Kenneth C. Fletcher, Jr, MD, and colleagues evaluated patients undergoing Mohs surgery and determined several factors that can help anticipate the need for internal lining replacement. Aggressive histologic subtypes of basal cell carcinoma (morpheaform, infiltrative, and micronodular) are at increased risk for internal lining defects. More specifically, defects of intermediate size (1-2 cm2) that are located on the nasal ala and that occur from aggressive subtypes, as well as large defects (>2 cm2), regardless of histologic subtype, frequently result in full-thickness defects. In contrast, defects of the dorsum and nasal sidewall are unlikely to result in a lining defect. The authors provide a concise review of their approach to nasal lining replacement.
Growth factors are known to affect wound healing. Despite extensive research, many questions remain unanswered. Anthony P. Sclafani, MD, and colleagues have added another piece to the puzzle by studying platelet concentrate. Disks of porous high-density polyethylene or acellular dermal graft were implanted into an animal model. Platelet concentrate that is known to release a variety of growth factors was used to treat the implants. Both treated implants showed statistically significant increases in capillary ingrowth and fibroblast ingrowth compared with controls. This model holds promise for situations that require accelerated wound healing.
Norman J. Pastorek, MD, and colleagues present a 15-year experience with the extended columellar strut–tip graft, which combines the attributes of a columellar strut and a tip graft. Surgeons performing endonasal rhinoplasty who require projection and contour of the tip will find this graft extremely helpful. The authors provide a detailed account of how and when to use this graft. A single piece of firm cartilage is required and fashioned to extend from just above the premaxilla to just below the domes. The graft is then placed into a precise pocket, without the need for suture fixation. This article provides a thorough discussion of technical points to maximize the successful use of this graft.
Botulinum toxin type A treatment of facial rhytids is the most commonly used nonsurgical cosmetic procedure. It has been used in a multitude of disorders as diverse as hyperhydrosis, headache, and rhytids in nearly every region of the face. Jeffrey H. Spiegel, MD, reviews relevant periorbital anatomy based on his cadaver dissections to assist the physician in avoiding complications such as ectropion, blepharoptosis, and xerophthalmia. The author’s recommendations for periorbital rhytids include injection below the dermis rather than into the muscle, staying 1.5 cm lateral to the lateral canthus, and the use of 5 to 7.5 U divided into 2 or 3 treatment sites while staying above the Frankfort horizontal plane.
The Magdalene by Bernardino Luini.Article
This issue’s Highlights were written by DeWayne Bradley, MD.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2005;7(3):157. doi:10.1001/archfaci.7.3.157