Journal of Cutaneous and Aesthetic Surgery

Laser dermatology in the subcontinent: Coming of age! Sanjeev J Aurangabadkar Journal of Cutaneous and Aesthetic Surgery 2019 12(2):75-75

Laser toning in melasma Swapnil D Shah, Sanjeev J Aurangabadkar Journal of Cutaneous and Aesthetic Surgery 2019 12(2):76-84 Melasma is a common acquired disorder of hyperpigmentation. A variety of treatment options has been suggested for the management of melasma. A range of different lasers had been tried in the treatment of melasma. Q-switched Nd-YAG laser (QSL) is the most commonly used laser in the treatment of melasma. Recently, laser toning or low-fluence, multi-pass technique has become popular in treatment of melasma. Authors aimed to review the procedure, its effectiveness, combination therapies using laser toning, and complications of laser toning. A PubMed search was made using keywords such as laser toning, QSL, melasma, and lasers in melasma, and relevant articles were reviewed.

Fractional carbon dioxide laser: Optimizing treatment outcomes for pigmented atrophic acne scars in skin of color Shehnaz Z Arsiwala, Swasti R Desai Journal of Cutaneous and Aesthetic Surgery 2019 12(2):85-94 Dark skin type has high propensity to acne scarring and is often complicated by persistent erythema or pigmentation at the base. Fractional lasers are available for the longest period and are able to improve most atrophic acne scars. Often pigmented scar bases and dark skin types limit the use of aggressive laser parameters. Long pulse mode is preferred over short pulse to prevent epidermal damage; low fluence is chosen versus high fluence and low density versus high density. Repeated treatments are needed to minimize complications and optimize results; all these must be achieved through a controlled stage of inflammation. Interventional priming with chemical peels and laser toning before ablative fractional carbon dioxide laser helps to reduce photodamage, recent tan, and pigment at scar base, thus minimizing the risk of post-inflammatory hyperpigmentation. Multiple recent literature evidence validates the combinations to optimize outcomes in atrophic acne scars as discussed in this review article.

A prospective open-labeled study of tattoo removal with Q-switched Nd:YAG laser utilizing the R0 technique and correlation with Kirby–Desai scale Sanjeev J Aurangabadkar, Swapnil D Shah, Deepak S Kulkarni, Madhavi S Auragabadkar Journal of Cutaneous and Aesthetic Surgery 2019 12(2):95-104 Introduction: The Q-switched Nd: YAG (QSNY) laser is considered the standard device of choice for laser tattoo removal. Newer concepts such as R0 , R20 methods aided in faster clearance of tattoos. The Kerby-Desai scale [KD scale] has been proposed to predict the approximate number of sessions needed for tattoo clearance. Objective: To access the efficacy of R0 technique for tattoo removal in skin types IV to VI To evaluate the Kerby-Desai scale and its correlation to the number of sessions actually required for tattoo clearance Material and Methods: Twenty-two patients with single colored amateur were treated using modified R0 technique and the number of sessions were corelated with Kirby Desai scale. Results: We found that R0 method require significantly less sessions than predicted by KD scale. Conclusion: Tattoo removal with the R0 technique using PFD allows faster clearing of tattoos and significantly cuts down the total treatment duration needed for tattoo removal.

Noncultured extracted hair follicle outer root sheath cell suspension versus noncultured epidermal cell suspension in the treatment of stable vitiligo Ashraf Mahmoud Hamza, Tarek Mahmoud Hussein, Hadir AbdelGawad Ragab Shakshouk Journal of Cutaneous and Aesthetic Surgery 2019 12(2):105-111 Background: Various treatment modalities exist for vitiligo, yet none of them are curative. Vitiligo is still considered a challenging disease to manage. Surgical treatment offers an excellent option for patients with stable vitiligo, especially those who fail to respond to medical treatment. Cell suspension techniques carry the advantage of covering large surface areas. Objective: To compare noncultured extracted hair follicle outer root sheath cell suspension (NCORSHFS) and noncultured epidermal cell suspension (NCES) in producing repigmentation. Subjects and Methods: Twenty patients were randomly allocated into two groups. They were objectively evaluated for the extent of repigmentation (after 1, 2, and 3 months), complications, cosmetic outcome, and satisfaction. Results: In NCORSHFS group, 10% showed excellent pigmentation, 20% showed good pigmentation, 50% fair, and 20% poor pigmentation. In NCES group, 10% showed excellent pigmentation, 10% good pigmentation, 40% fair, and 40% poor pigmentation. This difference was not statistically significant. Excellent color match was observed in 80% of NCORSHFS and in 70% of NCES. Donor area complications were absent in NCORSHFS group, whereas in NCES, mild scarring in 20% and hyperpigmentation in 40% of patients was observed. The difference in patients’ satisfaction between the two groups was not statistically significant. Conclusion: Both NCORSHFS and NCES are effective in producing good repigmentation with perfect color match and patients’ satisfaction. NCORSHFS has no donor area complications because it is a scarless procedure.

Does the optimal layer of the skin include the orbicularis oculi muscle when elevating cheek rotation flap? Naohiro Ishii, Masayoshi Takayama, Shigeki Sakai, Kazuo Kishi Journal of Cutaneous and Aesthetic Surgery 2019 12(2):112-117 Background: The cheek rotation flap is widely used as an optimal technique for lower eyelid reconstruction; however, the elevation layer of the skin including the orbicularis oculi muscle (OOM) remains unresolved. Materials and Methods: Between February 2006 and October 2012, 11 patients who underwent repair of partial-thickness defects of the lower eyelids using the cheek rotation flap were included in this prospective study. We investigated the influence of elevating the layer of skin including the OOM on the incidence of perioperative complications, operation time, long-term postoperative morphology, and function of the lower eyelid. The layer of flap elevation was deep to the OOM in four patients (deep to OOM cases) and superficial to the OOM in seven (superficial to OOM cases). Results: The superficial to OOM cases had a similar incidence of perioperative complications including flap congestion as the deep to OOM cases. However, the superficial to OOM cases required a significantly longer operation time. Furthermore, lid retraction was found in all of the deep to OOM cases and none of the superficial to OOM cases. In addition, the postoperative results in all the superficial to OOM cases showed satisfactory contours of the lower eyelid without revision surgery. However, many of the deep to OOM cases needed revision surgery to improve lid retraction. Conclusion: The cheek rotation flap should be elevated in superficial to the OOM cases because postoperative lid retraction occurred significantly more in the deep to OOM cases than in the superficial to OOM cases, although elaborate dissection may prolong the operation time.

A comparative study on the rate of anagen effluvium and survival rates of scalp, beard, and chest hair in hair restoration procedure of scalp Jyoti Gupta, Kavish Chouhan, Amrendra Kumar, Ariganesh Chandrasegaran Journal of Cutaneous and Aesthetic Surgery 2019 12(2):118-123 Background: The use of non-scalp donor hair is considered in situations of a relative or absolute lack of head donor hair supply. Till now, very few published works are present on body hair transplant. None of them have compared scalp and non-scalp hair in terms of survival as well as characteristics. Objective: To compare the characteristics such as rate of anagen effluvium and survival rates of scalp, beard, and chest hair in hair restoration procedure of scalp. Materials and Methods: Three blocks of 1cm2 were marked on a non-frontal area. Thirty slits with a 0.9mm blade were made in each block. Single follicular unit was taken from scalp, beard, and chest area and was implanted simultaneously in each block, respectively. The areas were evaluated for any graft loss, anagen effluvium, and survival rate. Results: During initial period of 2 months, anagen effluvium in scalp (40%) and beard (30%) were significantly less than body (53.3%) hair with excellent survival rate of beard (95%), followed by scalp (89%) and then followed by chest hair (76%) at 1 year. Conclusion: Non-scalp hair can become an excellent source of donor area for hair restoration procedure.

Wound closure in large neural tube defects: Role of rhomboid flaps Digamber Chaubey, Vijayendra Kumar, Vinit K Thakur, Ramdhani Yadav, Zaheer Hasan, Ramjee Prasad, Sandip K Rahul Journal of Cutaneous and Aesthetic Surgery 2019 12(2):124-127 Background: Large wounds following surgery for neural tube defects are difficult to close; physical wound characteristics such as position and dimension would serve as a guide for their surgical closure. Aim: To study how wound dimension determines the choice between primary and rhomboid flap closure of skin defects following surgery for neural tube defects. Materials And Methods: A retrospective study was carried out on cases of neural tube defects operated in the department of paediatric surgery at a tertiary center for 3 years from January 2015 to December 2017. Data regarding clinical features, location, wound dimensions following surgery, any bony deformity, method of closure used, distance of wound from anus, and postoperative complications were collected and analyzed. Results: A total of 114 cases were operated during this period; 86/114 had primary closure, whereas 28/114 needed rhomboid flap for tension-free cover. Primarily closed wounds had a biphasic distribution of (long axis)/(short axis) ratio (with values either >1.65 or <0.63), whereas those covered by rhomboid flaps had a mean ratio of 1.25 (range, 0.71–1.45). All six cases with bony deformity needed rhomboid flaps. Although all lipomeningomyelocele defects could be primarily closed, all rachischisis needed flap cover. Infected lesions had a mean wound distance of 5.3cm from posterior anal margin. Conclusion: Defect’s position, its size and shape, and any bony deformity determine the choice of closure of postoperative wound. The versatile, safe, and universal rhomboid flap is an aesthetic solution to the large skin defects in patients of neural tube defects.

NBUVB phototherapy at the donor site can enhance the graft uptake in the nonhealing ulcers of mycosis fungoides: A case report Imran Ahmad, Rajesh K Maurya, Sushama Sushama, Ali A Mahmud Journal of Cutaneous and Aesthetic Surgery 2019 12(2):128-131 Mycosis fungoides is a rare form of non-Hodgkin’s lymphoma, which is formed of mature, skin homing, clonal, malignant T lymphocytes. It can sometimes present with skin ulcers that are difficult to heal because of the presence of large number T lymphocytes and antigen-presenting cells. We present a case of nonhealing ulcers in a patient with mycosis fungoides, which was treated by narrow band ultraviolet B targeted phototherapy followed by split-thickness skin grafting. The graft uptake was well and the donor area also healed without any complications.

Human skin allograft: Is it a viable option in management of burn patients? Saurabh Gupta, Devi P Mohapatra, Ravi K Chittoria, Elankumar Subbarayan, Sireesha K Reddy, Vinayak Chavan, Abhinav Aggarwal, Likhitha C Reddy Journal of Cutaneous and Aesthetic Surgery 2019 12(2):132-135 Tangential excision and autologous split-thickness skin grafting is the standard management of the burn wound, but autograft has limitation of donor-site availability and morbidity. Human skin allograft is an alternate option of wound coverage when autograft is not available. Various synthetic skin substitute dressings are now available in the market, and thus use of human skin allograft has decreased. This case report explores the role of human skin allograft in burn wound management. Allograft facilitates excision of burn wounds during acute phase of burn injury in pediatric patients. It is cost-effective, reduces pain and risk of infection, and avoids frequent dressing changes. Availability of allograft and risk of infection are the two main constraints in its regular use.