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Thermal Injuries as a result of CO2 laser resurfacing
J Oral Maxillofac
57~529.634,
Surg 1999
Abstracts comprehensive care model of clinical education. This new model was proposed to more closely reflect patient care in a manner and setting similar to those found in general practice. Some schools have eliminated set requirement levels by using competency as the criteria for assessment. Other schools maintain unit requirements within a comprehensive care teaching program. The authors investigated the effect of clinical targets on clinical productivity and perceptions of clinical competency of final-year undergraduate dental students. Students were randomly divided into two groups of 24. One group was assigned clinical targets for the year (target group), while no targets were assigned for the other group (nontarget group). Perceptions of clinical competency were evaluated by all students and their clinical teachers by completing a questionnaire rating six different categories of student clinical competency at the end of the first and second semesters. Clinical output of both groups was also measured. Results showed that there was no significant difference in performance between the two groups as assessed by both teachers and students. There was no significant difference in clinical productivity between the target and nontarget groups. Although results of this study should be interpreted with caution, the authors feel that standards of care may not be affected by the presence or absence of numerical goals.-A.J. LEXJNAO
Physiology of the Chronic Wound. Nwomeh BC, Yager DR, Cohen IK. Clin Plast Surg 25:341, 1998 The normal response to tissue injury is a timely and orderly reparative process that results in sustained restoration of anatomic and functional integrity. In chronic wounds, the healing process is prolonged and incomplete, proceeding in an uncoordinated manner, and resulting in poor anatomic and functional outcome. Most chronic wounds (70%) are associated with a small number of well-defined entities, particularly chronic venous stasis, diabetes mellitus, and pressure necrosis. The classification of chronic wounds includes the following: pressure ulcers, vascular insticiency, metabolic, infections, inflammatory disorders, hematologic, malignant, and miscellaneous. Pressure ulcers are characterized by deep tissue necrosis and a loss of volume disproportionately greater than the overlying skin defect. Pressure over bony prominences, shear forces, friction, and moisture are important casual factors. External pressure can cause venous and lymphatic obstruction, may progress to arterial occlusion, and results in tissue ischemia with the accumulation of toxic metabolites as a consequence. Venous ulcers occur almost exclusively in association with chronic venous insufficiency. The resulting venous hypertension is caused by incompetent valves, deep vein thrombosis or muscle dysfunction. Diabetic ulcers are caused by the triad of neuropathy, ischemia, and infection. Patients who suffer from diabetes, malnutrition, systemic malignancy, or who take steroids or immunosuppressive therapy are more susceptible to infection. Simple clinical observation attests to the poor healing characteristics of ischemic tissue. Cytokines and growth factors have an uncertain role in mediating the chronic wound response. Impairment of any of the steps the keratinocytes response to injury-detachment, migration, proliferation, differentiation, and stratification-will jeopardize smooth and rapid epithelial resurfacing. Because many chronic wounds are characterized by massive tissue loss, it has been speculated that an imbalance in the extracellular matrix is involved in the establishment and maintenance of many chronic wounds. Repeated trauma, infection, hypoxia, ischemia, and malnutrition will ultimately lead to excessive matrix degradation, degradation of growth factors, and impaired epithelialization. This chain of events produces the chronic wound.-R.H. HAUG
Reprint requests to Dr Stacey: School of Dental Science, The University of Melbourne, 711 Elizabeth St, Melbourne 3000, Victoria, Australia. Thermal Injuries as a Result of CO2 Laser Resurfacing. Grossman AR. Plast Reconstr Surg 102: 1247, 1998 Laser resurfacing of the face for fine wrinkles has gained great popularity over a short period of time. Until now there has been few reported cases of complications with use of the carbon dioxide (CO& laser. This article is a review of 20 consecutive patients referred over a l&month period who had received injuries from CO2 laser resurfacing. The patients were all women between the age of 34 and 70 years. There were 11 patients with prolonged erythema (greater than 6 months), 13 patients developed hypertrophic scars, 3 patients developed hypopigmentation, 2 patients developed hyperpigmentation, 2 patients with microstomia secondary to contracture from perioral scarring, 2 patients developed lower lid ectropion, and 2 patients sustained full-thickness burns. Burn injuries were treated with debridement and skin grafting; hypertrophic scars were treated with multiple steroid injections and a custom fit uvex clear plastic facial pressure mask worn for 6 to 12 months. Conclusions drawn by the authors were that laser skin resurfacing is an effective tool for the treatment of fine wrinkles, but that it can have serious complications including thermal injury to the skin.-J. BROKLOFF
Reprint requests to Dr Nwomeh: Laboratory of Tissue Repair, Department of Surgery, Virginia Commonwealth University, Richmond, VA 2329%N0117.
The Effect of Clinical Targets on Productivity and Perceptions of Clinical Competency. Stacey MA, Morgan MA, Wright C. J Dent Educ 62:409,1998 Traditionally, dental schools used numerical clinical requirements to ensure that students obtained adequate experience in the traditional disciplines and to drive clinical activity. The effectiveness and validity of this approach to dental education has been questioned, with an increasing number of institutions implementing the newly proposed
Reprint requests to Dr Grossman: 4190 Van Nuys Blvd, Suite 306, Sherman Oaks, CA 91406.
629
57~529.634,
Surg 1999
Abstracts comprehensive care model of clinical education. This new model was proposed to more closely reflect patient care in a manner and setting similar to those found in general practice. Some schools have eliminated set requirement levels by using competency as the criteria for assessment. Other schools maintain unit requirements within a comprehensive care teaching program. The authors investigated the effect of clinical targets on clinical productivity and perceptions of clinical competency of final-year undergraduate dental students. Students were randomly divided into two groups of 24. One group was assigned clinical targets for the year (target group), while no targets were assigned for the other group (nontarget group). Perceptions of clinical competency were evaluated by all students and their clinical teachers by completing a questionnaire rating six different categories of student clinical competency at the end of the first and second semesters. Clinical output of both groups was also measured. Results showed that there was no significant difference in performance between the two groups as assessed by both teachers and students. There was no significant difference in clinical productivity between the target and nontarget groups. Although results of this study should be interpreted with caution, the authors feel that standards of care may not be affected by the presence or absence of numerical goals.-A.J. LEXJNAO
Physiology of the Chronic Wound. Nwomeh BC, Yager DR, Cohen IK. Clin Plast Surg 25:341, 1998 The normal response to tissue injury is a timely and orderly reparative process that results in sustained restoration of anatomic and functional integrity. In chronic wounds, the healing process is prolonged and incomplete, proceeding in an uncoordinated manner, and resulting in poor anatomic and functional outcome. Most chronic wounds (70%) are associated with a small number of well-defined entities, particularly chronic venous stasis, diabetes mellitus, and pressure necrosis. The classification of chronic wounds includes the following: pressure ulcers, vascular insticiency, metabolic, infections, inflammatory disorders, hematologic, malignant, and miscellaneous. Pressure ulcers are characterized by deep tissue necrosis and a loss of volume disproportionately greater than the overlying skin defect. Pressure over bony prominences, shear forces, friction, and moisture are important casual factors. External pressure can cause venous and lymphatic obstruction, may progress to arterial occlusion, and results in tissue ischemia with the accumulation of toxic metabolites as a consequence. Venous ulcers occur almost exclusively in association with chronic venous insufficiency. The resulting venous hypertension is caused by incompetent valves, deep vein thrombosis or muscle dysfunction. Diabetic ulcers are caused by the triad of neuropathy, ischemia, and infection. Patients who suffer from diabetes, malnutrition, systemic malignancy, or who take steroids or immunosuppressive therapy are more susceptible to infection. Simple clinical observation attests to the poor healing characteristics of ischemic tissue. Cytokines and growth factors have an uncertain role in mediating the chronic wound response. Impairment of any of the steps the keratinocytes response to injury-detachment, migration, proliferation, differentiation, and stratification-will jeopardize smooth and rapid epithelial resurfacing. Because many chronic wounds are characterized by massive tissue loss, it has been speculated that an imbalance in the extracellular matrix is involved in the establishment and maintenance of many chronic wounds. Repeated trauma, infection, hypoxia, ischemia, and malnutrition will ultimately lead to excessive matrix degradation, degradation of growth factors, and impaired epithelialization. This chain of events produces the chronic wound.-R.H. HAUG
Reprint requests to Dr Stacey: School of Dental Science, The University of Melbourne, 711 Elizabeth St, Melbourne 3000, Victoria, Australia. Thermal Injuries as a Result of CO2 Laser Resurfacing. Grossman AR. Plast Reconstr Surg 102: 1247, 1998 Laser resurfacing of the face for fine wrinkles has gained great popularity over a short period of time. Until now there has been few reported cases of complications with use of the carbon dioxide (CO& laser. This article is a review of 20 consecutive patients referred over a l&month period who had received injuries from CO2 laser resurfacing. The patients were all women between the age of 34 and 70 years. There were 11 patients with prolonged erythema (greater than 6 months), 13 patients developed hypertrophic scars, 3 patients developed hypopigmentation, 2 patients developed hyperpigmentation, 2 patients with microstomia secondary to contracture from perioral scarring, 2 patients developed lower lid ectropion, and 2 patients sustained full-thickness burns. Burn injuries were treated with debridement and skin grafting; hypertrophic scars were treated with multiple steroid injections and a custom fit uvex clear plastic facial pressure mask worn for 6 to 12 months. Conclusions drawn by the authors were that laser skin resurfacing is an effective tool for the treatment of fine wrinkles, but that it can have serious complications including thermal injury to the skin.-J. BROKLOFF
Reprint requests to Dr Nwomeh: Laboratory of Tissue Repair, Department of Surgery, Virginia Commonwealth University, Richmond, VA 2329%N0117.
The Effect of Clinical Targets on Productivity and Perceptions of Clinical Competency. Stacey MA, Morgan MA, Wright C. J Dent Educ 62:409,1998 Traditionally, dental schools used numerical clinical requirements to ensure that students obtained adequate experience in the traditional disciplines and to drive clinical activity. The effectiveness and validity of this approach to dental education has been questioned, with an increasing number of institutions implementing the newly proposed
Reprint requests to Dr Grossman: 4190 Van Nuys Blvd, Suite 306, Sherman Oaks, CA 91406.
629