ANZ Journal of SurgeryVolume 74, Issue 6 p. 497-498 Management of contrast extravasation injury of the forearm during computed tomography Pradnya Valanju MBBS, Pradnya Valanju MBBS RadiologySearch for more papers by this author Elias Moisidis FRACS, Elias Moisidis FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author Richard Waugh FRACR, Richard Waugh FRACR RadiologySearch for more papers by this author David Pennington FRACS, David Pennington FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author Ken Lee FRACS, Ken Lee FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author Pradnya Valanju MBBS, Pradnya Valanju MBBS RadiologySearch for more papers by this author Elias Moisidis FRACS, Elias Moisidis FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author Richard Waugh FRACR, Richard Waugh FRACR RadiologySearch for more papers by this author David Pennington FRACS, David Pennington FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author Ken Lee FRACS, Ken Lee FRACS Plastic and Reconstructive Surgery Royal Prince Alfred Hospital Camperdown, New South Wales, AustraliaSearch for more papers by this author First published: 08 June 2004 https://doi.org/10.1111/j.1445-2197.2004.03050.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Ayre-Smith G. Tissue necrosis following extravasation of contrast media. J. Can. Assoc. Radiol. 1982; 33: 104. 2 Cohan RH, Ellis JH, Garner WL. Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology 1996; 200: 593− 604. 3 Vandeweyer E, Heymans O, Deraemaecker R. Extravasation injuries and emergency suction as treatment. Plast. Reconstr. Surg. 2000; 105: 109− 10. 4 Benson LS, Sathy MJ, Port RB. Case report. Forearm compartment syndrome due to automated injection of computed tomography contrast material. J. Orth. Trauma 1996; 10: 433− 6. 5 Gault DT. Extravasation injuries. Br. J. Plast. Surg. 1993; 46: 91− 6. Citing Literature Volume74, Issue6June 2004Pages 497-498 ReferencesRelatedInformation

Piercing the upper ear to retain jewellery is now commonplace. When infection ensues, devastating chondritis leads to collapse of the ear. To our knowledge, the surgical reconstruction of post-piercing deformities has not been documented in the literature. We present five such cases referred for autogenous-tissue ear reconstruction. In four of these, the destroyed segments of ear cartilage were replaced with a carved costal-cartilage framework. One patient declined surgery. The importance of preventing infection is stressed.

Hemifacial microsomia describes a congenital orofacial malformation in which there is insufficient or disrupted development of the mandible affecting one side of the face. The aetiology of this condition remains unclear, but it has been postulated that twins (predominantly monozygotic) are more liable to be affected than singletons. This study investigates the incidence of multiple births amongst a large number of affected individuals and their families. Data were collected on 145 individuals with hemifacial microsomia and microtia, using postal questionnaires and interviews in a hospital setting. These data were compared with the mean age-standardised twin maternity prevalence for England and Wales between 1975 and 1995 of 1.06% and the triplet maternity prevalence for England and Wales for 1995 of 0.034% (a multiple maternity being where more than one baby is born, either alive or stillborn). The prevalence of twin maternities amongst the affected individuals was 3.96% (P>0.05) and amongst their siblings it was 4.02% (P<0.02). There was also an excess of twins in the rest of the family groups, predominantly due to a stronger history of twinning on the maternal side. As there were more twins amongst the affected individuals than in the general population, it seems likely that whatever the aetiology of hemifacial microsomia and microtia, the presence of a co-twin (or co-triplets) may make the causal event, or series of causal events, more likely to occur. This study supports the hypothesis that hemifacial microsomia and microtia are in some way linked to multiple births. Analysis of this link may provide new directions for research into the aetiology of a variety of congenital defects.

Department of Plastic Surgery Mount Vernon Hospital Northwood Middlesex, United Kingdom Correspondence to Dr. Scevola Tenuta Limido 27020 Zerbolo' (Pavia) Italy[email protected]

The long-pulsed ruby laser has been used to remove unwanted body hair with encouraging results. It is clear from various studies that complete removal of hair is unlikely after a single treatment and diverse response rates have been observed in various individuals. It was the aim of this study to examine the efficacy of ruby laser hair removal after repeated treatments and to assess the patients’ satisfaction with this method of hair removal. In all, 88 patients were treated with the Chromos 694 Depilation Ruby Laser (SLS/Biophile, Wales) at monthly intervals for 4 months and their hair density was measured at 7 and 12 months after the first treatment. The average reduction in hair density was 13.7% at 1 year, which was statistically significant. No adverse long-term side effects were seen. Although only 44.3% of patients had reduced hair count at 1 year, 79.5% patients were satisfied with their treatment. In conclusion, we have shown in this study that the long-pulsed ruby laser is only effective in permanently removing a small proportion of unwanted dark coloured body hair. This method of hair removal is, however, superior to other conventional types of hair removal according to the patients’ subjective observation, because it slows the hair growth, causes thinning of hair, and provides good temporary control of hair from most treatment sites.

Vinorelbine tartrate (Navelbine, Burroughs Wellcome Company, Research Triangle Park, NC, USA) is a semisynthetic vinca alkaloid approved in many countries for the first-line treatment of patients with advanced non-small-cell lung cancer. It is also used in the treatment of advanced breast and ovarian cancers and lymphoma. Like other vinca alkaloids, Navelbine can cause skin necrosis as a consequence of inadvertent extravasation in surrounding tissues during intravenous administration. In such cases, early treatment is strongly advocated. There is no documented case of vinorelbine extravasation in the literature. The authors herein report two cases successfully treated with hyaluronidase injections plus saline flushout under local anesthesia.

Carbon dioxide laser ablation has been advocated as an alternative therapeutic modality for basal cell carcinoma. This study examined the limitations of carbon dioxide laser ablation for BCCs by the formal excision and histological examination of the tumour bed, following laser therapy. We evaluated the tumour type and ablation depth required to ablate the tumours completely. Fifty-one selected BCCs, ranging from 4 to 35 mm, were ablated with a carbon dioxide laser combined with a microprocessor controlled optomechanical flash scanner. Clinically there were 21 superficial, 28 nodular and 2 infiltrative types. Complete ablation at the deep margin was associated with ablation depth (P=0.006) and with tumour type (P=0.01). Overall, all tumours of superficial subtype (found most commonly on the trunk) could be completely ablated reliably, provided they were lasered to a depth of the middle dermis or deeper. In contrast, nodular tumours could not reliably be ablated by this method. A small subset of nodular tumours less than 10 mm diameter, however, were all completely ablated provided they were lasered to a depth of the lower dermis or deeper, however this may result in delayed healing and scarring. We conclude that this fast modality is useful for the treatment of some BCCs provided strict selection criteria are met. Laser ablation would be most beneficial for patients with multiple superficial BCCs.

Ruby laser-assisted hair removal is thought to work via selective photothermolysis, which relies on light reaching the deeper layers of skin, and the absorption of light by the target chromophore, melanin. It is therefore possible that efficacy of treatment is affected by anatomic factors that determine the amount of light reaching the hair bulbs (i.e., skin color, depth of intracutaneous hair, epidermal thickness and dermal density) and the melanin content of hair. To examine this hypothesis, a prospective study was performed. Forty-eight volunteers were treated with the Chromos 694 Depilation Ruby Laser at a single standard fluence of 11 J/cm2. Treatment efficacy was determined by measuring hair density at 3 and 7 months after treatment. Epidermal depth and dermal density were measured from 2-mm biopsies taken before treatment, and the intracutaneous hair length was determined from plucked hair. Skin color was assessed using a spectrophotometer, and melanin content of dissolved hair was assessed using spectrophotometry. Efficacy of treatment for each patient was compared with the patient's age, intracutaneous hair length, epidermal depth, dermal density, skin color, and total melanin content and relative eumelanin content of hair. No correlation was found between the efficacy of treatment and age and the various anatomic factors. Patients with higher eumelanin content in their hair had better long-term results (Spearman rank test, p = 0.00219). The results suggested that the efficacy of treatment did not depend solely on the amount of laser light penetrating the skin but correlated well with the eumelanin content of hair. The clinical implication of this finding is discussed.

A ruby laser has been developed to remove unwanted hair. Melanin within the hair is used as a natural chromophore. It is postulated that photothermal damage destroys the hair itself and also key cells surrounding the hair follicle to prevent regrowth. A prospective study of laser depilation in 116 patients or 175 sites was performed over a period of 18 months. All the patients had tried other methods of hair removal and found them to be unsatisfactory. Hair counts (follicles/cm2) were used to judge the outcome. The mean follow-up time was 23.25 weeks (range 12-76 weeks). After a mean number of treatments of 1.92 (range 1-20) there was a 56.4% reduction in hair density. Comparing pre- and post-treatment hair density, there was a highly significant reduction (paired t-test: P < 0.00001). Laser removal of hair is now a realistic treatment option.

There have been anecdotal reports that hairs that regrow after ruby laser-assisted hair removal are finer in appearance. If true, this phenomenon adds to the improved aesthetic effect of laser treatment of unwanted hair. It is the aim of this study to determine whether this phenomenon indeed occurs, and if so, assess its permanence and its mode of action. In this prospective clinical study, 71 patients with 94 treatment sites were treated with the Chromos 694 Depilation Ruby Laser. Hair diameter was measured pre-treatment, and at 3 and 7 months post-treatment. In addition, ex vivo scalp skin was used to assess if the ruby laser selectively damaged coarser hairs. Laser-treated and matched untreated skin samples were histologically assessed and the diameters of hair shafts (normal or obviously damaged) were measured. Results of this study were analysed using Kruskal-Wallis one-way analysis. There was no statistically significant difference between the hair diameter of non-lasered specimens and the hair diameter of the normal hair in lasered specimens. However, a statistically significant difference was seen between the hair diameter of non-lasered specimens and diameters of damaged hair in lasered specimens (P < 0.05). There was a statistically significant difference (P < 0.05) between pre-treatment and 3 month hair diameters, but no statistically significant difference was found between pre-treatment and 7 month hair diameters. In conclusion, ruby laser-assisted hair removal results in a temporary reduction in hair diameter of regrowing hair. This is not due to the selective targeting of larger hair follicles.

Ruby laser-assisted hair removal is thought to act via selective photothermolysis of melanin in the hair follicles. Although initial clinical trials of permanent hair removal using ruby lasers are promising, the exact mechanisms of hair destruction and the potential damage to other structures of skin are not known. The aim of this study was to evaluate the cutaneous ultrastructural changes following ruby laser hair removal. Nineteen healthy Caucasian patients with dark (brown/black) hair were treated with the ruby laser and biopsies taken after 0, 2, 3, 5, 7, 14 and 21 days. Specimens were examined by light and electron microscopy. Laser-treated specimens showed widespread coagulation and charring of subcutaneous hair shafts. These obviously damaged follicles were randomly dispersed amongst intact follicles within the same treatment sites. Microscopic changes were also seen in the basal epidermis where melanin was concentrated, irrespective of any obvious macroscopic damage. A low level of inflammatory response seen up to 2 weeks after treatment always followed laser treatment. Suprabasal epidermal necrosis was only seen in patients with blister formation after treatment. Ruby laser irradiation results in selective damage to the hair follicles, with microscopic changes to the basal epidermis. The damage is probably compounded by the inflammatory response to the damaged hair. The normal appearance and distribution of collagen in the dermal layer supported the clinical evidence that laser-assisted hair removal, if performed correctly, does not lead to scar formation.

Acquired sub-total ear defects are common and challenging to reconstruct. We report the use of an autologous costal cartilage framework to reconstruct sub-total defects involving all anatomical regions of the ear. Twenty-eight partially damaged ears in 27 patients were reconstructed with this technique. The defects resulted from bites (14), road traffic accidents (five), burns (four), iatrogenic causes (four) and chondritis following minor trauma (one). Computerised image analysis revealed a median of 31% (range 13-72%) ear loss. An autologous costal cartilage framework was fashioned in all cases. If adequate local skin was available, this was draped over the framework, but in nine cases preliminary tissue expansion was used and in a further three cases with significant scarring, the framework was covered with a temporoparietal fascial flap. Clinical assessment after ear reconstruction was undertaken, scoring for symmetry, the helical rim, the antihelical fold, the lobe position and a 'natural look' to produce a four-point scale; 11 were excellent, 12 were good, two were fair and three were poor. Our experience suggests that formal delayed reconstruction with autologous costal cartilage is to be recommended when managing acquired, sub-total ear deformity.

Laser treatment of pigmented lesions requires melanocytes to lie within the range of penetration of the laser, and to contain melanin in order to absorb and covert light energy into heat by photothermolysis. This study investigated whether these limitations could be tested by immunohistology and used to predict the outcome of treatment. Punch biopsies were taken from 32 patients prior to laser treatment. Immunohistology targeting the S-100 antigen allowed measurement of melanocytic depth and the presence of amelanosis. These parameters provided an accurate method of predicting good results (sensitivity 81%, specificity 93%) and were particularly useful in delineating the likelihood of a poor/very poor outcome (sensitivity 100%), even beyond the predictive capacity of the test patch. No complications were associated with the biopsy technique which reliably provided sufficient material for histological assessment. This study reports the clinical applications of this test to laser treatment.

Department of Plastic Surgery Dundee Royal Infirmary Barrack Road Dundee DD1 9ND, Scotland, United Kingdom Mount Vernon Hospital Rickmansworth Road Northwood, Middlesex HA6 2RN England, United Kingdom