A novel technique using a rotation flap for repairing adjacent surgical defects.

BACKGROUND: The incidence of head and neck carcinomas continues to rise. Surgical excision is a frequently used method for removing these carcinomas. It is not uncommon to have multiple skin carcinomas present at the same time or in close proximity to each other. Therefore, surgeons can be presented with the challenge of repairing adjacent surgical defects while avoiding unacceptable wound closure tension and distortion of neighboring structures. OBJECTIVE: The presentation of a novel method for repairing adjacent surgical defects with a rotation flap. MATERIALS: Standard excision tray. CONCLUSION: We present a novel method for repairing adjacent surgical defects with a rotation flap. Surgeons are presented with adjacent surgical defects and challenged to find the repair option that will give the most optimal cosmetic result. The options for closing small adjacent surgical defects include making the defects a single large defect for primary closure, full-thickness skin grafting, primary closure of each defect separately, flap coverage, secondary intention healing, or any combination of these. The use of a single rotation flap to cover two adjacent surgical defects provides the surgeon with a convenient and cosmetically acceptable option that avoids unacceptable wound tension and does not distort neighboring structures.

Versatile sterile field for nail surgery using a sterile glove.

Nail surgery is frequently done by dermatologists. Post-operative complications of nail surgery include infection, bleeding, pain, pyogenic granuloma, and nail dystrophy. Infectious complications after nail surgery can be prevented with proper aseptic techniques. Standard fenestrated surgical drapes used for a sterile field during nail surgery are cumbersome and difficult to keep in place during surgery. We present a versatile sterile field for nail surgery using a sterile glove that will facilitate nail surgery and concomitantly decrease the risk of infection.

A diagnosis of chronic lymphocytic leukemia prompted by cutaneous lymphocytic infiltrates present in mohs micrographic surgery frozen sections.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the United States. Patients with CLL are at an increased risk for the development of second malignant neoplasms, the most common of which is cuta-neous squamous cell carcinoma (SCC). Cutaneous infiltrates of CLL have been reported in association with primary cutaneous neoplasms, including SCC, basal cell carcinoma, and actinic keratosis. The finding of a dense lymphocytic infiltrate surrounding a cutaneous neoplasm should prompt consideration of possible underlying CLL. OBJECTIVE: To review the relationship of CLL to cutaneous SCC and to raise awareness of the possible coexistence of these two neoplasms. METHODS: The case report describes a patient with a SCC of the left cheek treated with Mohs micrographic surgery. A dense lymphocytic infiltrate was noted on the frozen sections, and a complete blood count was obtained. RESULTS: A lymphocytosis was detected, leading to the diagnosis of CLL, stage 0. CONCLUSION: Patients with CLL are at an increased risk for the development of cutaneous neoplasms. An infiltrate of leukemic cells in documented CLL patients can be associated with cutaneous neoplasms such as SCC. We present a patient with no known hematologic malignancy who demonstrated a dense lymphocytic infiltrate on Mohs sections. The diagnosis of CLL was considered based on the appearance of this infiltrate. Subsequently, a new case of CLL was confirmed with appropriate testing. The finding of a dense subcutaneous infiltrate of lymphocytes on Mohs frozen sections should raise the possibility of CLL and lead to appropriate screening tests.