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Re: “Acanthosis nigricans and an alternative for its surgical therapy”
704 elsewhere) and left in situ as removal may cause discomfort (they usually self deliver subsequently). The everting mattress sutures are removed at 14 days. The quartet of figure of eight sutures stay in three or even four weeks, depending on the tension.
Conflict of interest None.
References 1. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003;73:112e20. 2. Gault DT, Brain A, Sommerlad BC, et al. Loop mattress suture. Br J Surg 1987;74:820e1. 3. Field LM. Closure of wounds under tension with the pulley suture. J Dermatol Surg Oncol 1993;19:173e4. 4. Hitzig GS, Sadick NS. The pulley suture, utilisation in scalp reduction surgery. J Dermatol Surg Oncol 1992;18:220e2. 5. Snow SN, Dortzbach R, Moyer D. Managing common suturing problems. J Dermatol Surg Oncol 1991;17:502e8.
Correspondence and communications their patient had received prior therapies (cryotherapy and electrosurgery) and these therapies may have altered the appearance of her condition, her lesions are not typical of acanthosis nigricans which tends to have confluent velvety hyperpigmented plaques. Instead, the figure in their article demonstrates patchy involvement with skip areas and linear lesions. The histopathological findings of ‘hyperkeratosis, mild acanthosis, and papillomatosis in the epidermis’ would be equally consistent with an epidermal nevus or extensive seborrheic keratoses. The additional histopathological finding of ‘a cystic space lined by a double layer of cuboidal cells’ in their case seems of uncertain etiology and not explained by the authors. Regardless, the surgical approach described by Isket et al. seems to represent a good option for managing either acanthosis nigricans or epidermal nevi, although the more patchy and linear nature of epidermal nevi and their smaller chance for recurrence (due to the lack of an underlying endocrine or genetic defect) would make them more appropriate for this therapy.
Conflicts of interest The author does not have any conflicts of interest.
Felix C. Behan Department of Surgical Oncology, Peter McCallum Cancer Institute, St Andrews Place, East Melbourne, Victoria 3002, Australia Cheng Hean Lo Department of Plastic & Reconstructive Surgery, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia 33 Australis Circuit, Port Melbourne, Victoria 3207, Australia. E-mail address: [email protected] Pauline Wong David Sau Yan Wong Department of Plastic & Reconstructive Surgery, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong ª 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.047
Re: ‘‘Acanthosis nigricans and an alternative for its surgical therapy’’ I read with interest the article by Isket et al. describing an alternative surgical therapy for acanthosis nigricans.1 The authors nicely summarize the multiple variants of acanthosis nigricans, but do not specify which variant their patient had. Their patient’s results after surgery appear very good. However, in my judgment, the patient’s lesion appeared more consistent with an epidermal nevus rather than acanthosis nigricans. Although the authors note that
Reference 1. Isken T, Sen C, Iscen D, et al. Acanthosis nigricans and an alternative for its surgical therapy. J Plast Reconstr Aesthet Surg Jan 2009;62:148e50.
David R. Berk Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305, USA E-mail address: [email protected] ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.010
Reply to ‘The dead space technique for preparing ‘surgical concentrations’ of adrenaline with local anaesthetic’ We read the article of Chew et al.1 with interest. They describe a method for preparing a ‘surgical concentration’ of adrenaline in local anaesthetic. We found some discrepancies upon repeating the measurements; in addition we also demonstrated that either pushing down on the plunger or not at all made a difference to the ‘dead space’ volume. Our findings are summarized in Table 1. Firstly, the dead space volumes are different from those described by the authors. This may be due to batch variation and should be considered when applying this
Conflict of interest None.
References 1. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003;73:112e20. 2. Gault DT, Brain A, Sommerlad BC, et al. Loop mattress suture. Br J Surg 1987;74:820e1. 3. Field LM. Closure of wounds under tension with the pulley suture. J Dermatol Surg Oncol 1993;19:173e4. 4. Hitzig GS, Sadick NS. The pulley suture, utilisation in scalp reduction surgery. J Dermatol Surg Oncol 1992;18:220e2. 5. Snow SN, Dortzbach R, Moyer D. Managing common suturing problems. J Dermatol Surg Oncol 1991;17:502e8.
Correspondence and communications their patient had received prior therapies (cryotherapy and electrosurgery) and these therapies may have altered the appearance of her condition, her lesions are not typical of acanthosis nigricans which tends to have confluent velvety hyperpigmented plaques. Instead, the figure in their article demonstrates patchy involvement with skip areas and linear lesions. The histopathological findings of ‘hyperkeratosis, mild acanthosis, and papillomatosis in the epidermis’ would be equally consistent with an epidermal nevus or extensive seborrheic keratoses. The additional histopathological finding of ‘a cystic space lined by a double layer of cuboidal cells’ in their case seems of uncertain etiology and not explained by the authors. Regardless, the surgical approach described by Isket et al. seems to represent a good option for managing either acanthosis nigricans or epidermal nevi, although the more patchy and linear nature of epidermal nevi and their smaller chance for recurrence (due to the lack of an underlying endocrine or genetic defect) would make them more appropriate for this therapy.
Conflicts of interest The author does not have any conflicts of interest.
Felix C. Behan Department of Surgical Oncology, Peter McCallum Cancer Institute, St Andrews Place, East Melbourne, Victoria 3002, Australia Cheng Hean Lo Department of Plastic & Reconstructive Surgery, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia 33 Australis Circuit, Port Melbourne, Victoria 3207, Australia. E-mail address: [email protected] Pauline Wong David Sau Yan Wong Department of Plastic & Reconstructive Surgery, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong ª 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.047
Re: ‘‘Acanthosis nigricans and an alternative for its surgical therapy’’ I read with interest the article by Isket et al. describing an alternative surgical therapy for acanthosis nigricans.1 The authors nicely summarize the multiple variants of acanthosis nigricans, but do not specify which variant their patient had. Their patient’s results after surgery appear very good. However, in my judgment, the patient’s lesion appeared more consistent with an epidermal nevus rather than acanthosis nigricans. Although the authors note that
Reference 1. Isken T, Sen C, Iscen D, et al. Acanthosis nigricans and an alternative for its surgical therapy. J Plast Reconstr Aesthet Surg Jan 2009;62:148e50.
David R. Berk Department of Dermatology, Stanford University School of Medicine, Stanford, CA 94305, USA E-mail address: [email protected] ª 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.bjps.2009.01.010
Reply to ‘The dead space technique for preparing ‘surgical concentrations’ of adrenaline with local anaesthetic’ We read the article of Chew et al.1 with interest. They describe a method for preparing a ‘surgical concentration’ of adrenaline in local anaesthetic. We found some discrepancies upon repeating the measurements; in addition we also demonstrated that either pushing down on the plunger or not at all made a difference to the ‘dead space’ volume. Our findings are summarized in Table 1. Firstly, the dead space volumes are different from those described by the authors. This may be due to batch variation and should be considered when applying this