tendency toward explosives and suicide bombings, which led to a rise in the incidence of thermal injuries among victims. The Israeli-Palestinian conflict of October 2000 marked a turning point when an organized terror campaign commenced. This article presents data of terror-associated burns from the Israeli National Trauma Registry (ITR) during the years 1997 to September 2000 and October 2000 to 2003.We analyzed demographic and clinical characteristics of 219 terror-related burn patients and 6,546 other burn patients admitted to hospitals in Israel between 1997 and 2003. Data were obtained from the ITR.Burns contributed about 9% of all terror related trauma and about 5% of all other trauma (p0.0001). These percentages have not changed significantly before and after October 2000. Terror-related burns afflict Jewish males more than predicted by their percentage in the population, whereas other burns afflict non-Jewish males more than predicted. Adults and young adults (15-59 years) are the predominant group in terror-related burns (80%), whereas children younger than 15 years are the predominant group in other burns (50%). Large burns (20% to 89% total body surface area) are more common in terror casualties, with greater mortality (6.4% in terror-related versus 3.4% in others; p = 0.0258).Although the incidence of burns has risen because of an organized campaign, this change was noticeable in other trauma forms as well in similar proportions. Terror-related burns afflict a targeted population, and generally take on a more severe course with greater mortality rates, thus requiring appropriate medical treatment.

Background: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. Methods: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. Results: The authors present two major complications, a rare case of Stensen's duct laceration and a case of chronic inflammation mandating surgical treatment. Conclusions: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.

Summary Background Several techniques are currently available for reconstruction of helical rim defects including Antia and Buch's technique. Some of these techniques produce unsatisfying aesthetic results or are time consuming or technically challenging. Herein, we present the earlobe-based advancement flap (ELBAF) technique and its anatomical basis for reconstruction of helical rim defects. Methods A case series of 13 patients with helical rim defects of up to 3.8 cm in length were reconstructed using the ELBAF technique solely or with additional procedures. Patients were followed for the occurrence of complications and evaluation of aesthetic results for up to 8 years. An anatomical assay that included cadaver dissection and anatomical corrosion technique was performed in order to support the ELBAF technique. Results Thirteen patients (68.5 ± 9 years, two females) with full-thickness helical rim defects of up to 3.8-cm length caused by basal cell carcinoma in 92.3% underwent reconstruction surgery using the ELBAF technique solely or with additional procedures. No complications related to the ELBAF technique were encountered during follow-up. Cadaver dissections demonstrated a consistent arterial blood supply emerging from the earlobe area, producing arteries that run circularly along the helical rim. Conclusions Based on the axial vessel pattern, the ELBAF technique seems to be a useful strategy to reconstruct full-thickness helical defects of up to 3.8 cm in length. This procedure can be regarded as a valid addition to the ear reconstruction repertoire, which can be used alone or in combination with other established techniques. Level of evidence: Level 4, case series.

Background. The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall following Mohs surgery. However, both extirpation of a tumor in the region of the base of the flap or previous use of the flap often destroy the proximal axial blood supply to the flap, excluding its immediate utilization. We describe a different use of the nasolabial flap and a technique for preserving its capacity in the case of reutilization Objective. To describe the versatility of the nasolabial flap and a delay procedure that enables its exploitation despite prior disruption of the proximal blood supply. Methods. Three different uses of the same nasolabial flap are demonstrated in one patient. The surgical techniques are discussed in detail. Results. The reconstructive results were excellent. There were no postoperative complications. Conclusion. The nasolabial flap is a versatile and effective option for the closure of nasal defects of the cheek and nasal sidewall. When the nasolabial flap has been used before, or its blood supply compromised, the delay procedure can reestablish its applicability.

Background and Objective Rhinophyma is a benign, disfiguring disorder of the nose which presents the end stage of acne rosacea, and can also occasionally result in nasal airway obstruction. We describe the first series of patients treated with Erbium laser. Study Design/Materials and Methods Severe-to-moderate rhinophyma in six patients were treated at our institution between 1995 and 1996, using the Erbium:YAG (Erb:YAG) laser. Results All patients achieved marked cosmetic improvement, with no complications. Post-operative healing time was seven to fourteen days-significantly shorter than similar other modalities. Conclusions The Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period as shown in our study. Lasers Surg. Med. 29:230–235, 2001. © 2001 Wiley-Liss, Inc.

Germline mutations in the p16 (CDKN2A) tumour suppressor gene have been linked to inherited predisposition to malignant melanoma (MM). Variable frequencies of p16 germline mutations were reported in different collections of melanoma families but it can be as high as 50%. Here we describe the results of p16 mutation screening in 30 melanoma kindreds in Israel. The entire coding region of the p16 gene, including exons 1, 2 and 3, flanking exon/intron junctions, and a portion of the 3' untranslated (UTR) region of the gene were examined by single-stranded conformation polymorphism (SSCP) analysis and direct sequencing. Two p16 germline mutations were identified: G101W, which has been previously observed in a number of melanoma kindreds, and G122V, a novel missense mutation. Thus, the frequency of mutations identified in this collection of Israeli families was 7%. Functional analysis indicated that the novel G122V variant retained some capacity to interact with cyclin dependent kinases (CDKs) in vitro, yet it was significantly impaired in its ability to cause a G1 cell cycle arrest in human diploid fibroblasts. This partial loss of function is consistent with the predicted impact of G122V substitution on the 3-dimensional structure of the p16 protein.

Gross migration of silicone gel from ruptured breast implants is a rare event. It is associated with extravasation of gel into the breast parenchyma, and to distant locations such as the abdominal wall and inguinal areas. This silicone deposits present as subcutaneous nodules and cause a local reaction known as siliconoma. We evaluated a 56-year-old woman who presented with a 2-year history of painful, firm and ill-defined subcutaneous nodules on the medial aspect of the shins and ankles. Her medical history was notable for bilateral breast augmentation with silicone implants 30 years before presentation. Although there were no signs or symptoms on breast examination, ultrasonography and magnetic resonance imaging confirmed that both implants had ruptured. Histological examination of a punch biopsy from a nodule on the shin found lobular granulomatous panniculitis. An excisional biopsy of the lesion was analysed by scanning electron microscopy and was found to contain silicone. This is a rare case of gross migration of silicone to the shins, originating from ruptured breast implants. To our knowledge, there is no previous report of silicone migration to such a distant location. We discuss the common presentation of silicone migration and highlight the importance of awareness among dermatologists and plastic surgeons about this unusual occurrence.

Partial lateral nasal defects challenge the plastic surgeon both technically and aesthetically. Many methods for reconstruction of these defects have been described. We have used a turnover forehead flap in conjunction with composite auricular graft for the reconstruction of nasal defects. The forehead flap is turned over so that the forehead skin serves as internal lining in the nose. The composite auricular graft serves as external nasal lining and provides mechanical support to the ala. The technique was used in seven patients and is presented here with illustrations, selected cases, results, and conclusions concerning patient selection.

Since it was first described by Dr. Marjolin in 1828 [1], squamous cell carcinoma (SCC) has been established as a well-recognized late complication of post-operative, posttraumatic and chronic scars. However, identification of SCC arising in a split-thickness skin graft (STSG) donor site is an entity that has been rarely reported in the literature. We report a case of a donor site SCC, which appeared on a patient’s thigh 6 weeks after harvesting skin to cover a groin soft tissue defect.

Local flaps may be required to reconstruct defects on the face, neck, and scalp. Occasionally, delay techniques are indicated to reduce the risk for flap ischemia and subsequent necrosis. Delay may be employed before the flap is raised, as done to improve blood supply to a random flap when length to breadth proportions are not ideal, or after the flap is raised and before separation of the pedicle in the final reconstructive step to improve vascularity in the distal end of an interpolation flap. We present our techniques and results of delay procedures for interpolation and similar flaps.

Reconstruction of full-thickness defects may benefit from integration of dermal substitutes, which serve as a foundation for split-thickness skin grafts, thus enhancing short and long-term results. We present a series of 7 patients who were treated between 2010 and 2012 for complicated full-thickness defects by the second-generation collagen/elastin matrix Matriderm® covered by a split-thickness skin graft. The defects resulted from malignancy resection, trauma, and post-burn scar reconstruction. Overall graft take was excellent and no complications were noted regarding the dermal substitute. Graft quality was close to normal skin in terms of elasticity, pliability, texture, and color. Good contour and cushioning of defects in weight bearing areas was also achieved. Matriderm was found to be a useful adjunct to full-thickness defect reconstruction, especially in difficult areas where the desired result is a scar of the highest quality possible.

Second degree facial burns usually impart high wound site pain levels and patient discomfort due to the abundance of facial sensory innervation, as well as the development of edema and inflammation that accompany wound healing. Frequent changing of adherent dressings causes additional procedural pain and may prolong healing due to recurring damage to the wound bed. We applied face masks, made on-site from a drug free polymeric membrane dressing, to 8 patients with superficial and deep 2nd degree facial burns. Time to full re-epithlialization was recorded during treatment. Pain, overall comfort, and result satisfaction were evaluated using a questionnaire (10-point Likert scales. From 1=minimum to 10=maximum) on follow-up (mean follow up 14.4 months, range 9-18). These results were compared to a historical cohort of patients with facial burns that were treated with an antibiotic ointment. Results showed mean re-epithelialization time of 6.5 days (as compared to 8.5 days in the cohort group), low pain ratings (mean: 2.6; range: 4.7 in the control group), mixed comfort levels (mean: 4.7/10; 4 in the control group) and high result satisfaction (mean: 7.8; 6.2 in the control group). Nursing staff described pain-free dressing changes and positively noted non-adherence and high absorbance capacity of the polymer, necessitating less dressing changes. Inflammation was contained to the actual site of injury. No complications in terms of infection or allergic reaction were observed. Overall, the polymeric membrane facial dressing seems to be a promising means of reducing pain and ensuring uninterrupted wound healing in 2nd degree facial burns.

Upper lip wrinkling is a common complaint of patients seeking perioral rejuvenation. Lately, manual dermabrasion has become more popular due to its safety, minimal cost, and favorable results. In several hospitals, the ability to efficiently sterilize sand paper has been questioned.Between 2007 and 2010, 29 patients underwent manual dermabrasion of the skin of the upper lip using an electric cautery scratch pad during their surgeries.The average patient was aged 60.2 years. The average healing period was 5.8 days. Patient satisfaction from the procedure ranged from very good to excellent. No serious or long lasting complications have been encountered during our follow-up period.

Full-Thickness skin grafts are routinely used to reconstruct defects throughout the body. When planning the size of the graft, the surgeon usually copies a template from the defect and measures the graft to fit its full dimensions. This may lead to an oversized graft, resulting an unaesthetic outcome.To evaluate discrepancy in size between the excised full-thickness skin and the excision (donor) site.Data from 20 cases of full-thickness excisions was reviewed and analyzed.There was a considerable difference in length of both the short and long axes between the excised full-thickness skin and the excision site.The initial size of a full-thickness skin graft should be smaller than the defect it is planned to cover.

Defects of the nasal ala present a complex reconstructive challenge. Composite grafts comprise all layers required to successfully reconstruct these full thickness deformities making them the ideal reconstructive method, yet they are usually avoided because of unjustified disreputable failure rates.The authors introduce a stepladder approach for alar reconstruction with a crus of helix composite graft according to the severity and complexity of the defect.Data from 25 patients who underwent correction of full thickness alar defects with composite grafts was collected and reviewed.There were no complete graft failures in any of the cases. Ten patients (40%) had partial graft necrosis ranging from 5 to 50% (average 18%); two of them (20%) were heavy smokers.Composite grafts should be considered for reconstruction of full thickness nasal ala defects, given the correct surgical technique is implemented.

OBJECTIVES To evaluate the use of single-dose flumazenil in the diagnosis of coma of unknown etiology, and of continuous flumazenil infusion in the treatment of benzodiazepine-induced coma. DESIGN Prospective study. SETTING Emergency room and general medicine ward of a teaching hospital. PATIENTS A total of 42 comatose adults in whom metabolic, neurologic, or traumatic causes of coma were excluded. INTERVENTIONS a) Intravenous bolus injections of 0.25 mg flumazenil were given at 1-min intervals, either until improvement by two coma grades or a total dose of 2.0 mg was reached. b) Loading doses as in (a) followed by a maintenance infusion administered as long as indicated by repeated coma grade evaluation. MEASUREMENTS AND MAIN RESULTS a) Of 34 patients, 28 received only the flumazenil loading dose responded promptly. Twenty-one of 25 available urine samples of the responding patients contained only benzodiazepine metabolites. Four urine samples contained benzodiazepines in combination with other drugs. Six patients did not respond to the flumazenil loading dose. The urine of three patients contained a combination of benzodiazepines and another coma-exerting drug; the remaining three were negative. A total of 24 patients, who initially responded to flumazenil loading, deteriorated to their previous coma state and were admitted to the general medical ward. Six (25%) patients developed complications related to hospitalization and their bedridden state. b) Eight other patients, who deteriorated after an initial loading dose, received a second iv bolus of flumazenil, followed by maintenance infusions over 5 to 24 hrs. Their hospital course was uneventful. CONCLUSIONS These findings indicate that flumazenil is safe and effective in the diagnosis of benzodiazepine-induced coma. Furthermore, the use of continuous flumazenil maintenance infusion is of considerable therapeutic value in patients who exhibit deterioration after initial response to the single loading dose.

Patients with thick melanomas4 mm deep are at great risk for regional and distant metastatic disease. Historically, the appropriate management of thick melanomas has remained unclear and there is no consensus in the literature. Many have taken the nihilistic view that surgical intervention to excise regional nodal basins is not justified in light of the poor overall prognosis and risk of occult distant disease.To review the outcome of patients with thick node negative melanoma treated at a multidisciplinary academic centerWe retrospectively reviewed a database of melanoma patients to identify patients with thick melanomas,4 mm, who were either clinically or sentinel node biopsy negative, staged T4N0, stage IIb or IIc. The charts of these patients were reviewed and updated, with a median follow-up of 4 years.We identified 23 patients who fit these criteria. Of these, 18 (78%) remain alive with a median follow-up of 4 years. Five patients died of metastatic disease. Of the 18 surviving patients, 14 remained with no evidence of disease after initial resection of their primary lesions. The majority of the recurrences were non-nodal.The overall survival of patients in our study remains above 75% at median follow-up of 4 years, even with thick initial index tumor depths. Most of the failures were due to hematogenous spread with lymphatic sparing. Tumor biology that may inhibit lymphatic spread could be a target of future investigation.

Dermatol Surg

The APTOS threading procedure is a relatively new method in antifacial ptosis surgery. The reported cases present a small percentage of minor complications. A 57-year-old woman experienced scarring after APTOS threading. Scar biopsy showed an epidermoid inclusion cyst. Epidermoid inclusion cysts are a potential complication of APTOS threading. Proper surgical technique may reduce their likelihood.

Cheilitis is a precancerous skin lesion most often affecting the lower lip. We describe a technique in which this disorder can be treated using Er:YAG laser vaporization. The Er:YAG laser wavelength at 2940 nm lies in a very strong water absorption peak; tissue interaction results mainly in vaporization with minimal heat conduction to adjacent tissue.To evaluate the efficacy and outcome of a new modality in the treatment of actinic cheilitis with the Er:YAG laser.Between 2002 and 2005, 12 patients with actinic cheilitis were treated at our institute with the Er:YAG laser. All patients were cured with no recurrence to date, and none suffered postoperative complications.Patients were men and women aged between 37 and 71 years. The healing duration varied from 7 to 30 days (mean 22.33+/-6.91 days) and the follow-up ranged from 8 months to 3 years (mean 23.16+/-9.48 months). No recurrences were detected in our study.Using the Er:YAG laser provides accurate tissue ablation, giving a very satisfactory cosmetic result, with a short healing period, no lip deformity and no sensation loss.