High magnification assessment improves complete resection of facial tumors

Complete resection with minimal sacrifice of healthy skin is the goal in treatment of basal cell carcinoma (BCC) of the face. In a randomized trial, preoperative assessment of tumor extension with the Varioscope, a combination of microscope and loupe glasses with strong illumination and a maximal magnification of 7X, was compared with tumor assessment without. Forty consecutive, primary BCC of the solid subtype of the face were randomly assigned to the study groups. Preoperative tumor marking was done by a surgeon not involved in tumor resection, reconstruction, and patient follow-up. All BCC marked with the high magnification were completely excised in the first resection. In the control group, frozen section was used in 12 tumors and permanent section in the remaining 8. The first resection did not yield tumor-free margins as assessed in the frozen section analysis in 3 tumors. In 2 of 8 tumors not supported by frozen section analysis, incomplete excision was detected, and 1 case of false-negative frozen section analysis occurred. In conclusion, the use of high magnification resulted in a trend towards reduction of positive tumor margins in the subgroups that were performed under either intraoperative frozen section or permanent, fixed section histology control, and a significant reduction in tumor-positive margins of all first resections. This was attributed to enhanced preoperative tumor visualization by high (7X) loupe magnification and additional lightin

Laser surface scanning analysis in reconstructive rhytidectomy

The implementation of laser surface scanning to assess facial symmetry after unilateral face-lift procedures used to reconstruct defects after skin tumor resection is presented. Six patients who had undergone defect reconstruction with a flap raised from the subcutaneous plane were included in the study. Immediate postoperative photographic evaluation confirmed facial asymmetry because of unilateral skin tension. After a minimum follow-up period of 1 year, photographic and laser surface scanning analysis showed restored facial symmetry. In conclusion, laser surface scanning is a promising technology for objectifying results obtained and could be implemented for evaluation of the immediate and long-term effects from rhytidectomy procedures. Subcutaneous flaps without duplication or resection of the superficial musculoaponeurotic system are ideal for unilateral procedures because facial symmetry is restored after 1 yea

Is ultracision knife safe and efficient for breast capsulectomy? A preliminary study.

BACKGROUND: Silicone breast implants are used to a wide extent in the field of plastic surgery. However, capsular contracture remains a considerable concern. This study aimed to analyze the effectiveness and applicability of an ultracision knife for capsulectomy breast surgery. METHODS: A prospective, single-center, randomized study was performed in 2009. The inclusion criteria specified female patients 20-80 years of age with capsular contracture (Baker 3-4). Ventral capsulectomy was performed using an ultracision knife on one side and the conventional Metzenbaum-type scissors and surgical knife on the collateral side of the breast. Measurements of the resected capsular ventral fragment, operative time, remaining breast tissue, drainage time, seroma and hematoma formation, visual analog scale pain score, and sensory function of the nipple-areola complex were assessed. In addition, histologic analysis of the resected capsule was performed. RESULTS: Five patients (median age, 59.2 years) were included in this study with a mean follow-up period of 6 months. Three patients had Baker grade 3 capsular contracture, and two patients had Baker grade 4 capsular contracture. The ultracision knife was associated with a significantly lower pain score, shorter operative time, smaller drainage volume, and shorter drainage time and resulted in a larger amount of remaining breast tissue. Histologic analysis of the resected capsule showed no apoptotic cells in the study group or control group. CONCLUSIONS: The results suggest that ventral capsulectomy with Baker grade 3 or 4 contracture using the ultracision knife is feasible, safe, and more efficient than blunt dissection and monopolar cutting diathermy and has a short learning curve. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266