Skin closures using cyanoacrylate tissue adhesives. Plastic Surgery Educational Foundation DATA Committee. Device and Technique Assessment.

Studies have been done and approval is soon possible from the FDA for an octylcyanoacrylate tissue glue for closure of lacerations of incisions. This is a newer-generation cyanoacrylate that improves on the butylcyanoacrylates currently in use in Canada and other countries but not approved by the FDA. It is a pliable, waterproof, film adhesive that can be applied to a laceration and left in place until it disintegrates in 7 to 14 days. It is safe and effective and represents an improvement over the butylcyanoacrylates that have been used for years in many countries. It is not a replacement for sutures but does offer an alternative. Some indications that seem appropriate are for closure of incisions that would be under casts; for simple lacerations in children to avoid the fear of suturing and suture removal; and for closure of incisions or lacerations where it would be a problem for a follow-up visit. This adhesive is less indicated for closure over highly mobile areas such as joints; for areas with usage and friction such as hands or feet; or for areas where exact alignment is a priority, such as the face or eyelids.

Skin expansion--a sword that "stretches" two ways: scalp expansion and bone erosion.

Tissue expanders, which are used to enlarge the soft tissue of the scalp, eroded the outer table of the skull as well as a portion of the inner table. The patient in this case study is documented with photographs, and the entity of pressure due to skin expanders is discussed. A growing list of complications makes it important to be aware of the possible pitfalls of expanders and to discuss them with patients and/or their families, particularly when tissue expanders are used in children.

The office treatment of tattoos: a simple and effective method.

A simplified method for the treatment of tattoos is described. The method is based on an older method called the "French method" known to tattoo artists. The treatment consists of superficial dermabrasion of the skin followed by application of a tannic acid solution which is then "rubbed" into the skin by the dermabrasion wheel. The treatment site is then "painted" with a silver nitrate stick. A heavy eschar forms which separates in approximately 2 to 3 weeks. The method incorporates the use of equipment that is present in the usual plastic surgical office. The method has produced excellent improvement in tattoos, with obliteration of the tattoo in the majority of cases. This report covers 85 patients with 207 tattoos treated over an 11-year period. The method is presented as a treatment of tattoos that are too large for simple excision. Details of the treatment are presented.

Traumatic lipomas/pseudolipomas.

The occurrence of lipomas following trauma is reported in three cases with a review of the literature including 36 additional cases. This condition is usually related to massive trauma in the hip, buttock, and thigh area that is most frequently secondary to a motor vehicle accident. It is most common in the female and may be attributed to the characteristic hip, buttock, thigh fat deposition of the female. The "tumor" usually follows heavy bruising and/or hematoma of the region and is clinically noticeable approximately 6 months thereafter. Initial treatment is preventive by drainage of the hematoma and compression of the site. Late treatment is surgical excision of the tumor.