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1. Functionality of Patients 75 Years and Older Undergoing Mohs Micrographic Surgery: A Multicenter Study

Author

Patrick K. Lee, Christopher B. Harmon, David E. Kent, Marc Glashofer, Ryan Johnson, Ramona Behshad, C. William Hanke, Christie G. Regula, Murad Alam, and Naomi Lawrence

Subjects
Male, medicine.medical_specialty, Skin Neoplasms, medicine.medical_treatment, Dermatology, Micrographic surgery, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Older patients, Internal medicine, Health care, Mohs surgery, medicine, Humans, Effective treatment, Prospective Studies, Karnofsky Performance Status, Aged, Aged, 80 and over, business.industry, General Medicine, Mohs Surgery, medicine.disease, Surgery, Multicenter study, 030220 oncology & carcinogenesis, Female, Functional status, Skin cancer, business
Abstract

BACKGROUND Mohs surgery is indisputably a highly effective treatment for nonmelanoma skin cancers. In the current health care environment, physicians are challenged to provide high quality, efficacious care in a manner that is mindful of the patient's general health and well-being. We have used a functional assessment to evaluate older patients who present for Mohs surgery. OBJECTIVE The purpose of this study is to categorize the functional status, using the Karnofsky Performance Status (KPS) Scale, of patients 75 years and older undergoing Mohs surgery of a nonmelanoma skin cancer and to identify distinguishing characteristics of lower functioning patients. METHODS Patients 75 years and older undergoing Mohs surgery for nonmelanoma skin cancer at 8 separate geographically diverse sites were included. Patient and tumor characteristics were recorded. Physicians scored subjects on the KPS scale and administered a questionnaire to categorize the symptoms and impact of their skin cancer. RESULTS A total of 291 subjects completed the study. The average KPS score was 90.1. 93.1% of our subjects had a KPS score of ≥70. Subjects with a KPS score

Published
2017
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2. Expertise in Head and Neck Cutaneous Reconstructive Surgery

Author

Jennifer DePry, Kendra Lesiak, John A. Carucci, Jeremy S. Bordeaux, Brian Raphael, Shari A. Ochoa, H. William Higgins, Jonathan L. Cook, Jeffrey F. Scott, Min Deng, Christie G. Regula, Aria Shafai, Thomas E. Rohrer, Naomi Lawrence, Omar A. Ibrahimi, Ashley Decker, Haider K. Bangash, Mary L. Stevenson, and Glenn D. Goldman

Subjects
medicine.medical_specialty, Reconstructive surgery, Skin Neoplasms, Specialty, Dermatology, Micrographic surgery, Surgical Flaps, 030207 dermatology & venereal diseases, 03 medical and health sciences, Otolaryngology, 0302 clinical medicine, Medicine, Humans, Surgery, Plastic, Head and neck, business.industry, Wound Closure Techniques, General surgery, Suture Techniques, General Medicine, Plastic Surgery Procedures, Mohs Surgery, Surgical training, United States, Plastic surgery, Search terms, Otorhinolaryngology, 030220 oncology & carcinogenesis, Surgery, Clinical Competence, business
Abstract

Background The management of skin cancers has evolved with the development of Mohs micrographic surgery and a greater emphasis on surgical training within dermatology. It is unclear whether these changes have translated into innovations and contributions to the reconstructive literature. Objective To assess contributions from each medical specialty to the cutaneous head and neck oncologic reconstructive literature. Methods The authors conducted a systematic review of the head and neck reconstructive literature from 2000 through 2015 based on a priori search terms relating to suture technique, linear closure, advancement, rotation, transposition and interpolation flaps, and identified the specialty of the senior authors. Results The authors identified 74,871 articles, of which 1,319 were relevant. Under suture technique articles, the senior authors were primarily dermatologists (58.2%) and plastic surgeons (20.3%). Under linear closure, the authors were dermatologists (48.1%), plastic surgeons (22.2%), and otolaryngologists (20.4%). Under advancement and rotation flaps, the senior authors were plastic surgeons (40.5%, 38.9%), dermatologists (38.1%, 34.2%), and otolaryngologists (14.4%, 21.6%). Under transposition and interpolation flaps, the senior authors were plastic surgeons (47.3%, 39.4%), dermatologists (32.3%, 27.0%), and otolaryngologists (15.3%, 23.4%). Conclusion The primary specialties contributing to the cutaneous head and neck reconstructive literature are plastic surgery, dermatology, and otolaryngology.

Published
2019

3. Suture Products and Techniques

Author

Cyndi Yag-Howard and Christie G. Regula

Subjects
Suturing techniques, medicine.medical_specialty, Dermatologic Surgical Procedures, Tissue glue, Dermatology, Skin Diseases, Suture (anatomy), Risk Factors, Surgical Stapling, Humans, Medicine, Dermatologic surgery, Surgical Tape, Wound Healing, Evidence-Based Medicine, business.industry, Tissue adhesives, Suture Techniques, General Medicine, Bandages, Surgery, Treatment Outcome, Practice Guidelines as Topic, Tissue Adhesives, Wound closure, Surgical tape, business, Wound edge
Abstract

Background There are an increasing number of wound closure materials and suturing techniques described in the dermatologic and surgery literature. A dermatologic surgeon's familiarity with these materials and techniques is important to supplement his or her already established practices and improve surgical outcomes. Objective To perform a thorough literature review of wound closure materials (sutures, tissue adhesives, surgical tape, and staples) and suturing techniques and to outline how and when to use them. Materials and methods A literature review was conducted using PubMed and other online search engines. Keywords searched included suture, tissue adhesive, tissue glue, surgical tape, staples, dermatologic suturing, and suturing techniques. Results Numerous articles outline the utility of various sutures, surgical adhesives, surgical tape, and staples in dermatologic surgery. In addition, there are various articles describing classic and novel suturing techniques along with their specific uses in cutaneous surgery. Conclusion Numerous factors must be considered when choosing a wound closure material and suturing technique. These include wound tension, desire for wound edge eversion/inversion, desired hemostasis, repair type, patient's ability to care for the wound and return for suture removal, skin integrity, and wound location. Careful consideration of these factors and proper execution of suturing techniques can lead to excellent cosmetic results.

Published
2015
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4. List of Contributors

Author

Anthony Abdullah, Michael Abrouk, Tashmeeta Ahad, Imtiaz Ahmed, Anwar Al Hammadi, Caroline Allen, Amer Ali Almohssen, Wisam Alwan, Mahreen Ameen, Sadegh Amini, Bryan E. Anderson, Grant J. Anhalt, Donald J. Baker, Harini Rajgopal Bala, Julia Baltz, David Banach, Cedric C. Banfield, Robert Baran, Ajoy Bardhan, Melissa C. Barkham, Ysabel M. Bello, Emma Benton, Wilma F. Bergfeld, Eric Berkowitz, Brian Berman, Jeffrey D. Bernhard, Daniel Bernstein, John Berth-Jones, Chinmoy Bhate, Bhavnit K. Bhatia, Jonathan E. Blume, Nevianna Bordet, Catherine Borysiewicz, Gary J. Brauner, Robert T. Brodell, Marc D. Brown, Robert M. Burd, Anne E. Burdick, Niraj Butala, Jeffrey P. Callen, Ivan D. Camacho, Helena Camasmie, Daniel Caplivski, Mitchell S. Cappell, Genevieve A. Casey, Lawrence S. Chan, Loi-Yuen Chan, Jennifer K. Chen, Chen 'Mary' Chen, Nicole Yi Zhen Chiang, Anthony J. Chiaravalloti, Fiona J. Child, Anthony C. Chu, Timothy H. Clayton, Steven R. Cohen, Elizabeth A. Cooper, Susan M. Cooper, Nick Collier, Christina M. Correnti, Ian H. Coulson, M. Laurin Council, Shawn E. Cowper, Nicholas M. Craven, Daniel Creamer, Ponciano D. Cruz, Carrie Ann R. Cusack, Adam Daunton, Mark D.P. Davis, Robert S. Dawe, David P. D’Cruz, David de Berker, Danielle M. DeHoratius, Min Deng, Seemal R. Desai, Georgina Devlin, John J. DiGiovanna, Alexander Doctoroff, Roni P. Dodiuk-Gad, Dawn Z. Eichenfield, Lawrence F. Eichenfield, Drore Eisen, Ure Eke, Dirk M. Elston, Patrick O.M. Emanuel, Clinton W. Enos, Shaheen H. Ensanyat, Anna F. Falabella, Aaron S. Farberg, Lawrence S. Feigenbaum, Kristen Heins Fernandez, Nicole Fett, Andrew Y. Finlay, Bahar F. Firoz, Elnaz F. Firoz, James E. Fitzpatrick, Amy E. Flischel, Kelly A. Foley, Derek Freedman, Georgina A. Fremlin, Richard Fried, Philip Friedlander, Adam Friedman, Amy K. Forrestel, Brian S. Fuchs, Joanna E. Gach, Anjela Galan, Jaya Ganesh, Amit Garg, Lauren Geller, Carlo M. Gelmetti, Elizabeth Ghazi, Sneha Ghunawat, Leonard H. Goldberg, Mark J.D. Goodfield, Marsha L. Gordon, Asha Gowda, Daniel A. Grabell, Matthew Grant, Clive E.H. Grattan, Malcolm W. Greaves, Justin J. Green, Christopher E.M. Griffiths, Charles A. Gropper, Anna L. Grossberg, Aditya K. Gupta, Ali S. Hadi, Suhail M. Hadi, Iris A. Hagans, Bethany R. Hairston, Analisa Vincent Halpern, Caroline Halverstam, Natasha Harper, Matthew J. Harries, John Harris, Shannon Harrison, Michael M. Hatch, Adrian H.M. Heagerty, Adelaide A. Hebert, Stephen E. Helms, Camile L. Hexsel, Doris M. Hexsel, Warren R. Heymann, Elisabeth M. Higgins, Claire L. Higgins, Whitney A. High, Herbert Hönigsmann, Marcelo G. Horenstein, George J. Hruza, Andrea Hui, Ran Huo, Sally H. Ibbotson, Sherrif F. Ibrahim, Andrew Ilchyshyn, Dina Ismail, Stefania Jablonska, Heidi T. Jacobe, William D. James, Aysha Javed, Gregor B.E. Jemec, Graham A. Johnston, Stephen K. Jones, Jacqueline M. Junkins-Hopkins, Jessica Kaffenberger, Kelly R. Kane, Antonios Kanelleas, Ayşe Serap Karadağ, Laura Karas, Ruwani P. Katugampola, Bruce E. Katz, Roselyn Kellen, Murtaza Khan, Hooman Khorasani, Ellen J. Kim, Hee J. Kim, Brian Kirby, Joslyn S. Kirby, Rachel S. Klein, Kate Kleydman, Dimitra Koch, John J. Kohorst, John Y.M. Koo, Sandra A. Kopp, Neil J. Korman, Carrie Kovarik, Kenneth H. Kraemer, Bernice R. Krafchik, Karthik Krishnamurthy, Knut Kvernebo, Charlene Lam, Peter C. Lambert, James A.A. Langtry, Amir A. Larian, Cecilia A. Larocca, E. Frances Lawlor, Clifford M. Lawrence, Mark G. Lebwohl, Oscar Lebwohl, Julia S. Lehman, Tabi A. Leslie, Stuart R. Lessin, Jacob O. Levitt, Fiona M. Lewis, Maryam Liaqat, Kristina J. Liu, Michael P. Loosemore, Thomas A. Luger, Omar Lupi, Boris D. Lushniak, Calum C. Lyon, Andrea D. Maderal, Bassel H. Mahmoud, Slawomir Majewski, Richard B. Mallett, Steven M. Manders, Ranon Mann, Yasaman Mansouri, David J. Margolis, Orit Markowitz, Alexander Marsland, Agustin Martin-Clavijo, Daniela Martinez, Catalina Matiz, Marcus Maurer, Kevin McKerrow, Nekma Meah, Giuseppe Micali, Robert G. Micheletti, Leslie G. Millard, James E. Miller, Jillian W. Wong Millsop, Daniel Mimouni, Ginat W. Mirowski, Sultan A. Mirza, Sonja Molin, Adisbeth Morales-Burgos, Warwick L. Morison, Cato Mørk, Colin A. Morton, Richard J. Motley, Megan Mowbray, Eavan G. Muldoon, Anna E. Muncaster, George J. Murakawa, Jenny E. Murase, Michele E. Murdoch, Adam S. Nabatian, Mio Nakamura, Rajani Nalluri, Zeena Y. Nawas, Glen R. Needham, Glenn C. Newell, Julia Newton-Bishop, Adam V. Nguyen, Rosemary L. Nixon, Jack C. O’Brien, Stephanie Ogden, Suzanne M. Olbricht, Sally Jane O’Shea, Cindy E. Owen, Michael Pan, Lisa Pappas-Taffer, Jennifer L. Parish, Lawrence Charles Parish, Michael Payette, Gary L. Peck, Sandra Pena, Jarad Peranteau, Frederick A. Pereira, William Perkins, Clifford S. Perlis, Robert G. Phelps, Tania J. Phillips, Maureen B. Poh-Fitzpatrick, Miriam Keltz Pomeranz, Samantha R. Pop, Pierluigi Porcu, James B. Powell, Lori D. Prok, Tia M. Pyle, Surod Qazaz, Vikram Rajkomar, Rabia S. Rashid, Mehdi Rashighi, Ravi Ratnavel, Christie G. Regula, Michael Renzi, Jean Revuz, Rachel V. Reynolds, Elisabeth Richard, Gabriele Richard, Darrell S. Rigel, Wanda Sonia Robles, Megan Rogge, Alain H. Rook, Jamie R. Manning, Ted Rosen, Misha Rosenbach, David Rosenfeld, Christopher Rowland Payne, Adam I. Rubin, Courtney Rubin, Malcolm H.A. Rustin, Thomas Ruzicka, Sara Samimi, Lawrence A. Schachner, Noah Scheinfeld, Bethanee J. Schlosser, Rhonda E. Schnur, Robert A. Schwartz, Matthew J. Scorer, Bryan A. Selkin, Jamie Seymour, Christine M. Shaver, Christopher R. Shea, Neil H. Shear, Tang Ngee Shim, Hiroshi Shimizu, Julia Siegel, Elisha Singer, Maral Kibarian Skelsey, Chris Sladden, Michael Sladden, Janellen Smith, Joanne E. Smucker, Najwa Somani, Lacy L. Sommer, Mary Sommerlad, Christine Soon, Jennifer A. Sopkovich, Nicholas A. Soter, James M. Spencer, Richard C.D. Staughton, Jane C. Sterling, Cord Sunderkötter, Saleem M. Taibjee, Deborah Tamura, Eunice Tan, William Y-M. Tang, Lynsey Taylor, Bruce H. Thiers, Lucy J. Thomas, Cody R. Thornton, Anne-Marie Tobin, Rochelle R. Torgerson, Antonella Tosti, Fragkiski Tsatsou, Yukiko Tsuji-Abe, William F.G. Tucker, Stephen K. Tyring, Jeremy Udkoff, Robin H. Unger, Walter P. Unger, Sarah Utz, Martha C. Valbuena, Peter van de Kerkhof, Abby S. Van Voorhees, Ramya Vangipuram, David Veitch, Vanessa Venning, Sarah G. Versteeg, Martha Viera, Carmela C. Vittorio, Ruth Ann Vleugels, Gorav N. Wali, Joanna Wallengren, Joy Wan, Karolyn A. Wanat, Gabriele Weichert, Anja K. Weidmann, Jeffrey M. Weinberg, Victoria P. Werth, Lucile E. White, Adam H. Wiener, Jonathan K. Wilkin, Nathaniel K. Wilkin, Jason Williams, Niall Wilson, Karen Wiss, Joseph A. Witkowski, Lauren E. Wiznia, Henry K. Wong, Junie Li Chun Wong, Andrew L. Wright, Cooper C. Wriston, Benedict C. Wu, Adam Wulkan, Andrea L. Zaenglein, Irshad Zaki, Joshua A. Zeichner, Tian Hao Zhu, John J. Zone, Christos C. Zouboulis, and Torstein Zuberbeir

Published
2018
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5. Update on Liposuction: Laser-Assisted Liposuction Versus Tumescent Liposuction

Author

Christie G. Regula and Naomi Lawrence

Subjects
Alternative methods, medicine.medical_specialty, Laser assisted liposuction, business.industry, medicine.medical_treatment, Localized fat, Laser lipolysis, Dermatology, Surgery, Tumescent liposuction, Liposuction, Nd:YAG laser, Body contouring, medicine, business
Abstract

Tumescent liposuction has become an increasingly popular cosmetic procedure since its inception nearly 30 years ago. Laser lipolysis has more recently been studied as an alternative method of body contouring. We discuss the efficacy and safety of laser lipolysis in comparison to tumescent liposuction. Ultimately, while laser lipolysis is effective for localized fat reduction, data is lacking to show its superiority to tumescent liposuction.

Published
2014
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6. Versatility of the O-Z Flap in the Reconstruction of Facial Defects

Author

Christie G. Regula, Austin Liu, and Naomi Lawrence

Subjects
Adult, Male, medicine.medical_specialty, Functional impairment, Skin Neoplasms, Computer science, medicine.medical_treatment, Dermatology, Surgical Flaps, Conservation, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Surgical site, Mohs surgery, medicine, Humans, Canthus, Aged, Aged, 80 and over, General Medicine, Middle Aged, Plastic Surgery Procedures, Nasal tip, Mohs Surgery, eye diseases, Tumor registry, Surgery, 030220 oncology & carcinogenesis, Face, Female, Facial Neoplasms
Abstract

BACKGROUND The O-Z flap has traditionally been used for surgical defects adjacent to critical anatomic structures requiring a repair option that minimizes distortion and functional impairment. However, another advantage of the O-Z flap is that it is tissue conservative, particularly in comparison to primary closure. In fact, the design simply takes the Burow's triangles that would be discarded and rotates them inward. OBJECTIVE The purpose of this work is to detail the type of post-Mohs defects, which might benefit from consideration of the O-Z flap with emphasis on tissue conservation and restoration of contour to the surgical site. Furthermore, the authors wish to describe unique considerations in each location and methods to appropriately plan the O-Z flap in each circumstance. METHODS AND MATERIALS The authors reviewed all flaps classified as O-Z in their tumor registry. The approximate size of the defect reconstructed, complications, and long-term outcomes were recorded. RESULTS O-Z flap implementation is described in detail for repair of defects located at the lateral nasal tip, nose-cheek junction, medial canthus, and mid-cheek. CONCLUSION The O-Z flap can be effectively used to repair defects located at the lateral nasal tip, nose-cheek junction, medial canthus, and mid-cheek. It is a mechanically simple flap with predictable tension vectors, which can be specifically oriented to protect the free margin.

Published
2015

7. Woman with hyperpigmented plaque and alopecia

Author

Christie G. Regula and Jennie T. Clarke

Subjects
Voriconazole, Antifungal, medicine.medical_specialty, Erythema, business.industry, medicine.drug_class, Mucormycosis, Dermatology, medicine.disease, Surgery, Subcutaneous nodule, medicine, In patient, Differential diagnosis, Risk factor, medicine.symptom, business, medicine.drug
Abstract

stimulating factor, and hyperbaric oxygen. Breakthrough infections have been reported in patients receiving voriconazole for the prophylaxis of fungal infections and should not be neglected from the differential diagnosis because of the use of this agent. Previous exposure to voriconazole has been shown to be an independent risk factor to the development of mucormycosis. Cutaneous mucormycosis should be considered in the differential diagnosis of a necrotic ulcer with surrounding erythema, nonhealing wound, or subcutaneous nodule in an immunocompromised patient because the rapid diagnosis and initiation of antifungal and surgical therapy may be life-saving. For this series, the recommended choices are: 1, e; 2, e; 3, c; 4, d; 5, c.

Published
2009
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9. Quality of care from a patient's perspective

Author

Jeffrey J. Miller, Christie G. Regula, David T. Mauger, and James G. Marks

Subjects
Adult, Male, business.industry, Perspective (graphical), Dermatology, General Medicine, Middle Aged, United States, Nursing, Ambulatory care, Patient Satisfaction, Health care, Self care, Medicine, Humans, Female, Quality of care, business, Point of care, Aged, Quality of Health Care
Published
2007

10. Interstitial granulomatous drug reaction to anakinra

Author

Christie G. Regula, Michael D. Ioffreda, Jeannie Hennessy, Klaus F. Helm, Emmy M. Graber, Loren E. Clarke, and David R. Adams

Subjects
musculoskeletal diseases, Pathology, medicine.medical_specialty, Arthritis, Dermatology, Asymptomatic, Arthritis, Rheumatoid, Biopsy, medicine, Humans, Histiocyte, Anakinra, Granuloma, medicine.diagnostic_test, business.industry, Interleukin, Middle Aged, medicine.disease, Discontinuation, Interleukin 1 Receptor Antagonist Protein, Antirheumatic Agents, Interstitial granulomatous drug reaction, Female, Drug Eruptions, medicine.symptom, business, medicine.drug
Abstract

Interstitial granulomatous drug reactions are an uncommon entity presenting as asymptomatic, annular, erythematous to violaceous plaques. The incidence of such reactions has been increasing with the use of biologic agents. We report, to the best of our knowledge, the first such reaction to the interleukin (IL)-1 inhibitor anakinra. Our patient presented with pink dermal plaques and nodules in the periaxillary region which resolved with discontinuation of anakinra and recurred upon restarting anakinra. Biopsy revealed a diffuse dermal infiltrate of lymphocytes and histiocytes with interspersed neutrophils and eosinophils. Fragmentation and degeneration of collagen and elastic fibers was also present. Withdrawal of anakinra led to complete resolution of the lesions. Interstitial granulomatous drug reactions are increasing in frequency and we add anakinra to the list of causative agents.

Published
2007

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