Complications in Cutaneous Surgery

Complications in Cutaneous Surgery

Hugh M. Gloster, Jr., MDAssociate Professor, Director of Dermatologic Surgery, Department of Dermatology, University of Cincinnati, Cincinnati, Ohio, USA

Editor

Hugh M. Gloster, Jr., MDAssociate ProfessorDirector of Dermatologic SurgeryDepartment of DermatologyUniversity of CincinnatiCincinnati, OHUSA

Library of Congress Control Number: 2007930545

ISBN: 978-0-387-73151-3 e-ISBN: 978-0-387-73152-0

Printed on acid-free paper.

© 2008 Springer Science+Business Media, LLC.All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

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Preface

The demand for outpatient cutaneous surgery procedures has increased at a rapid rate over the last several decades. Cosmetic, excisional, and reconstructive proce-dures are being performed by primary care physicians and a variety of specialists in different disciplines, such as dermatology, plastic surgery, ophthalmology, and otolaryngology. As the number of cutaneous surgery procedures rises, so will the rate of complications, which are inevitable and occur even with the most skilled, careful, and meticulous surgeons.

In the practice of medicine, we often learn more from complications than tri-umphs. The authors of the chapters in this book were recruited based on their experience and respective areas of expertise. To my knowledge, no book exists that summarizes the medical literature regarding complications in cutaneous surgery. The goal of this book is to provide a comprehensive text that will enable the prac-ticing physician to formulate a preoperative strategy to prevent complications before they occur and to properly diagnose and manage complications when they arise in order to provide a better service to the patient.

This book is divided into three sections: acute surgical complications, chronic surgical complications, and complications of cosmetic procedures. Each chapter discusses a different complication and outlines proper preventative, diagnostic, and management strategies based on the medical literature and the experience of the author. Acute complications, some of which may be associated with serious morbid-ity and mortality, are those experienced within the fi rst few weeks of surgery. Chronic complications primarily are the result of suboptimal scarring. Scar revision techniques are reviewed in detail. Psychological complications, which no longer can be overlooked with the growing popularity of cosmetic procedures, are also dis-cussed in this section. Finally, the section on complications of cosmetic procedures covers a wide variety of pertinent topics such as lasers, chemical peels, dermabrasion, liposuction, fi ller substances, botulinum toxin, and sclerotherapy. This section was included because of the recent increase in cosmetic surgery as physicians look for new ways to expand their practices in the current healthcare market.

All physicians performing cutaneous surgery will experience complications. Each complication should serve as a learning experience that should enable the surgeon to make arrangements to prevent the same complication from occurring again in the future. Hopefully, this book will enhance patient care by allowing the reader to benefi t from the collective experience of others instead of learning “the hard way”.

Hugh M. Gloster, Jr., MD

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Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vContributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Section I Acute Surgical Complications

1 Preoperative Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Marcy Neuburg

2 Acute Emergencies in the Dermatology Offi ce . . . . . . . . . . . . . . . . . . . . 9 Darrell Fader

3 Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Shawn Allen and Roberta Sengelmann

4 Hemorrhagic Complications in Cutaneous Surgery . . . . . . . . . . . . . . . . . 36 Hugh M. Gloster, Jr.

5 Wound Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Gregory J. Fulchiero, Jr., and Elizabeth M. Billingsley

6 Prophylaxis for Wound Infections and Endocarditis . . . . . . . . . . . . . . . . 62 Michelle Pipitone and Hugh M. Gloster, Jr.

7 Dehiscence and Necrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Ross M. Campbell and Raymond G. Dufresne, Jr.

Section II Chronic Surgical Complications

8 Hypertrophic Scars and Keloids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 A. Paul Kelly

9 Free Margin Distortion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Sumaira Z. Aasi and David Leffell

10 Scar Revision and Camoufl age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Tri H. Nguyen

11 Miscellaneous Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Mary E. Maloney and Nathaniel J. Jellinek

Section III Complications of Cosmetic Procedures

12 Preoperative Cosmetic Consultation and Psychological Complications of Cosmetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Evan C. Jones and Dee Anna Glaser

13 Complications of Ablative and Nonablative Lasers and Light Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

Elizabeth L. Tanzi and Tina S. Alster

14 Complications of Dermabrasion and Chemical Peeling Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

Chris Harmon and Betty Davis

15 Complications of Liposuction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 J. Barton Sterling and C. William Hanke

16 Complications of Soft Tissue Fillers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Steven C. Bernstein

17 Complications of Botulinum Toxin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Deborshi Roy and Neil S. Sadick

18 Complications of Sclerotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Girish S. Munavalli and Robert A. Weiss

19 Complications of Facelifting Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . 224 Greg S. Morganroth, Hayes B. Gladstone, and Isaac M. Neuhaus

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

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Contributors

Sumaira Z. Aasi, MDAssistant Professor, Department of Dermatology, Yale University, New Haven, CT, USA

Shawn Allen, MDDirector, Dermatology Specialists of Boulder, Boulder, CO, USA

Tina S. Alster, MDDirector, Washington Institute of Dermatologic Laser Surgery, Clinical Professor of Dermatology, Georgetown University, Washington DC, USA

Steven C. Bernstein, MD, CM, FRCP(C)Assistant Professor, Department of Medicine, University of Montreal, Montreal, Quebec, Canada

Elizabeth M. Billingsley, MDAssociate Professor, Department of Dermatology, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA, USA

Ross M. Campbell, MDTotal Skin and Beauty Dermatology Center, Birmingham, AL, USA

Betty Davis, MDArizona Medical Clinic, Sun City West, AZ, USA

Raymond G. Dufresne, Jr., MDProfessor, Department of Dermatology, Brown Medical School, Rhode Island Hos-pital, Providence, RI, USA

Darrell J. Fader, MDClinical Assistant Professor, Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, USA

Gregory John Fulchiero, Jr., MD, MS BioEngFellow in Dermatologic Surgery, Department of Dermatology, University of Texas, Southwestern, Dallas, TX, USA

Hayes B. Gladstone, MDDirector, Division of Dermatologic Surgery, Department of Dermatology and Oto-laryngology, Stanford University, Stanford, CA, USA

Dee Anna Glaser, MDAssociate Professor, Department of Dermatology, St. Louis University, St. Louis, MO, USA

Hugh M. Gloster, Jr., MDAssociate Professor, Director of Dermatologic Surgery, Department of Dermatol-ogy, University of Cincinnati, Cincinnati, OH, USA

C. William Hanke, MD, MPH, FACPVisiting Professor, Department of Dermatology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

Christopher B. Harmon, MDClinical Instructor, Department of Dermatology, University of Alabama at Birming-ham, Birmingham, AL, USA

x Contributors

Nathaniel J. Jellinek, MDAssistant Professor, Brown Medical School, Providence, RI, USA

Evan C. Jones, MD, MPHClinical Instructor, Department of Dermatology, St. Louis University, St. Louis, MO, USA

A. Paul Kelly, MDProfessor and Chief, Division of Dermatology, Charles R. Drew University of Medi-cine and Science, Department of Internal Medicine, King/Drew Medical Center, Los Angeles, CA, USA

David Leffell, MDProfessor and Surgery Chief, Department of Dermatology, Section of Dermatologic Surgery and Cutaneous Oncology Director, Yale School of Medicine, New Haven, CT, USA

Mary E. Maloney, MDProfessor, Department of Dermatology, Chief, Division of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA

Greg S. Morganroth, MDAssistant Clinical Professor, Department of Dermatology, University of California, San Francisco, San Francisco, CA, Adjunct Clinical Assistant Professor, Department of Otolaryngology, Head and Neck Surgery, Stanford University, Stanford, CA, USA

Girish S. Munavalli, MD, MHSClinical Instructor, Department of Dermatology, Johns Hopkins University School of Medicine, Charlotte, NC, USA

Marcy Neuburg, MDAssociate Professor, Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA

Isaac M. Neuhaus, MDAssistant Professor, Department of Clinical Dermatology, University of California, San Francisco, San Francisco, CA, USA

Tri H. Nguyen, MDAssociate Professor, Department of Dermatology and Otorhinolaryngology, M. D. Anderson Cancer Center, University of Texas, Houston, TX, USA

Michelle Pipitone, MDDepartment of Dermatology, University of Cincinnati, Cincinnati, OH, USA

Deborshi Roy, MD772 Parks Avenue, New York, NY, USA

Neil Scott Sadick, MDClinical Professor, Department of Dermatology, Weill Medical College of Cornell University, New York, NY, USA

Roberta Sengelmann, MDAssistant Professor, Department of Dermatology and Otolaryngology, Department of Internal Medicine and Dermatology, Washington University School of Medicine, St. Louis, MO, USA

J. Barton Sterling, MDCosmetic and Procedural Dermatology Cernter, Spring Lake, NJ, USA

Elizabeth L. Tanzi, MDCo-Director, Wahington Institute of Dermatologic Laser Surgery, Clinical Instructor of Dermatology, Johns Hopkins Medical Center, Washington DC, USA

Robert A. Weiss, MDAssociate Professor, Department of Dermatology, Johns Hopkins University School of Medicine, Director, Maryland Laser, Skin, and Vein Institute, Hunt Valley, MD, USA