Head Skin Research Articles

Antithrombotic treatment and risk of complications after head and neck full thickness skin graft surgery

Head and neck skin cancer surgery using a full thickness skin graft is a common procedure. Evidence concerning the effects of perioperative antithrombotic treatment on complications is limited. The aim of this study was to evaluate whether perioperative antithrombotic treatment is associated with risk of necrosis, bleeding or infection after full thickness skin graft surgery. Retrospective single-center cohort study with medical records review. Patients operated with a head and neck full thickness skin graft in 2010 and 2013–2015 had available data and were included. Any antithrombotic treatment was continued and all patients were routinely followed-up on days 7–10 after surgery. Data on demographics, concurrent disease, clinical characteristics, antithrombotic medications and postoperative necrosis, bleeding and infection were collected from electronic medical records. Associations with complications were examined using multivariate logistic regression adjusted for age, sex, reoperation, size of excision, site of surgery and concurrent disease. In total, 302 patients (53% women) were included. Antithrombotic treatment (n = 125 patients) was not associated with higher adjusted risk of total complications in multivariate analysis (OR 0.70; 95% CI: 0.34–1.46). In subgroup analyses, the total risk was not increased in patients on aspirin (OR 0.76; 95% CI: 0.39–1.48) or warfarin (OR 1.20; 95% CI: 0.47–3.10). In the warfarin subgroup (N = 26), there was a statistically non-significant trend towards increased risk of graft necrosis. This study supports that aspirin and warfarin should not be discontinued prior to head and neck full thickness skin graft surgery.

Selenium deficiency impaired structural integrity of the head kidney, spleen and skin in young grass carp (Ctenopharyngodon idella)

This study focused on the effects of dietary selenium deficiency on structural integrity of the head kidney, spleen and skin in young grass carp (Ctenopharyngodon idella). A total of 540 healthy grass carp (mean weight 226.48 ± 0.68 g) were randomly divided into six groups and fed six separate diets with graded dietary levels of selenium (0.025–1.049 mg/kg diet) for 80 days. Results showed that selenium deficiency (1) caused oxidative damage in part by reducing the activities of antioxidant enzymes (such as SOD, CAT, GPx, GST and GR) and glutathione (GSH) content, down-regulating the transcript abundances of antioxidant enzymes (except GSTp1) partly related to Kelch-like-ECH-associated protein 1a (Keap1a)/NF-E2-related factor 2 (Nrf2) signalling; (2) aggravated apoptosis in part by up-regulating the mRNA levels of caspase-2, -3, -7, -8 and -9, which were partially related to p38MAPK/FasL/caspase-8 signalling and JNK/(BAX, Bcl-2, Mcl-1b, IAP)/(Apaf1, caspase-9) signalling; (3) damaged the tight junctions in part by down-regulating the mRNA levels of ZO-1 (except spleen), ZO-2 (except spleen), claudin-c, -f, -7, -11 and claudin-15, and up-regulating the mRNA levels of claudin-12, which were partially related to myosin light chain kinase (MLCK) signalling. Interesting, selenium deficiency failed to affect the expression of GSTp1, Keap1a, occludin, claudin-b, claudin-3c, ZO-1 (spleen only) and ZO-2 (spleen only) in the head kidney, spleen and skin of grass carp. Finally, based on the activities of glutathione peroxidase (GPx) and reactive oxygen species (ROS) content in the head kidney, spleen and skin, the dietary selenium requirements for young grass carp were estimated to be 0.558–0.588 mg/kg diet.

Effect of Stress Ball Use or Hand-holding on Anxiety During Skin Cancer Excision

Patients undergoing skin surgery under local anesthesia can experience anxiety. Adjuvant intraoperative anxiety reduction methods may help. To assess whether hand-holding or holding a stress ball reduces patient anxiety during excisional surgery of head or neck skin cancer with the patient under local anesthesia and to measure pain and patient satisfaction. In this nonblinded, single-center randomized clinical trial, performed from January 24 through April 26, 2017, at a dermatology outpatient service in an urban, academic medical center, a consecutive sample of 135 adults who required excisional removal of nonmelanoma skin cancer of the head or neck was randomized and studied. Participants were randomized 1:1:1 to 3 groups: hand-holding, stress ball, or control (treatment as usual). Participants in the hand-holding group had a female researcher hold one of their hands during administration of anesthesia and extirpation, and those in the stress ball group held a round compressible ball and squeezed it as desired during the same period. The primary outcome was anxiety, measured by a visual analog scale (VAS), 6-item State Trait Anxiety Inventory (STAI), and physiologic measures (blood pressure and heart rate). Secondary outcomes were pain during the procedure and overall participant satisfaction. In addition, participants were asked how many hours they spent researching the procedure before surgery. A total of 135 participants, 45 per study arm, were enrolled (mean [SD] age, 65.5 [13.9] years; 84 [62.2%] male; 134 [99.3%] white). There were no withdrawals or dropouts. Anxiety decreased over time in all groups, but no significant differences were found in the 3 anxiety measures across the 3 groups (VAS anxiety score before: control group, 3.11; hand-holding group, 3.04; stress ball group, 3.09 [P > .99]; VAS anxiety score during: control group, 1.89; hand-holding group, 2.31; stress ball group, 2.47 [P = .55]; STAI score: control group, 8.91; hand-holding group, 8.93; stress ball group, 8.76 [P = .96]). The 3 groups also did not significantly differ in postprocedure pain scores (control group, 0.78; hand-holding group, 0.64; stress ball group, 0.67; P = .85). Almost all participants (134 [99.2%]) were very satisfied. Participants who had done research had higher preoperative VAS anxiety scores (researched, 3.84; did not research, 2.62; P = .04). Hand-holding and squeezing a stress ball do not appear to provide incremental anxiety reduction in patients during excisional skin cancer surgery. It is possible that some subgroups may respond better or that patients may respond better when able to select and tailor their preferred anxiety reduction method. ClinicalTrials.gov identifier: NCT02816996.

Clinical Feasibility of a Wearable Mixed-Reality Device in Neurosurgery

Neuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a proof of concept by testing the clinical feasibility and accuracy of a wearable mixed-reality device (Hololens) for preoperative neurosurgical planning. In patients with an indication for brain tumor surgery, preoperative planning of tumor localization with the Hololens was compared with standard neuronavigation in the operating room. Magnetic resonance imaging-based 3-dimensional holograms of the patient's head and tumor were created and projected on the physical patient's head using the Hololens. The 2-dimensional projection of the tumor borders as perceived by the neurosurgeon on the skin of the patient's head was outlined both with the Hololens and neuronavigation. Accuracy of the Hololens localization was assessed using neuronavigation as the gold standard. Twenty-five patients were included in this study. Holograms were successfully created in all cases. In 9 patients tumor localization with the Hololens did not differ from the standard neuronavigation system and the overall median difference was 0.4 cm (interquartile range 0-0.8). This prospective clinical study offers a proof of concept of the clinical feasibility of the Hololens for brain tumor surgery planning in the operating room, with quantitative outcome measures. Further development is needed to improve the accuracy of this wearable mixed-reality device.

Optimal α-lipoic acid strengthen immunity of young grass carp (Ctenopharyngodon idella) by enhancing immune function of head kidney, spleen and skin

This study was for the first time to investigate the effects of α-lipoic acid (LA) on growth and immune function of head kidney, spleen and skin in young grass carp (Ctenopharyngodon idella). A total of 540 healthy grass carp (with initial body weight at 216.59 ± 0.33 g) were randomly divided into six groups and fed six separate diets with graded dietary levels of LA for 70 days. Un-supplemented group did not find LA and its concentrations in the other five diets were 203.25, 403.82, 591.42, 781.25 and 953.18 mg kg−1, respectively. After the growth trial, fish were challenged with A. hydrophila for 14 days. The results showed that, compared with the un-supplemented group, optimal LA improved lysozyme (LZ) and acid phosphatase (ACP) activities, enhanced complement 3 (C3), C4 and immunoglobulin (Ig) M contents and up-regulated hepcidin, liver expressed antimicrobial peptide (LEAP)-2A, LEAP-2B and β-defensin-1 mRNA levels in the head kidney, spleen and skin of young grass carp; meanwhile, optimal LA up-regulated anti-inflammatory cytokines transforming growth factor (TGF)-β1, TGF-β2, interleukin (IL)-4/13A (not IL-4/13B), IL-10 and IL-11 mRNA levels partly related to target of rapamycin (TOR) signaling and down-regulated pro-inflammatory cytokines tumor necrosis factor (TNF)-α, interferon (IFN)-γ2, IL-1β, IL-6, IL-8, IL-12p40 (not IL-12p35), IL-15 (not in the skin) and IL-17D mRNA levels partially associated with nuclear factor-kappa B (NF-κB) signaling in the head kidney, spleen and skin of young grass carp. Above results indicated that optimal LA enhanced the immune function of head kidney, spleen and skin in fish. Interestingly, excessive LA decreased the growth and impaired the immune function of head kidney, spleen and skin in fish. Finally, on the basis of the percent weight gain (PWG), the ability against skin hemorrhage and lesion, the IgM content in the head kidney and the LZ activity in the spleen, the optimal dietary LA levels were estimated to be 315.37, 382.33, 353.19 and 318.26 mg kg−1 diet, respectively.

Clinicopathological investigations during an outbreak of camelpox in a dromedary camel herd in India

Camelpox is an important infectious viral skin disease of camelids. However, clinicopathological aspect of the disease has not been studied in detail so far. This study was carried out to investigate the clinicopathological changes associated with camelpox outbreak in a dromedary camel herd in India. The clinical signs, pathological lesions and haematological and blood biochemical parameters were studied in infected camels. For diagnosis, the scab samples were subjected to PCR for amplification of haemagglutinin (HA) gene of camelpox virus (CMLV). The camelpox infection was reported in total 55 (17.02%) camels of the herd. The age of infected camels varied from 1 to 13 years with significantly more incidence in camels of age group 1–3 years (61.81%) than camels of age group more than 3 years (38.18%). The infected camels showed clinical signs of fever, anorexia, lacrimation and characteristic pock lesions on the skin of lips, mouth, nostrils, head, neck, thighs, legs, abdomen and inguinal region. The haematological and serum biochemical parameters revealed anaemia and hypoproteinemia in infected camels. The histopathology of the scabs revealed hyperplasia of epidermis, hydropic degeneration of the keratinocytes and intracytoplasmic eosinophilic inclusion bodies. The PCR revealed amplification of HA gene of CMLV in all the scab samples collected from infected camels. The clinicopathological studies in camelpox infection will give further insight into the pathogenesis of the disease and can help clinicians in the effective management of the disease.

Peripheral histological clearance of cutaneous BCC and SCC excised using the wet blotting technique

IntroductionAccurate identification of the peripheral margin of cutaneous basal cell and squamous cell carcinomas plays a crucial role in ensuring complete excision of the skin cancer. The recommended margin of excision for cutaneous malignancies varies in the current guidelines. The aim of this study was to assess the success rate of peripheral margin clearance with a 4 mm peripheral margin of excision when the clinical margin of the lesion has been identified using the wet blotting technique. MethodsThe peripheral margin of each skin cancer was marked using the wet blotting technique and a 4-mm margin of excision rule was applied to all skin cancers regardless of their type and other clinical features. Data collection was performed from patients who were operated on over a period of 34 months (2011 to 2014). Information gathered included patient demographics, clinical details of the lesion and histopathological data. ResultsThe total number of patients identified were 456. The case notes were reviewed and eventually 276 patients were included and 180 patients were excluded. The histology report showed 95–97% clearance of the peripheral margin in all BCCs and SCCs regardless of their clinical features and their location. ConclusionsOur study has shown that a standard rule of maintaining a 4 mm margin around all head and neck skin BCCs and SCCs, measured after the visible margin of the lesion had been accurately identified by the wet-blotting technique, can successfully achieve 95–97% peripheral clearance of all lesions, irrespective of the subtype, size and location.

Low or excess levels of dietary cholesterol impaired immunity and aggravated inflammation response in young grass carp (Ctenopharyngodon idella)

The present study explored the effect of cholesterol on the immunity and inflammation response in the immune organs (head kidney, spleen and skin) of young grass carp (Ctenopharyngodon idella) fed graded levels of dietary cholesterol (0.041–1.526%) for 60 days and then infected with Aeromonas hydrophila for 14 days. The results showed that low levels of cholesterol (1) depressed the innate immune components [lysozyme (LZ), acid phosphatase (ACP), complements and antimicrobial peptides] and adaptive immune component [immunoglobulin M (IgM)], (2) up-regulated the mRNA levels of pro-inflammatory cytokines [interleukin 1β (IL-1β), IL-6, IL-8, IL-12p35, IL-12p40, IL-15, IL-17D, tumor necrosis factor α (TNF-α) and interferon γ2 (IFN-γ2)], partly due to the activated nuclear factor kappa B (NF-κB) signalling, and (3) down-regulated the mRNA levels of anti-inflammatory cytokines [IL-4/13B, IL-10, IL-11, transforming growth factor (TGF)-β1 and TGF-β2], partly due to the suppression of target of rapamycin (TOR) signalling in the immune organs of young grass carp. Interestingly, dietary cholesterol had no influences on the IκB kinase α (IKKα) and IL-4/13A mRNA levels in the head kidney, spleen and skin, the IL-1β and IL-12p40 mRNA levels in the spleen and skin, or the β-defensin-1 mRNA level in the skin of young grass carp. Additionally, low levels of cholesterol increased the skin haemorrhage and lesion morbidity. In summary, low levels of cholesterol impaired immunity by depressing the innate and adaptive immune components, and low levels of cholesterol aggravated the inflammation response via up-regulating the expression of pro-inflammatory cytokines as well as down-regulating the expression of anti-inflammatory cytokines partly through the modulation of NF-κB and TOR signalling in the immune organs of fish. Similar to the low level of cholesterol, the excess level of dietary cholesterol impaired immunity and aggravated inflammation response in the immune organs of fish. Finally, based on the percent weight gain (PWG), the ability against skin haemorrhage and lesions as well as the LZ activity in the head kidney and the ACP activity in the spleen, the optimal dietary cholesterol levels for young grass carp were estimated as 0.721, 0.826, 0.802 and 0.772% diet, respectively.

Functional Connectivity Magnetic Resonance Imaging Reveals Rapid and Reversible Changes in the Brain Following Induction of Psoriasiform Dermatitis in Mice

Functional connectivity magnetic resonance imaging (fcMRI), a specific form of MRI imaging, quantitatively assesses connectivity between brain regions that share functional properties. Functional connectivity magnetic resonance imaging has already provided unique insights into changes in the brain in patients with conditions such as depression and pain and symptoms that have been reported by patients with psoriasis and are known to impact quality of life. To identify the central neurological impact of psoriasiform inflammation of the skin, we applied fcMRI analysis to mice that had been topically treated with the Toll-like receptor agonist, imiquimod (IMQ) to induce psoriasiform dermatitis. Brain insula regions, due to their suggested role in stress, were chosen as seed regions for fcMRI analysis. Mouse ear and head skin developed psoriasiform epidermal thickening (up to 4-fold, P < .05) and dermal inflammation after 4 days of topical treatment with IMQ. After fcMRI analysis, IMQ-treated mice showed significantly increased insula fc with wide areas throughout the brain, including, but not limited to, the somatosensory cortex, anterior cingulate cortex, and caudate putamen ( P < .005). This reflects a potential central neurological impact of IMQ-induced psoriasis-like skin inflammation. These data indicate that fcMRI may be valuable tool to quantitatively assess the neurological impact of skin inflammation in patients with psoriasis.

Selenium deficiency impaired immune function of the immune organs in young grass carp (Ctenopharyngodon idella)

This study aimed to investigate the effects of dietary selenium on resistance to skin haemorrhages and lesions and on immune function as well as the underlying mechanisms of those effects in the head kidney, spleen and skin of young grass carp (Ctenopharyngodon idella). A total of 540 healthy grass carp with initial body weight (226.48 ± 0.68 g) were randomly divided into six groups and fed six separate diets with graded dietary levels of selenium (0.025, 0.216, 0.387, 0.579, 0.795 and 1.049 mg/kg diet) for 80 days. After the feeding period, an immunization trial was performed by infection with Aeromonas hydrophila for 14 days. The results showed that, compared with the optimal selenium level, (1) selenium deficiency impaired the production of antibacterial compounds and immunoglobulins and down-regulated the transcript abundances of antimicrobial peptides and selenoproteins; (2) selenium deficiency aggravated inflammatory responses in part by up-regulating pro-inflammatory cytokines and down-regulating anti-inflammatory cytokines mRNA levels, which were partially related to [IKKα, β, γ/IκBα/NF-κB] signalling and [TOR/(S6K1, 4E-BP1)] signalling, respectively. Interestingly, selenium deficiency had no effect on the expression of TGF-β2, IL-4/13B, IL-10, IL-12p35, IL-15 (skin only) or 4E-BP2 in the head kidney, spleen and skin of young grass carp. Finally, based on the percent weight gain (PWG), the morbidity of skin haemorrhages and lesions, the ACP activity in the head kidney and the lysozyme activity in spleen, the optimal dietary selenium requirements for young grass carp were estimated to be 0.546–0.604 mg/kg diet. In summary, selenium deficiency decreased the growth performance and impaired the immune function in the head kidney, spleen and skin of young grass carp.

Orbital invasion routes of non-melanoma skin cancers and survival outcomes

ABSTRACTPurpose/Objectives: Overall non-melanoma head and neck skin cancer has a good prognosis; however, rarely patients have an aggressive variant which results in orbital invasion via perineural spread or direct extension. Despite these consequences, there are limited published studies defining this clinical entity. The main objectives of the current study are to describe orbital invasion patterns of non-melanoma head and neck skin cancers and their impact on survival.Methods: Retrospective case series from a tertiary-care, academic institution performed between 2004 and 2014. Demographic and tumour characteristics are reported as well as patterns of orbital invasion, types of treatments received, and survival outcomes.Results: There were 17 consecutive patients with non-melanoma skin cancer and orbital invasion who met inclusion criteria. Average age at orbital invasion diagnosis was 70.8 years old. 76% were male. Mean follow-up time was 28.5 months. Of these patients, 71% had squamous cell carcinoma and 29% had basal cell carcinoma. Brow (41%) was the most common primary sub-site followed by cheek (23%) and temple (12%). 76% of patients had a history of prior treatment. The lateral orbital wall (41%) was the most common site of invasion, followed by the medial orbital wall (29%) and antero-superior invasion (23%). Age, histology, and location of orbital invasion were associated with disease-specific and overall survival.Conclusion: Orbital invasion for non-melanoma head and neck skin cancers creates a treatment dilemma and the patterns of invasion are described. In addition, the location of orbital invasion is associated with survival outcomes.

PHOTODYNAMIC THERAPY FOR HEAD AND NECK BASAL CELL SKIN CANCER WITH ADDITIONAL INTERSTITIAL LASER IRRADIATION

The article is devoted to the development and evaluation of the effi ciency of photodynamic therapy (PDT) with photosensitizer photolon with additional interstitial laser irradiation in patients with head and neck basal cell skin cancer (BCSC). Treatment was performed in 55 patients. On the fi rst stage, all patients underwent photodynamic therapy with interstitial irradiation using fl exible optical fi bers with cylindrical diffuser, on the second stage PDT with distant delivery of laser at a dose of 50-300 J/cm2 was carried out. During the follow- up period of 6 months to 4 years in 13 (23.6%) of the 55 patients a recurrence of the disease was diagnosed. A higher rate of recurrence was in the group of patients who underwent PDT for recurrent neoplasms compared with patients with primary disease (37.5% and 4.3%, respectively), in patients with endophytic growth of the tumor compared to patients with exophytic component (30.0% and 16.0%, respectively) and in patients with large tumors (up to 2.0 cm – 14.3%, from 2.0 to 5.0 cm – 16.7% and more than 5.0 cm – 54.4%).

Radiotherapy regimens in patients with nonmelanoma head and neck skin cancers.

To assess the effectiveness and outcomes of adjuvant radiotherapy regimens for nonmelanoma skin cancers (NMSC) of the head and neck, particularly for elderly patients. A retrospective review of patients with head and neck NMSC was conducted. Radiotherapy dose per fraction regimens included ≤200, 240-250, 300-400, and 500-600 cGy. Demographics, tumor characteristics, local control (LC), regional control (RC), and survival outcomes were analyzed. Of the 90 patients with 140 disease sites, 76.6% were squamous cell carcinoma, 15.5% were basal cell carcinoma, and 7.7% were other histologies. The mean age at diagnosis was 72.1 years old. The most common location was preauricular (20.0%), followed by temple, scalp, cheek, and forehead. The overall LC and RC rates were 88.8% and 88.8%, respectively by patients, and 92.8% and 86.4%, respectively by treatment sites. Age, primary tumor location, T classification, N classification, overall stage, perineural invasion, comorbid disease, skull base invasion, and radiotherapy subgroup were significantly associated with disease-free and overall survival (P < 0.05). LC and RC were not significantly different among the radiotherapy dose subgroups. The mean survival was longer in patients treated with 240-250 cGy/fraction (50.3 months). There was no significant difference in radiotherapy toxicity between the subgroups. Short-term radiotherapy regimens for patients with locally or regionally advanced head and neck NMSC appear feasible and effective, particularly in elderly patients or those that cannot tolerate the length of standard regimens.

A Novel, Disease-Specific Self-Report Instrument to Measure Body Image Concerns in Patients With Head and Neck Skin Cancer.

Skin cancer commonly occurs on areas that are salient to body image perception (i.e., head and neck). Patients with head and neck skin cancer (HNSC) may experience negative body image perceptions related to their disease, which is concerning, given the numerous negative sequelae of poor body image. However, there are no existing disease-specific measures of body image concerns in HNSC. To develop and examine the psychometric properties of a brief self-report, disease-specific measure of body image concerns in patients with HNSC-the Body Image Questionnaire (BIQ). Patients with HNSC completed the BIQ before (n = 239) and 6 months after (n = 80) treatment with Mohs micrographic surgery. Analyses examined the internal consistency, convergent validity, and factor structure of the BIQ. Internal consistency reliability was acceptable, and the measure demonstrated convergent validity with well-being. Four dimensions underlie the BIQ: appearance satisfaction, appearance avoidance, head/neck/skin-specific dissatisfaction, and perceived change. The BIQ is a valid and internally reliable disease-specific instrument that measures body image concerns in patients with HNSC.

Skin Metastasis of Upper Trunk, Neck and Head Skin One Year after Distal Gastrectomy for Early Gastric Cancer

Skin Metastasis of Upper Trunk, Neck and Head Skin One Year after Distal Gastrectomy for Early Gastric Cancer

Retki maligni tumori kože glave i vrata

Introduction: Malignant skin tumors in the majority of cases arise from the squamous epithelium, although they may occur in other accompanying skin structures, such as skin adnexa (hair follicle, sweat and sebaceous glands), as well as soft tissues participating in the building of skin structure, such as muscles, fibrous, fatty tissue and cartilagå. Those tumors may also have a neuroendocrine origin or may arise from a premalignant lesion (solar keratosis and lentigo maligna). Regardless of their origin, they usually present as a nodule or longstanding, non-healing ulceration. Their early recognition enhances the treatment results and decreases the possibility of complications (invasion of deeper tissue structures and occurrence of regional and distant metastases). Material and methods: Our retrospective study included 100 patients of both sexes surgically treated for skin malignancy in the Department for Otorhinolaryngology and Maxillofacial surgery of the Clinical Hospital Centre "Zemun" , Belgrade, Serbia. The goal of this paper is to highlight the frequency of rare malignant tumors compared to the more frequent ones and consider the most appropriate clinical-diagnostic approach as well as the treatment modality for the patient. Conclusion: Our study has shown that the most frequent tumor of the head and neck skin is basal cell carcinoma.

THE MODERN APPROACH TO CHOOSING OF METHODS OF EXAMINATION OF PATIENTS WITH HEAD AND NECK SKIN SCARS

THE MODERN APPROACH TO CHOOSING OF METHODS OF EXAMINATION OF PATIENTS WITH HEAD AND NECK SKIN SCARS

Kalp Nakilli Bir Hastada Baş-Boyun Cilt Kanseri Tedavisinde Setuksimab Kullanımı

Kalp Nakilli Bir Hastada Baş-Boyun Cilt Kanseri Tedavisinde Setuksimab Kullanımı

Noninvasive Determination of Blood Glucose Concentration by Comparing the Eardrum and Head Skin Temperatures

A noninvasive method for determination of blood glucose concentration from the eardrum and head skin temperatures was suggested and tested. The method takes into account the effects of food intake and ambient temperature on blood glucose concentration. The method successfully underwent tests in healthy subjects and patients with diabetes mellitus.

Healing by secondary intention for head and neck skin lesions – patient survey and case series

Introduction: Facial skin surgery, for both benign and malignant lesions, can pose awkward areas to reconstruct. Distortion of tissues and scarring can be caused when a flap is used and may require further surgical intervention, should histological margins be positive. Allowing the skin to heal by secondary intention avoids additional surgery and gives a good cosmetic result. It also allows us to ascertain histologically clear margins before embarking on reconstruction. Healing is a complex and fragile process, affected by co- morbidities such as diabetes, venous or arterial disease, infection and immunosuppression. It is important that patients are available to attend frequent dressings and wound check appointments with our team of specialist wound care nurses.