The utility of the lateral orbital orbicularis propeller flap in periocular reconstruction.

AIMS: The lateral orbital orbicularis propeller flap (LOOP) is a propeller flap raised on a non-axial orbicularis oculi pedicle. Once mastered, it is speedy to raise, extremely reliable, and capable of transposing thin, supple, and relatively hairless skin and subcutis from the temple region to the periocular region. We aim to present our experience in using the LOOP flap for the reconstruction of a range of periocular defects. METHOD: Retrospective review utilising our Mohs database, electronic records, and image library. RESULTS: A total of 44 reconstructions were performed. Of the 39 lower lid defects, 22 were full-thickness (bilamellar). Posterior lamella reconstructions in these 22 cases were free tarsoconjunctival graft (20), conchal cartilage with perichondrium (1), and Hewes flap (1). A total of 13 reconstructions of the 22 were total or near-total lid reconstructions. A further 17 patients had anterior lamella defects alone, of which 3 amounted to resurfacing the entire lid. However, 5 patients underwent upper lid reconstruction, 2 of which were 50% lid, 2 required a free tarsal graft, and 1 conchal cartilage graft with buccal mucosa. There were no instances of necrosis of either the flap or the posterior lamella grafts. There were 7 minor complications. CONCLUSION: In our unit, the LOOP flap has become the reconstruction of choice for laterally based, transversely extensive defects of upper lid, lower lid, and malar areas. Its reliability, relative simplicity, and excellent cosmetic and functional outcomes merit much wider utilisation amongst the plastic and ophthalmic surgery community.

Multiple eruptive clear cell acanthomas successfully treated with CO2 laser ablation.

Clear cell acanthoma (CCA) is a rare, benign epidermal lesion of clear glycogen-containing keratinocytes. The exact etiology is unknown. Although CCA usually appear as solitary lesions, cases of multiple CCAs have also been described. The rare eruptive CCA variant describes cases with more than 30 lesions.Current therapeutic evidence for the management of multiple CCAs is limited. CO2 laser remains the most widely used laser in clinical practice. However, literature describing its effectiveness on CCA is sparse, and previous reports have described its use for a maximum of three lesions. To our knowledge, this is the first report of successful CO2 laser treatment of the multiple eruptive CCA variant with an excellent cosmetic outcome.Our case adds to the evidence that CO2 laser is an effective treatment for this condition. Particularly in those patients with refractory or multiple eruptive CCAs, or for those who may not tolerate repeated courses of cryotherapy, or who are concerned about scarring and cosmetic outcome.

Can intralesional cryotherapy reshape the management of difficult keloid scars?

Keloid scars are notoriously difficult to treat with very high recurrence rates despite a range of treatment options. We present a case report of a 43-year-old man with a resistant keloid scar on his left ear from a piercing. After 15 years of multimodal treatments including surgery, steroid and 5-fluorourcil injections, the keloid persisted. It has responded very well to a single treatment of intralesional cryotherapy (trademark: CryoShape, Etgar Group International Ltd). The authors would now consider intralesional cryotherapy as a useful tool in their armamentarium for prominent, resistant or recurrent keloids. Future experience will guide its clinical applications.