Rotation Flaps-Principles and Locations

BACKGROUND: The rotation flap is a classic method of tissue rearrangement. It is a simple yet effective tool for recruiting tissue from areas of laxity and redirecting vectors of tension to reconstruct wounds not amenable to primary closure. OBJECTIVE: This article presents the basic design principles and specific applications of the rotation flap in dermatologic surgery. METHODS: A Medline search of articles describing rotation flaps published prior to April 1, 2015 was performed, and several prominent texts in dermatologic surgery were reviewed. RESULTS: Information gathered from the above sources is combined with the clinical experience of the author and editors to present surgeons with a guide for planning and executing various rotation flaps. CONCLUSIONS: Mastering the technique of the rotation flap will allow a surgeon to repair a wide variety of cutaneous defects

Modified purse string closure for excisional biopsy of pigmented lesions on extremities

Proper selection of biopsy technique is imperative, especially when approaching a suspicious pigmented lesion on the extremity. When possible, a complete excisional biopsy with narrow margins is preferred to prevent partial sampling and inadequate evaluation of a lesion. A vertically oriented fusiform excisional biopsy is often selected for biopsy as it preserves lymphatics and prevents circumferential scarring. In this communication, we highlight possible pitfalls of selecting a fusiform ellipse for potential melanomas and provide a patient centered step-by-step guide to the use of narrow excisional biopsy with modified purse string closure. Purse string closure for biopsy of suspected melanoma is both tissue sparing at the time of biopsy and definitive excision. This approach also minimizes the possibility of interfering with lymphatic drainage should a sentinel lymph node biopsy be warranted. Although traditional purse string closures demonstrate similar cosmetic outcomes to secondary intention wounds, they allow for simplified wound care. The use of modifying dermal sutures allows for similar cosmetic outcomes to that of a linear excision

Guidelines for the use of local anesthesia in office-based dermatologic surgery

There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion