Cerebriform eruption related to acute coral dermatitis.

A 27-year-old woman presented with an acute, tender, geographic lesion on her left shin that developed after contact with a brain coral while scuba diving. Photographs obtained two hours after the incident reveal a well-demarcated, geographic, erythematous plaque with a serpiginous and cerebriform pattern at the site of contact, resembling the outermost surface contour of brain coral. The plaque resolved spontaneously over a three-week period. The biology of corals and potential biological features that lead to cutaneous eruptions are reviewed.

Repair of Alar Defects Using the Alar Rotation Flap: Our Experience with 394 Patients.

BACKGROUND: The purpose of this study was for the authors to describe their patient selection, surgical technique, and results with the alar rotation flap for surgical defects of the nasal ala. METHODS: The authors performed a retrospective analysis of all alar rotation flaps performed between June of 2006 and February of 2019. Three hundred ninety-four patients were identified, and follow-up encounters were reviewed to assess for complications and need for revision procedures. RESULTS: The alar rotation flap was performed on 394 patients over a 13-year period. The mean defect size was 9.3 ± 2.8 mm by 7.2 ± 2.3 mm. Three hundred nineteen patients (81 percent) were evaluated postoperatively, with a mean average duration of follow-up of 2.3 years (range, 6 days to 11.9 years). Complications included hemorrhagic crust along the incision line [n = 9 (3 percent)], flap edema [n = 7 (2 percent)], internal nasal valve dysfunction [n = 3 (1 percent)], depressed surgical scar [n = 2 (1 percent)], hematoma [n = 1 (0.5 percent)], and paresthesia [n = 1 (0.5 percent)]. CONCLUSION: The alar rotation flap is a reliable one-stage flap for small- to medium-size partial-thickness defects of the nasal ala that can produce topographic restoration with minimal risk of aesthetic or functional complication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Repair of Apical Triangle Defects Using Melolabial Rotation Flaps.

BACKGROUND: The apical triangle of the upper cutaneous lip, also known as the alar-facial sulcus, is an anatomical structure bound medially by the nasal ala, laterally by the medial cheek, and inferiorly by the remainder of the upper cutaneous lip. During reconstruction, retaining the central concavity and the convex lateral and medial outlines of this location is required to maintain midfacial symmetry. OBJECTIVE: This is a retrospective study of our use of the melolabial rotation flap for reconstruction of surgical defects of the apical triangle. METHODS AND MATERIALS: Eighty-six surgical defects involving the apical triangle that were repaired with melolabial rotation flaps were included. All tumors were treated with Mohs micrographic surgery before reconstruction. Preoperative, intraoperative, and postoperative details of each case were analyzed. RESULTS: Of the 86 defects included in the study, 68 (79%) were evaluated postoperatively. The apical triangle was preserved in all cases. Clinical asymmetry was noted in 3 patients (3.4%). No major complications were noted, and no patient required surgical revision. CONCLUSION: Melolabial rotation flaps may be considered for single-stage reconstruction of surgical defects involving the apical triangle.

Repair of Anterior Ear Defects Using Transcartilage Island Pedicle Flaps.

BACKGROUND: Surgical reconstruction of the anterior surface of the ear (concha, antihelix, scapha, and triangular fossa) is complicated by the paucity of mobile local skin. OBJECTIVE: This is a retrospective study of the transcartilage island pedicle flap for reconstruction of surgical defects of the anterior ear. METHODS AND MATERIALS: Two hundred thirty-two Mohs micrographic surgery defects were included in the study. The technique involves circumferential incision of the flap in the postauricular sulcus, transfer of the flap to the anterior ear through a surgically created cartilage slit, suturing of the flap on the anterior surface of the ear, and repair of the secondary postauricular defect. Preoperative, intraoperative, and postoperative details of each case were tabulated and analyzed. RESULTS: The mean defect size was 1.9 × 1.5 cm. Complications included flap edema (n = 6, 2.6%), postoperative bleeding (n = 4, 1.7%), partial thickness flap necrosis (n = 2, 0.9%), pinning back of the ear (n = 2, 0.9%), and central flap dimpling (n = 2, 0.9%). There was 1 acute staphylococcal abscess and 1 sterile abscess that developed 13 months postoperatively. All complications resolved with medical or surgical management. CONCLUSION: Transcartilage island pedicle flaps may be considered for single-stage surgical reconstruction of defects involving the anterior ear.

Letter processing and font information during reading: beyond distinctiveness, where vision meets design.

Letter identification is a critical front end of the reading process. In general, conceptualizations of the identification process have emphasized arbitrary sets of distinctive features. However, a richer view of letter processing incorporates principles from the field of type design, including an emphasis on uniformities across letters within a font. The importance of uniformities is supported by a small body of research indicating that consistency of font increases letter identification efficiency. We review design concepts and the relevant literature, with the goal of stimulating further thinking about letter processing during reading.

Enhanced wound healing after emotional disclosure intervention.

OBJECTIVES: Psychological stress is believed to impair wound healing via a down-regulation of the immune system. Since previous research suggests that disclosure of tra-umatic experiences can result in an up-regulation of immune function, the present study aimed to investigate the impact of a disclosure intervention on the progress of wound healing. DESIGN: The study used a prospective, longitudinal design with random assignment to the control (writing about time management) and experimental group (writing about a traumatic event). METHODS: Participants (N=36) completed questionnaires measuring perceived and emotional distress, loneliness, self-esteem, social support, dispositional optimism, and health-related behaviours. Accurate indication of the healing of a small punch biopsy wound was determined by using a high-resolution ultrasound scanner. RESULTS: Repeated measures ANOVA indicated that the disclosure intervention impacted wound healing. Participants who wrote about traumatic events had significantly smaller wounds 14 and 21 days after the biopsy compared with those who wrote about time management. CONCLUSIONS: It is concluded that a relatively brief and easy to administer intervention can have beneficial effects on wound healing. The potential for use in patient samples is indicated.

Can dermal thickness measured by ultrasound biomicroscopy assist in determining osteoporosis risk?

BACKGROUND AND PURPOSE: A study was undertaken to evaluate the relationship between dermal thickness and bone density. Ninety-eight female subjects were recruited from a population of patients attending a university hospital osteoporosis clinic. The subject population ranged in age from 30 to 88 years with a mean age of 60. The weight range was from 91 to 274 pounds, mean 142 pounds. METHODS: Dermal thickness measurements were taken at the right forearm using a Longport high resolution 20 MHz ultrasound scanner. Bone density measurements were taken using a GE Lunar Prodigy DXA scanner at both hips. RESULTS: Statistical analysis using the intraclass correlation coefficient (ICC) of the skin measurements showed that the dermal measurement technique was highly reliable (CI=0.87, 0.92). Linear regression was used to examine the value of dermal thickness as a predictor of bone density. The correlation coefficient between dermal thickness and hip T score was statistically significant in the positive direction (corr.=0.304, P=0.001). We further investigated the relationship between dermal thickness and T scores using penalized splines. CONCLUSION: This analysis indicated that the strongest association with bone density occurred between 1.0 and 1.5 mm of dermal thickness. In those subjects identified as having osteoporosis dermal thickness measure of > or =1.04 corresponds to 4% of the subjects having osteoporosis. If dermal thickness is <1.04 then 23% have osteoporosis.

Use of high-resolution, high-frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development.

OBJECTIVES: To investigate the pathogenesis of pressure ulcers utilizing high-resolution ultrasound and to explore the utility of this technology for the detection of incipient pressure ulcers prior to visual clinical signs. DESIGN: An observational prospective study comparing high-resolution ultrasound images obtained from 119 long-term-care facility residents determined to be at risk for pressure ulcer development (Braden Scale score of 18 or less) with images obtained from 15 healthy volunteers (medical students and medical residents). Common pressure ulcer sites were scanned, including the heels, sacrum, and ischial tuberosity. SETTING: A medical center and a long-term-care facility. INTERVENTION: Anatomic sites universally accepted as at risk for pressure ulcer development were scanned using high-resolution ultrasound; the sites did not have visual evidence of skin breakdown. The images obtained from the long-term-care facility residents were compared with images considered normal that were obtained from healthy volunteers. In addition, documentation of the clinical assessment finding for erythema was reviewed, recorded, and compared with the high-resolution ultrasound finding for each specific site. MEASUREMENTS: The images obtained were classified as not readable, normal, or abnormal. The images classified as abnormal were further classified by depth of abnormal finding: pattern 1 (deep) or pattern 2 (superficial). The images classified with the abnormal finding pattern 1 (deep) were further classified and subdivided by anatomic location of abnormal finding(s): subgroup 1, abnormal findings in the subdermal area only; subgroup 2, subdermal and dermal abnormal findings; and subgroup 3, subdermal, dermal, and subepidermal edema. Pattern 2 (superficial) included images with abnormal findings limited to the dermal/epidermal junction. RESULTS: 630 (55.3%) of the images obtained from the long-term-care residents were different from the images obtained from the healthy volunteers. The healthy volunteers' images classified as normal had the expected ultrasound findings for homogeneous pattern of ultrasound reflections, allowing for visualization of various skin layers (epidermis, superficial papillary dermis, deep reticular dermis, and hypodermis) and subcutaneous tissue (subdermal). However, many images (55.3%) obtained from the residents at risk for pressure ulcer development had patterns where areas within the various skin layers were not visible, interrupted by areas indicative of fluid or edema. Moreover, most images (79.7%) with abnormal ultrasound patterns did not have documentation of erythema. CONCLUSION: High-resolution ultrasound is an effective tool for the investigation of skin and soft tissue changes consistent with the documented pathogenesis of pressure ulcers. A progressive process for pressure ulcer development from deep subdermal layers to superficial dermal then epidermal layers can be inferred. Dermal edema was only present with subdermal edema. In other words, there was never evidence of dermal edema in the absence of subdermal edema. A better understanding of the pathogenesis of pressure ulcers through the use of high-resolution ultrasound to detect soft tissue damage and edema before visible clinical signs could lead to earlier and more focused pressure ulcer prevention programs, resulting in reduced pain and suffering for improved patient quality of life and wound care cost savings.

Perceived stress and cortisol levels predict speed of wound healing in healthy male adults.

The main purpose of the present study was to investigate the association between perceived stress and impaired cutaneous wound healing in humans using a novel wound assessment technique, and taking into account putative mediating factors such as cortisol levels, health behaviours, and personality factors. The study made use of a prospective, within-subjects design in which 24 male non-smokers participated. Every subject received a standard 4mm-punch biopsy, and the healing progress was monitored via high-resolution ultrasound scanning. Participants completed questionnaires on perceived stress, health behaviours, and personality factors, and sampled saliva for cortisol assessment after awakening at 2 weeks prior, directly after, and 2 weeks after the biopsy. The overall results showed a significant negative correlation between speed of wound healing, and both Perceived Stress scale (PSS) scores (r=-.59; p<.01), and General Health Questionnaire (GHQ) scores (r=-.59; p<.01) at the time of the biopsy. The area under the morning cortisol response curve was negatively correlated with speed of wound healing (r=-.55; p<.05), indicating a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal. A median split of the complete sample yielded that the 'slow healing' group showed higher stress levels (PSS t=3.93, p<.01, GHQ t=2.50, p<.05), lower trait optimism (t=3.25, p<.05), and higher cortisol levels to awakening (F=5.60, p<.05) compared with the 'fast healing' group. None of the health behaviours investigated (i.e. alcohol consumption, exercise, healthy eating, and sleep) were correlated with healing speed at any time point. Our data hint at a considerable influence of stress on wound healing, and suggests that elevated cortisol levels, rather than altered health behaviours, play a role in this effect.

The effect of 880 nm low level laser energy on human fibroblast cell numbers: a possible role in hypertrophic wound healing.

Low level lasers (LLLs) have been shown to induce therapeutic effects in wound healing. However, there have been few LLL studies on burn wounds which may become unsightly, hypertrophic and impair function. Inhibitory effects on the healing of fibrotic wounds, prone to hypertrophy may be expected to reasonably reduce the problems accompanying hypertrophic scarring. The effects of LLL wavelengths and treatment parameters on wound healing cells in vitro often demonstrate meaningful results and without concurrent ethical difficulties of clinical trials. This experiment investigated the effect of an 880 nm, 16 mW GaAlAs diode at 2.4 and 4 J/cm(2) on cell numbers of two human fibroblast cell lines, derived from hypertrophic scar (HF) and normal dermal explants (NF), respectively. After irradiation by 880 nm LLL, cell numbers were measured utilising methylene blue bioassay and read by the spectrophotometer in the same microculture plates. HF and NF exhibited decreased cell numbers as compared to sham-irradiated controls. HF cell number, after 2.4 J/cm(2), was significantly lower on day 5 (P<0.05). The NF cell numbers were significantly lower on day 4 and/or day 5 (P<0.05). The results have implications on hypertrophic wound healing and further studies are required.

Advances in wound healing physiology: the comparative perspective.

Abstract Understanding of the processes involved in wound healing in vertebrates is increasing rapidly owing to the application of advances in cell and molecular biology, and in technology. The cellular mechanisms which result in some vertebrates having the ability to regenerate the dermis after injury, whereas in others it is replaced by scar tissue, are currently being explored with a view to restoring this regenerative ability by modulating the intercellular systems which control wound healing. This introductory review (a) compares and contrasts the response to injury of homoiofhermic and poikilothermic animals and of foetal and post-natal mammals; (b) describes the mechanisms involved in cutaneous wound healing; (c) illustrates how the rate and quality of healing can be assessed non-invasively and objectively, and (d) describes how cutaneous healing can be improved by the application of electrophysical modalities employing ultrasound and light. Zusammenfassung Unser Verständnis von Wundheilungsprozessen bei Wirbeltieren wächst wegen der Fortschritte in Zell- und Molekularbiologie und Technologie rapide. Die zellulären Mechanismen, die es einigen Wirbeltieren ermöglichen, die Haut nach einer Verletzung zu regenerieren, während sie bei anderen durch Narbengewebe ersetzt wird, werden gegenwärtig erforscht, um diese Regenerationsfähigkeit durch Veränderung der interzellulären Systeme, die die Wundheilung kontrollieren, wiederherzustellen. Diese einführende Übersicht (a) vergleicht die Reaktion auf Verletzung in homiothermischen und poikilothermischen Tieren und in Säugetierfeten und Säugetieren nach der Geburt; (b) beschreibt die Mechanismen der kutanen Wundheilung; (c) illustriert, wie die Heilungsrate und -fähigkeit nichtinvasiv und objektiv bewertet werden kann, und (d) beschreibt, wie Wundheilung durch die Anwendung von elektrophysikalischen Heilmitteln wie Ultraschall und Licht verbessert werden kann. [Dyson, M. Advances in wound healing physiology: the comparative perspective (Fortschritte in der Wundheilungsphysiologie: die vergleichende Perspektive). Veterinary Dermatology 1997; 8: 227-233] Resumé La compréhension des processus impliqués dans la cicatrisation des plaies chez les vertébrés croït rapidement suite à l'application des progrès en biologie cellulaire et moléculaire et en technologie. Les mécanismes cellulaires qui résultent chez certains vertébrés dans la capacité du derme à se régénérer après une blessure alors que chez d'autres, il est remplacé par du tissus cicatriciel, sont actuellement explorés avec pour but de restaurer cette capacité régénératrice en modulant les systèmes intercellulaires qui contrôlent la cicatrisation des plaies. Cette revue d'introduction (a) compare et contraste la réponse des animaux homoiothermiques et poikilothermiques et des mammifères foetaux et postnataux au traumatisme; (b) décrit les mécanismes impliqués dans la cicatrisation des plaies; (c) illustre comment le taux et la qualité de cicatrisation peuvent être évalués de manière non invasive et objective; et (d) décrit comment la cicatrisation cutanée peut être améliorée par l'application de modalités électrophysiques utilisant ultra sons et lumière. [Dyson, M. Advances in wound healing physiology: the comparative perspective (Progres de la physiologie de la cicatrisation des plaies: les perspectives comparatives). Veterinary Dermatology 1997; 8: 227-233] Resumen El conocimiento de los procesos implicados en la curación de heridas en los vertebrados aumenta rápidamente debido a la aplicación de avances en biologia celular y molecular, y a la tecnologia. Actualmente se estan estudiando los mecanismos celulares que hacen que algunos vertebrados tengan la capacidad de regenerar la dermis después de una herida, mientras que en otros se sustituye por tejido de cicatrización, con el objetivo de restaurar la capacidad regenerativa modulando los sistemas intercelulares que controlan la curación de heridas. Esta revision introductoria a) compara y contrasta la respuesta a las heridas en animales homoiotermos y poiquilotermos y en mamiferos fetales y post-natales; b) describe los mecanismos implicados en la curación de heridas cutáneas; c) ilustra cómo el ritmo y la calidad de curación puede ser monitorizado de forma no-invasiva y objetiva y d) describe como la curación cutánea mejora mediante la aplicación de modalidades electrofisicas utilizando ultrasonidos y luz. [Dyson, M. Advances in wound healing physiology: the comparative perspective (Avances en fisiologia de la curación de heridas: perspectiva). Veterinary Dermatology 1997; 8: 227-233].