Nevus anelasticus: how should such lesions be classified?

Nevus anelasticus represents a rare entity that is most commonly classified as a connective tissue nevus. It typically presents before 20 years of age with asymmetrically distributed white-to-skin-toned or pink-to-red papules or plaques on the trunk and upper extremities. The lesion is defined histopathologically by the absence or degeneration of elastic fibers in the dermis. We report the case of a healthy 17-year-old female who presented with an asymptomatic slowly progressive plaque on the right inferior areola. Histopathologic examination showed the absence of elastic fibers in the papillary and upper reticular dermis and fragmented elastic tissue fibers in the deep reticular dermis. Although there is ongoing controversy regarding the nosology of this uncommon disorder, we propose that it is a distinct entity based on its histopathologic and clinical features.

Current status of surgery in dermatology.

An article titled "Current issues in dermatologic office-based surgery" was published in the JAAD in October 1999 (volume 41, issue 4, pp. 624-634). The article was developed by the Joint American Academy of Dermatology/American Society for Dermatologic Surgery Liaison Committee. A number of subjects were addressed in the article including surgical training program requirements for dermatology residents and selected advances in dermatologic surgery that had been pioneered by dermatologists. The article concluded with sections on credentialing, privileging, and accreditation of office-based surgical facilities. Much has changed since 1999, including more stringent requirements for surgical training during dermatology residency, and the establishment of 57 accredited Procedural Dermatology Fellowship Training Programs. All of these changes have been overseen and approved by the Residency Review Committee for Dermatology and the Accreditation Committee for Graduate Medical Education. The fertile academic environment of academic training programs with interaction between established dermatologic surgeons and fellows, as well as the inquisitive nature of many of our colleagues, has led to the numerous major advances in dermatologic surgery, which are described herein.

Laser tattoo removal: a review.

BACKGROUND: Tattoos have played an important role in human culture for thousands of years, and they remain popular today. The development of quality-switched (QS) lasers has revolutionized the removal of unwanted tattoos. OBJECTIVES: To thoroughly review the literature on laser tattoo removal pertaining to its history, its theoretical basis, the various devices used, potential adverse effects, and future developments. MATERIAL AND METHODS: An extensive literature review of publications related to tattoo removal was conducted. RESULTS: Reports exist demonstrating the efficacy of laser removal of different tattoo types, including professional, amateur, traumatic, cosmetic, and medical. The literature supports the use of different QS lasers for removal of tattoos. Some colors have a more-complete response using particular wavelengths. CONCLUSION: QS lasers can effectively and safely remove different types of unwanted tattoos.

Effects of hyperbaric oxygen therapy on an accelerated rate of mandibular distraction osteogenesis.

BACKGROUND: Distraction osteogenesis has become a standard therapy for lengthening of the human craniofacial skeleton. Because the technique is used predominately in a paediatric population, limiting the treatment protocol is beneficial. METHODS: Twenty-four animals were divided into four groups with distraction rates of 1mm and 2mm/day with and without hyperbaric oxygen (HBO) therapy. Following a 5-day latency period, mandibular lengthening of 15mm was performed with a uniaxial distractor along the body of the mandible. Consolidation period was 4 weeks in all groups. HBO therapy was administered to one of the 1 and 2mm/day groups 1 day preoperatively, throughout the latency and distraction phases and 2 weeks into the consolidation period. Animals were euthanised after consolidation and the mandibles harvested for bone mineral densitometry evaluation. RESULTS: The mean bone mineral density (BMD) (g/cm(2)) was 0.208+/-0.04 in Group 1 (1mm/day distraction, no HBO therapy), 0.228+/-0.09 in Group 2 (1mm/day distraction, + HBO therapy), 0.180+/-0.1 in Group 3 (2mm/day distraction, no HBO therapy), and 0.269+/-0.05 in Group 4 (2mm/day distraction, + HBO therapy). Using the Student's t-test for equality of means and the one-way analysis of variance (ANOVA), we found that the mean BMD was significantly higher in the groups that were administered HBO (Groups 2 and 4) than not (P=< 0.05). For the groups that had distraction of 1mm/day and 2mm/day, those that underwent HBO therapy had significantly higher BMD than those without HBO therapy (P=< 0.05). CONCLUSION: We have found that HBO therapy may serve to augment the healing process in distraction osteogenesis, allowing for more rapid distraction in order to decrease the overall treatment time.

Evaluation of porcine dermal collagen (Permacol) used in abdominal wall reconstruction.

Various methods have been employed to reconstruct complex abdominal wall defects. Structural prosthetic materials such as polypropylene mesh and ePTFE (expanded polytetrafluoroethylene) have been widely used to close these large fascial defects, however, complications with infection and adhesions have led to the recent use of more biocompatible implants. Permacol (acellular porcine dermis) is used as a dermal scaffold, which eventually becomes vascularised and remodelled to reconstruct the abdominal wall in these complex patients. A retrospective review was performed of all patients who underwent consecutive abdominal wall reconstruction with Permacol at our institution in the year 2006. Twenty-eight patients were identified and included in our study. Factors evaluated were: body mass index, relevant co-morbidities, aetiology of hernia, hernia defect size based on CT scan and intraoperative measurement, size of Permacol implant, length of hospital stay, and postoperative complications. Surgical technique was standardised among six surgeons and involved a single layer of acellular porcine dermis as a subfascial 'underlay' graft under moderate tension upon maximal hernia reduction. Tissue expanders were not required for skin closure. Out of 28 patients, 12 were male and 16 were female. Mean intraoperative hernia size was 150 cm(2) (range of 10 cm(2) to 600 cm(2)). Mean age was 55 years with an average body mass index (BMI) of 34 (largest BMI of 61.4). Defects were attributed to either a previous laparotomy incision or open abdomen. Mean hospital stay was 9.67 days. At a mean follow-up of sixteen months, there were three recurrent hernias (10.7%) based on physical examination and postoperative CT scan evaluation. One patient developed a superficial wound dehiscence which was successfully treated with local wound care and one patient developed a cellulitis which was successfully treated with antibiotic therapy. Four patients (14.3%) developed a chronic, non-infected fluid collection lasting >one month all of which resolved. No patient required removal of the implant due to infection. Permacol can be successfully used in the reconstruction of both small and large ventral hernias. This biodegradable matrix serves as a safe and useful alternative to both synthetic mesh and AlloDerm.