Christensen, Kevin

Abstract Classically described repairs for helical rim defects include granulation, linear closure, wedge repair, full-thickness skin grafts, helical rim advancement flaps, and two-stage interpolation flaps. The bilateral bidirectional O to Z rotation flap (O to Z flap) is commonly used for large defects on the scalp. The purpose of this study is to examine the clinical and cosmetic outcomes of O to Z flap repairs to the helical rim. The flap was created by incising above and below the defect along the helical rim on opposite sides of the defect to the depth of the perichondrium. Back cuts were performed to facilitate movement along with extensive undermining. The bilateral flaps were rotated into the defect from either end meeting in the defect middle and sutured into place with a running 5–0 FAG. In total, 50 O to Z flap repairs for helical rim defects following Mohs micrographic surgery were performed. Defect depths ranged from subcutaneous fat to through cartilage. The defect size ranged from 0.9 × 0.7 cm to 2.5 × 1.4 cm. The flap repair size ranged from 1.5 × 1.2 cm to 5.1 × 2.1 cm (average size 5.1 cm2). The median follow-up was 6 weeks (range 2 weeks to 2 years). Complications were as follows: 4% (2 of 50) of cases had bleeding requiring intervention, 16% (8 of 50) of cases had partial superficial flap necrosis, and 22% (11 of 50) of cases had mild persistent tenderness at 6 weeks. Cosmetic outcomes were graded on a scale of poor, acceptable, good or excellent. Overall, 78% (39 of 50) were rated good to excellent, 20% (10 of 50) were rated acceptable, and 2% (1 of 50) were rated poor, but did not require revision. The O to Z flap is a reliable repair for helical rim defects. Flap downsides include persistent cartilage tenderness and risk of minor flap necrosis.

The increasing dependence on radiologic diagnostic modalities in clinical practice has necessitated innovative teaching methods that introduce radiology into early medical curriculum. At Mayo Medical School cadaveric CT images are integrated into the first year gross anatomy course. Using post‐preservation, non‐contrast full body CT scans of their cadavers, medical students are able to correlate radiologic images to their dissection specimen. The AquariusNET thin client software used to view the images provides students numerous options for image manipulation including standard and oblique sagittal and coronal images and three‐dimensional renderings. Students are requested to record interesting findings from the imaging studies as part of an autopsy report. They are also provided with daily radiology learning objectives that require them to visualize specific anatomic structures. At the end of the course, students were comfortable accessing the cadaver CT data, correlating gross and CT anatomy and appreciating relationships of anatomic structures. They enjoyed interactions with radiology faculty and were more prepared to evaluate radiologic examinations. Grant Funding Source : Department of Anatomy

Teaching assistants (TA's) are an important resource in facilitation of 1st year courses at Mayo Medical School. Formal student teaching positions are available to 3rd students seeking opportunities to develop and refine peer teaching skills. While the Gross Anatomy course has traditionally utilized TA's as peer teachers the role of the TA has not been formally defined. Student evaluations as well as structured faculty and TA interviews were used to quantitatively assess how well TAs perceived their achievement of those goals compared to student and faculty perception. Expectations of TA's role include peer teaching through formal delivery of briefing sessions, group supervision during laboratory sessions, preparation of prosections, organization of review and informal practical examination sessions. TA's may extend their interaction with students through tutoring and participate in medical education‐based research projects. Furthermore, TA's are role players in assessment of student course performance. TA perception of their ability to meet expectations matched faculty and student perceptions. Student evaluations showed TA's to be one of the most highly rated resources in their teaching and learning and valued TA's for their capacity to relate to them, provide hands‐on clinical applications for basic science concepts, emotional support, time commitment to tutoring and assistance in the laboratory. Grant Funding Source : Mayo Medical School

Recent publications in the dermatologic surgery literature have sparked a re‐emergence of interest in anatomy relevant for the Mohs surgeon necessitating a re‐visit of under‐appreciated concepts, regarding the topography of the face and its visceral contents from a surgically relevant perspective. This paper presents a pre‐operative review and a conceptual framework for intra‐operative planning for Mohs micrographic surgery and reconstruction. The key concepts presented are based on a series of (1) reviews regarding clinically significant points aimed at improving outcomes for reconstructive surgery, (2) anatomical dissections of fresh frozen cadavers, and (3) surgical experience of the authors. Basic anatomical concepts have been assimilated, surgically evaluated and re‐directed toward the dermatologic surgeon in the hope that improved anatomic competence will reduce surgical hesitance. Clin. Anat. 29:237–246, 2016. © 2015 Wiley Periodicals, Inc.

AbstractBackgroundHailey–Hailey disease (HHD) is an autosomal dominant genodermatosis that leads to skin breakdown and blister formation, usually in intertriginous areas. Laser ablation is a known surgical treatment for HHD.ObjectivesWe report outcomes in a series of patients with HHD treated with carbon dioxide (CO2) laser ablation.MethodsA retrospective chart review of data for 13 patients who underwent CO2 laser ablation for HHD was conducted. Questionnaires assessing effectiveness, pain, healing time, recurrence, new disease, complications, additional ablation, improvement in quality of life (QoL), and overall satisfaction were completed by all patients.ResultsAll patients had been recalcitrant to previous treatments prior to CO2 laser ablation. Anatomic sites treated and anesthesia techniques for the procedure varied. The mean ± standard deviation (SD) score for the effectiveness of CO2 laser ablation for HHD was 9.3 ± 0.9 (maximum: 10). All patients reported improved QoL. No patient had recurring disease within the treatment field. Five patients underwent additional CO2 laser treatments at new sites. One patient reported postoperative infection. No other complications were identified. The mean ± SD score for overall satisfaction with CO2 laser ablation was 8.9 ± 1.1.ConclusionsTreatment with CO2 laser ablation is very effective and can lead to prolonged or permanent remission in most HHD patients. Patients are highly satisfied with the results and report a substantial improvement in QoL.

Abstract Lichen planopilaris ( LPP ) is a rare form of cicatricial alopecia that has occasionally been reported in children. Because of the limited number of patients reported, little information is available about demographic characteristics, clinical presentation, or treatment options for these patients. A retrospective chart review of LPP cases in patients under 18 years of age from 1976 to 2013 was performed to further define clinicopathologic features of pediatric LPP . Four pediatric LPP patients ages 13 to 16 years were identified (three male, one female). One patient had scalp pruritus and one had other cutaneous findings of lichen planus ( LP ). Perifollicular scale and scarring were the most common physical examination findings, although changes mimicking those of alopecia areata were observed. Three patients were treated with topical or intralesional steroids. One patient was treated with minocycline. Histopathologic findings included perifollicular interface and perifollicular fibrosis in all cases. There was focal interfollicular interface in two cases and mild dermal mucin in one case. LPP is exceedingly rare in children. It may be misdiagnosed as alopecia areata in children because of the lack of symptoms and other features of LP . There should be a high index of suspicion for LPP in children with alopecia that is unresponsive to standard treatment or who have findings that are atypical for more common childhood alopecias.