Impact of Preoperative Acetaminophen and Carbohydrate Loading on Pain and Functional Status in Patients Undergoing Mohs Micrographic Surgery for Nonmelanoma Skin Cancers BACKGROUND Preoperative acetaminophen and carbohydrate loading has been shown to improve the functional recovery of surgical patients. OBJECTIVE To determine the effects of preoperative acetaminophen and carbohydrates on functional outcomes and the use of pain medications after surgery in patients undergoing Mohs Micrographic Surgery (MMS) for nonmelanoma skin cancer (NMSC). MATERIALS AND METHODS One hundred patients treated with MMS for NMSC at an academic center were randomized into a control group receiving standard preoperative care or an intervention group receiving acetaminophen and carbohydrate drinks immediately before surgery. Patients rated levels of pain, thirst, hunger, anxiety, and fatigue on the day of surgery on a scale of 0 to 100, and reported through a phone interview the use of pain medications within 48 hours of surgery. RESULTS There was no significant difference between intervention and control groups in maximum pain score on the day of surgery; maximum pain score 48 hours after surgery; use of nonopioid pain medications; and use of opioids. However, the intervention group had lower anxiety levels during and at the end of surgery. CONCLUSION Patients undergoing MMS for NMSC reported very low levels of pain during and after surgery. Preoperative acetaminophen and carbohydrate loading had no impact on pain levels or the use of pain medications but did reduce levels of anxiety. Address correspondence and reprint requests to: Bichchau Nguyen, MD, MPH, Department of Dermatology, Tufts Medical Center, 260 Tremont Street, 14th Floor, Boston, MA 02116, or e-mail: bnguyen2@tuftsmedicalcenter.org This study was funded by the 2015 Cutting Edge Research Grant (CERG) from the American Society of Dermatologic Surgery. The authors have indicated no significant interest with commercial supporters. The authors consent for publication of this manuscript. This study has been approved by the institutional review board at Tufts Medical Center. The principles outlined in the Declaration of Helsinki were followed in the production of this manuscript. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Use of Bridge Flaps for Primary Closure of Donor Sites of Interpolated Forehead Flaps No abstract available

Infliximab Prophylaxis in Patients With Postoperative Pyoderma Gangrenosum Requiring Surgical Intervention No abstract available

First Reported Case of Neuromodulator Use in a Patient Who Received the Botulinum Vaccine No abstract available

Technique to Minimize Local Anesthetic Injection for Scalp Reconstruction No abstract available

The Physician's Guide to Platelet-Rich Plasma in Dermatologic Surgery Part I: Definitions, Mechanisms of Action, and Technical Specifications BACKGROUND Platelet-rich plasma (PRP) is an increasingly popular treatment modality for various dermatologic conditions, but there are limitations in both the published literature and clinician knowledge. OBJECTIVE To create a high-yield, in-depth analysis of PRP in procedural dermatology by reviewing available data on its role in hair restoration, soft-tissue remodeling, resurfacing, and rejuvenation; identifying practice gaps and controversies; and making suggestions for future research that will establish dermatologists as pioneers of regenerative medicine. MATERIALS AND METHODS A 2-part systematic review and expert analysis of publications before October 2018. RESULTS AND CONCLUSION Most studies on PRP report favorable outcomes with the strongest level of evidence existing for androgenetic alopecia followed by postprocedure wound healing, scar revision, striae, rejuvenation, and dermal filling. There is a dearth of large randomized controlled trials, considerable heterogeneity in the variables studied, and lack of specificity in the preparatory protocols, which may influence clinical outcomes. Future investigations should use consistent nomenclature, find ideal solution parameters for each cutaneous indication, determine significant outcome metrics, and follow double-blinded, randomized, controlled methodologies. Addressing these deficiencies will take sound scientific inquiry but ultimately has the potential to benefit the authors' specialty greatly. Address correspondence and reprint requests to: Amelia K. Hausauer, MD, 3803 South Bascom Ave, Suite 100, Campbell, CA 95008, or e-mail: drh@aesthetx.com A. K. Hausauer led an investigator-initiated trial using an Eclipse Aesthetic PRP device. The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Commentary on Bridge Flaps No abstract available

Bridge Flaps: A Hybrid Family of Bipedicled Flaps for the Forehead, Temple, and Scalp: Experience With 103 Cases BACKGROUND Medium-sized defects of the scalp, temple, and forehead can be challenging to reconstruct in an aesthetic fashion. The author proposes the use of a hybrid flap that is at times bipedicled, perforator, and/or axially supplied. OBJECTIVE To describe the author's experience with the bridge flap and its various subtypes. METHODS An IRB-approved retrospective database review of all bridge flaps was performed at all Skin Cancer Institute facilities. The design and method of dissection are detailed and illustrated, including that of each hybrid of the bridge flap. RESULTS The bridge flap is a single-stage local flap that provides appropriate tissue match by harnessing adjacent laxity of tissues to recreate the original anatomy of the surgical site without disturbance of free margins or aesthetic landmarks. CONCLUSION The bridge flap is simple to perform and a reliable and robust method of obtaining immediate tissue reconstruction for medium sized defects of the scalp, temple, and forehead. Address correspondence and reprint requests to: Paul J.M. Salmon, FRACP, Skincentre, Unit GD, 95 Ascot Avenue, Remuera, Auckland, New Zealand 1095, or e-mail: paul@skincentre.com. The author has indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Invasive Melanoma and Melanoma in Situ Treated With Modified Mohs Micrographic Surgery With En Face Permanent Sectioning: A 10-Year Retrospective Review BACKGROUND Successful surgical treatment of cutaneous melanoma is dependent on margin control. OBJECTIVE To determine efficacy of modified Mohs micrographic surgery (mMMS) with en face permanent margins in management of invasive melanoma (IM) and melanoma in situ (MIS). METHODS A retrospective cohort study evaluating local recurrence, 5-year recurrence-free survival, and 5-year melanoma-specific survival. Overall, 657 melanomas (128 IM and 529 MIS) from 631 patients were treated using mMMS during a 10-year period. Follow-up information was obtained from medical records and telephone encounters. RESULTS The median follow-up time was 5.18 years. Most melanomas were located on the head and neck 93.6% (615/657). Margins required for clearance were 0.77 ± 0.44 cm (mean ± SD). Local recurrence was identified in 1.98% (13/657) of melanomas with no local recurrences in IM. Five-year local recurrence-free and melanoma-specific survival rates were estimated to be 96.9% (95% confidence interval [CI]: 94.6%–98.2%) and 99.0% (95% CI: 97.7%–99.6%). There were 5 melanoma-related deaths. CONCLUSION Modified Mohs micrographic surgery is an effective treatment of melanoma as evidenced by low local recurrence rates and high melanoma-specific survival. Address correspondence and reprint requests to: Anna Bar, MD, Department of Dermatology, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, Oregon 97239-3098, or e-mail: bara@ohsu.edu The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.

Use of Lasers for Iron-Induced Accidental Tattoos: Experience at a Tertiary Referral Center BACKGROUND Awareness of accidental tattoos after iron injections with paravenous leakage is low. No larger patient cohorts have been analyzed. The lesions are a burden to the patients. The only known treatment is laser therapy. OBJECTIVE To characterize the clinical appearance and development of iron-induced tattoos and to demonstrate safe and efficient removal with quality-switched (QS) and picosecond lasers. MATERIALS AND METHODS The authors conducted a retrospective systematic analysis on patients who presented at the Dermatology Department of the University Hospital of Zurich between Year 2008 and 2017 with accidental hyperpigmentations after iron injections. From 29 collected patients, 13 received laser treatment and were analyzed with reference to the lasers used, including wavelength, fluence, spot size, intervals, number of sessions, and overall success. The authors defined the latter as a complete removal or as patients' satisfaction. RESULTS The authors treated 13 patients and completed the treatment in 8 patients, with an average of 5.6 sessions. No complications occurred. CONCLUSION Spontaneous regression of iron-induced tattoos is possible within 1 to 2 years, but not guaranteed. Removal with QS ruby, Nd:YAG, and picosecond lasers can be achieved within a mean number of 5.6 sessions. Assuring a valid indication before intravenous iron administration is important. Address correspondence and reprint requests to: Laurence Imhof, MD, Director of Physical Treatments and Aesthetic Dermatology, Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland, or e-mail: laurence.imhof@usz.ch The authors have indicated no significant interest with commercial supporters. © 2019 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.