Rames, Melissa M.

BACKGROUND There is a paucity of literature investigating the use of liposomal bupivacaine (LB) in a dermatologic surgery setting. OBJECTIVE To identify the treatment characteristics and adverse events, including Local Anesthetic System Toxicity (LAST), in patients receiving perioperative LB. MATERIALS AND METHODS A retrospective chart review was performed at a single institution using an institutional database and key words “Exparel” or “liposomal bupivacaine.” Patients ≥18 years old who received perioperative LB to the surgical site and surrounding skin were included. RESULTS A total of 140 LB administrations and 129 patients were included. Liposomal bupivacaine was used most often in the setting of excisions ( n = 88, 62.9%) and Mohs micrographic surgery ( n = 49, 35%), with hidradenitis suppurativa ( n = 77, 55%) and cutaneous neoplasms ( n = 56, 40%) the most frequent diagnoses. The median postoperative area and length were 23.6 cm 2 and 15.4 cm, respectively. The median LB dosage was 20 mL (range 1.5–20). There were no adverse events in 134 out of 136 patients of LB administration (98.5%). There were 2 reports (1.5%) of nausea on POD1 while these patients were taking opioids. CONCLUSION Liposomal bupivacaine should be considered for postoperative analgesia in patients undergoing dermatologic surgery because it is well tolerated and efficacious. The authors observed no cases of LAST.

Background: Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. Methods: We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. Results: A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36–13.6], P = 0.01), larger size (1.07 [1.03–1.13], P < 0.001), and negative orbital vector (12.11 [2.65–65.42], P = 0.002) were independent risk factors for ectropion development. Conclusions: Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

BACKGROUND While increasing evidence supports the safety and effectiveness of immunohistochemistry-assisted Mohs micrographic surgery (MMS) for superficially invasive melanoma, there is a paucity of the literature investigating its effect on final defect size. OBJECTIVE To evaluate the tissue sparing effect of MMS for melanoma. MATERIALS AND METHODS Three hundred and twenty-eight patients with early-stage (T1a/T1b) cutaneous melanomas treated with MMS from January 2008 to December 2018 were evaluated. Measured defect sizes after Mohs tumor extirpation were compared with anticipated defect size that would result from standard-margin wide local excision (WLE). Average actual versus anticipated defect areas were compared using a paired t-test (95% confidence intervals). RESULTS The following groups demonstrated a significantly smaller defect area for MMS-treated tumors when compared with anticipated standard-margin WLE defect: All tumors combined (13.8 cm2 vs 10.4 cm2, p < .001), tumors requiring 1 stage (13.6 cm2 vs 10.1 cm2, p < .001), and tumors requiring 2 stages (13.2 cm2 vs 10.5 cm2, p = .004). The majority of patients (83.5%, n = 274) achieved clear margins with 1 stage. CONCLUSION Immunohistochemistry-assisted MMS for early-stage invasive melanoma is associated with smaller final defect size and overall tissue sparing effect compared with standard WLE margins.