Outcomes of Surgical Management of Xanthelasma Palpebrarum

BACKGROUND: Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment. METHODS: A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades. RESULTS: Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement. CONCLUSIONS: We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

Photogrammetric Analysis of the Correction of Nasal Deformity in Bilateral Cleft Lip using Bardach's Techique

The secondary nasal deformity in bilateral cleft lip has distinct characteristics such as the absence of septal deviation, short columella, both alar flaring, web of the alar rim, wide nostrils, dislocation and separation of the alar cartilage with an obtuse angle. Bardach's technique was applied for both a nasal tip projection and lengthening the columella in the secondary nasal deformity. In this procedure, the columella was lengthened using a skin flap from the prolabium, and the lateral crura of the lower lateral cartilages were dissected from the skin and nasal mucosa. The lower lateral cartilage was also restructured by lengthening the medial crura and shortening the lateral crura by suturing them together at the appropriate height to establish the proper cartilage support for a projected and symmetric nasal tip and to reconstruct the columella. A V-Y closure of the defect on the lip was done to lengthen the midsection of the lip. A photogrammetric comparison of the pre-operation and post-operation was made(n=10 ; M : F=7 : 3). The facial proportions and angles were measured by photography using defined anthropometric points. The following criteria were quantified for the preoperative states and postoperative states: the nasolabial angle, nasal tip angle and projection, nasal width, columellar length and width, and the philtral width. All parameters in both states were compared against each other. Results were analyzed by a non-parameter test. The nasolabial angle, nasal tip angle, nasal tip protrusion, columellar lengthening proved to be better after surgery(p<0.01). In conclusion, Bardach's technique is suitable method for correcting the secondary deformity associated with bilateral cleft lip by nasal tip projection, columella lengthening and preventing recurrence. However, It is not suitable for the reduction of alar width and the formation of philtral groove.

The Effect of Medifoam (Hydrophilic Polyurethane Foam) Dressing In Split Thickness Skin Graft Donor Site

The purpose of this study is to evaluate the effects of occlusive wet dressing by using hydrophilic polyurethane foam (Medifoam ) in the management of donor sites of split thickness skin graft. The outer layer of Medifoam is made of a polyurethane film, which is impermeable to water and microorganisms. It provides moist wound environment and effective bacterial barrier. The middle layer is polyurethane foam, the absorption layer. Its swelling ratio is 1020% and the layer contains wound promoters (Glycosamnioglycan, etc.). The inner layer is polyurethane film, which has micro pores whose size is below 20mum. It prevents epithelial ingrowth into the pore. We performed half side test to compare Medifoam to AHD (the hydrocellular dressing materials). We divided STSG donor site into AHD dressing site and Medifoam dressing site in random fashion. This study was performed in Seoul National University Hospital from April 2001 till August 2001 with 32 patients, who needed to skin graft. We investigated about pain, comfort, easiness of handling, and time for complete healing. The Medifoam dressed site had less pain, more comfortable, easier handling and more rapid wound healing. The average healing time of Medifoam is 9.4 +/- 1.9 days and AHD is 12.6 +/- 1.9 days(p< 0.001). So we concluded that the occlusive dressing with Medifoam is an effective dressing method in split thickness skin graft donor site. And we expect that it is also effective dressing material in many other wounds.