Retronychia: the importance of proper footwear.

Retronychia is commonly underdiagnosed and exhibits classic features of proximal nail fold elevation and nail plate layering. Herein we summarize the literature and discuss cause, diagnosis, and treatment of this condition.

The Effect of Preoperative Chlorhexidine Gluconate Cleanse on Lower Extremity Surgical Site Infections: A Retrospective Cohort Study.

BACKGROUND: Lower extremity surgical sites are at an increased risk of wound infection following Mohs micrographic surgery. OBJECTIVE: To evaluate the rate of lower extremity surgical site infections following a 14-day regimen of preoperative 4% chlorhexidine gluconate (CHG) rinses and postoperative wound occlusion for 14 days. MATERIALS AND METHODS: Retrospective data were collected from procedures performed by the senior author from January 2022 through June 2023. To meet inclusion, patients must have completed waist-down CHG soak and rinse for 14 days before surgery, including the day before surgery. In addition, the patient must have kept the dressing clean, dry, and intact until the postoperative appointment at 14 days. RESULTS: A total of 100 Mohs cases met inclusion criteria. Zero patients developed a surgical site infection. CONCLUSION: Chlorhexidine gluconate preoperative rinsing and postoperative occlusion for 14 days may minimize the risk of wound infection. Although further research is indicated, an opportunity exists for the adoption of CHG into routine clinical practice in the outpatient dermatology setting.

Reconstruction of High-Tension Scalp Defects by the Twizzler Technique: A Retrospective Case Series.

BACKGROUND: Scalp wounds are difficult to close primarily because of the inelasticity of the galea, often requiring adjacent tissue transfer or grafting. It is still debated whether intraoperative tissue expansion can occur on the scalp. OBJECTIVE: We report our experience with the Twizzler technique, a form of intraoperative tissue expansion and load cycling, to achieve primary closure of high-tension scalp wounds. MATERIALS AND METHODS: In this case series, scalp defects repaired by the Twizzler were identified and those with minimum 3 month follow-up underwent assessment by physicians and patients. RESULTS: All 50 scalp defects that could not be otherwise closed primarily were repaired successfully with the Twizzler. The average defect width was 2.0 cm (range 0.9-3.9 cm), the average physician aesthetic rating was 3.71 on a 5-point scale (very good; n = 25), and most patients rated the scars as "near normal skin" on the Patient and Observer Scar Assessment Scale 3.0 ( n = 32). CONCLUSION: Based on the findings of this case series, the Twizzler can be used to repair small and medium high-tension scalp defects after Mohs micrographic surgery. Intraoperative tissue expansion and creep deformation on the scalp is limited, but seemingly possible.

Superior Antihelix Composite Graft for Repair of Nasal Ala and Lateral Nasal Tip Defects: A Retrospective Case Series.

BACKGROUND: Deep defects on the nasal ala and lateral nasal tip may result in nasal valve insufficiency or alar notching and are often repaired with a 2-stage reconstruction. Previous literature has demonstrated high failure rates of composite grafts. OBJECTIVE: Identify survival rates and cosmetic outcomes of nasal composite grafts harvested from the antihelix. METHODS: A retrospective review of 52 patients who underwent ala or lateral nasal tip composite graft repair from April 2019 through May 2022, with statistical analysis of cosmetic outcomes graded by 2 surgeons. RESULTS: Defect size ranged from 0.7 cm × 0.8 cm to 1.9 cm × 2.5 cm. 48 grafts survived (92.3% survival rate). Four patients sustained at least partial integument sloughing (epidermal necrosis), but the cartilage survived in all 52 cases. Overall, aesthetic results yielded the following: excellent (19.5%), very good (35.5%), good (11.5%), decent (16.5%), and poor (6%). In 93% of cases, there was no evidence of nasal collapse or retraction. Two patients (3.8%) required surgical revision. Donor site morbidity was low. CONCLUSION: The antihelical composite skin graft is a 1-step reliable repair option for ala and lateral nasal tip defects with an acceptable cosmetic outcome.

Plume Generated by Different Electrosurgical Techniques: An In Vitro Experiment on Human Skin.

BACKGROUND: Plume generated by electrosurgical techniques is a health hazard to patients and dermatologists. OBJECTIVE: To compare the particle concentration generated by various energy devices used in dermatologic surgery. MATERIALS AND METHODS: Five surgical techniques were tested on human tissue samples in a closed chamber. A particle counter, positioned at a fixed point 20 cm away from the sample, recorded the concentrations of aerosolized particles generated over 7 particle sizes (0.3, 0.5, 0.7, 1, 2.5, 5, and 10 µm). RESULTS: Monopolar electrocoagulation created the greatest concentration of particles followed by electrocautery, electrodesiccation, electrofulguration, and bipolar electrocoagulation. Bipolar electrocoagulation created 80 times fewer 0.3 µm particles and 98 times fewer 0.5 µm particles than monopolar electrocoagulation. Across all electrosurgical techniques, the greatest concentrations of particles generated were of the 0.3 and 0.5 µm particle size. CONCLUSION: Bipolar electrocoagulation created the lowest concentration of particulate matter. Given the noxious and hazardous nature of surgical plume, the bipolar forceps offer surgeons a safer method of performing electrical surgery for both the surgical staff and the patient.

Bullous Dermatoses and Quality of Life: A Summary of Tools to Assess Psychosocial Health.

Autoimmune bullous dermatoses (ABDs), such as pemphigus and bullous pemphigoid (BP), cause cutaneous lesions that are painful and disfiguring. These conditions affect a patient's ability to perform everyday tasks, and individual lesions can take years to heal. Multiple small studies have examined how these conditions affect a patient's lifestyle. We systematically reviewed the trials that have evaluated the mental health of patients with bullous dermatoses. Of the 13 studies assessed, 2 domains of interest were primarily evaluated: quality of life (QOL) and psychological state. Quality of life predominantly was analyzed using the Dermatology Life Quality Index (DLQI). To evaluate psychological state, the General Health Questionnaire (GHQ) primarily was utilized. This review informs providers and summarizes the various ways that ABDs affect mental health.

Risk of Complications With the Total Contact Cast in Diabetic Foot Disorders.

The custom-fabricated total contact cast is commonly used in the treatment of diabetic foot disorders. This resource-consuming treatment option has been associated with iatrogenic morbidity as well as the need for urgent cast removal and inspection of the underlying limb when potential problems arise. Over a 10-year period, 381 diabetic patients had 2265 total contact cast applications by certified orthopaedic technologists, in a university orthopaedic practice, under the supervision of university faculty. Patients were stratified by glycemic control based on hemoglobin A1c levels, and obesity based on body mass index (BMI). Complications were grouped as (1) development of a new ulcer or wound, (2) new or increasing odor or drainage, (3) wound infection, (4) gangrene, (5) newly identified osteomyelitis, and (6) pain or discomfort necessitating cast change or removal. At least 1 complication was observed in 159 of 381 patients. The odds of experiencing a cast-related event for patients with a BMI greater than 30 kg/m2 was 1.55 times greater than patients with a BMI less than 25 kg/m2. As compared to patients with good glycemic control, the odds of experiencing a cast-associated complication was 1.27 times greater in patients with moderate glycemic control and 1.48 times greater in patients with poor glycemic control. The total contact cast is commonly used in the treatment of diabetic foot morbidity. Treatment-associated morbidity may well be greater than previously appreciated. Complications are more likely in patients who have poor glycemic control and are morbidly obese. This information will hopefully stimulate interest in developing commercially available nonrigid alternatives that retain the attributes of the resource-consuming rigid device, with the potential advantage of avoiding the associated morbidity.Levels of Evidence: Level IV, retrospective chart review.

The Potential Uses of N-acetylcysteine in Dermatology: A Review.

Background: In recent studies, N-acetylcysteine has been shown to be efficacious in several dermatologic conditions. Objective: The aim was to review clinical trials that assess the efficacy of N-acetylcysteine in cutaneous disorders. Design: The PubMed database was searched and a manual search of clinical trials in the references was performed. Studies included randomized, controlled studies, uncontrolled studies, meta-analyses, and systemic reviews published between years 1966 and 2017. Results: Efficacy of N-acetylcysteine was shown in excoriation disorder, onychophagia disorder, trichotillomania, acne vulgaris, Type I lamellar ichthyosis, bullous morphea, systemic sclerosis, toxic epidermal necrolysis, atopic dermatitis, xeroderma pigmentosum, and pseudoporphyria. Studies also show benefits in wound healing and photoprotection. Conclusion: The review of available literature suggests that N-acetylcysteine could potentially serve as a safe, tolerable, and effective therapeutic option for a variety of dermatologic conditions.