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BACKGROUND Variation in the design of a rotation flap may affect wound closure tension. Lengthening the leading edge of a rotation flap has been a method of reducing the tension of closure in the primary motion. An in vitro study negating this tenant has been published. OBJECTIVE The authors set out to design an in vivo experiment to determine if lengthening the leading edge of a rotation flap has the effect of reducing closure tension in the primary motion of the repair. MATERIALS AND METHODS An animal study approved by Institutional Animal Care and Use Committee was undertaken in a pig model. A tension-measuring apparatus was designed using Teflon-coated wires and digital tensiometers. Rotation flaps of a standard design and with elongated leading edges were incised on the flanks of pigs under general anesthesia. Flap closure tensions were measured at points along the leading edge of the flap and in the secondary motion. RESULTS Elongating the leading edge of a flap led to a statistically significant reduction in closure tension in the primary motion of the flap and at the flap tip. The secondary motion closure tensions were essentially unaffected. CONCLUSION The authors confirm that elongating the leading edge of a standard rotation flap will reduce closure tension in the primary flap motion.

Treatment of large facial skin cancers with surgery is a multistep process. First, both the patient and the lesion must be evaluated to ensure that surgery is the most appropriate form of treatment. When surgery is deemed appropriate, the method of tumor removal must be chosen and may vary depending on the size and type of lesion. In many cases, Mohs surgery is appropriate, but in other cases, excision with en face permanent section margins will be elected. Reconstruction should only be undertaken when negative margins have been assured. Repair may entail coverage or aesthetic coverage, depending on patient factors and preferences. Flaps will generally increase cosmesis but are often not feasible once a wound reaches a certain size.

Mycetoma is a chronic granulomatous infection that is present worldwide and endemic in tropical and subtropical regions. The infection is caused by the traumatic inoculation of a fungus (eumycetoma) or a bacterium (actinomycetoma) and generally remains localized, causing cutaneous and subcutaneous tissue swelling, nodule formation, and drainage through sinus tracts. This review details the history of mycetoma, which may date as far back as the Byzantine period (300-600 AD), the epidemiology of the disease, which is characterized by an endemic region located between the latitudes of 15 degrees south and 30 degrees north, and the clinical presentation and treatment of mycetoma, focusing on the differences between eumycete and actinomycete infections. Diagnosis is established by identifying the type of grains found in the discharge, which guides treatment. Mycetoma caused by bacteria can usually be managed effectively with antibacterial medication alone, while infections with fungi require antifungal medication and surgery. Without proper treatment, mycetoma can lead to deformity, amputation, and death.

Asymmetric periflexural exanthema of childhood is a benign, self-limiting disease of unknown origin. Patients generally present a few weeks after a viral-like prodrome with erythematous macules and papules within flexural spaces followed by centrifugal spread. Treatment focuses on alleviating symptoms of pruritus.

Plantar warts are a common problem frequently seen by dermatologists and other practitioners with an interest in skin disease management. The diagnosis is often straightforward, but the treatment is difficult and lengthy. The available treatment options are reviewed.

Xeroderma pigmentosum (XP) is a rare, autosomal-recessive inherited disease that is found worldwide at a frequency of approximately 1:250,000. XP is caused by a deficiency in either nucleotide excision repair (NER) or postreplication repair (PRR), and is characterized by severe actinic changes leading to early onset of skin cancers, various ocular manifestations, and occasional neurological abnormalities. Diagnosis is usually made clinically and can be confirmed by unscheduled DNA synthesis. Early preventative care is the most important treatment modality. We present a review of the history, clinical manifestations, pathogenesis, diagnosis, and treatment of XP.