The authors describe an easy to make and apply rule for local tumescent anesthetic solution in dermatologic surgical procedures. They attest the safety and simplicity of the rule, based on ambulatory surgery practice for over 20 years and 8 years usage of the solution in more than a thousand procedures.

Keywords: TUMESCENT LOCAL ANESTHESIA

Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Keywords: ANESTHESIA, LIDOCAINE, AMBULATORY SURGICAL PROCEDURES, IONTOPHORESIS

Introduction: Local anesthesia is the most common form of anesthesia used in cutaneous surgery. Some patients have comorbidities that put them at risk for general anesthesia.Tumescent anesthesia is the technique of injecting a large amount of dilute local anesthesia into the subcutaneous plane of the skin.Tumescent anesthesia can minimize discomfort, aid in hemostasis, and contribute to the ease of closing large surgical defects that would otherwise be challenging. Objective: To discuss the pros and cons of using tumescent anesthesia in dermatologic surgery. Conclusion: Tumescent anesthesia is a viable option that can aid in cutaneous reconstructive surgery, especially when removing tissue in the deeper subcutaneous fat or fascia.Tumescent anesthesia is also associated with good results and few adverse reactions.

Keywords: ANESTHESIA, SKIN NEOPLASMS, MOHS SURGERY

Introdução: The increase in the demand for cosmetic procedures has in turn stimulated the search for effective and safe analgesia.Topical anesthetics are an alternative to infiltrative anesthesia, and promote an appropriate analgesia without inducing adverse effects. Objective: To compare the pain ratings of two topical lidocaine formulations in patients undergoing fractional CO2 laser therapy. Methods: Eight patients underwent a single fractional CO2 laser session after applying a commercial formulation of 4% lidocaine on the right side of the face and a dispensed 30% lidocaine formulation combined with 7% tetracaine on the left side of the face.The intensity of the pain was assessed using the visual analogue pain intensity scale at the end of the procedure. Results: No significant statistical differences were detected between the formulations. Conclusions: Formulations with high concentrations of anesthetics are not more effective than commercial products in producing analgesia.

Keywords: ANESTHETICS, ANESTHESIA AND ANALGESIA, LASERS

Introduction: Liposuction is a cosmetic procedure that removes undesired body fat. More recently, it has been associated with complications and deaths, raising concerns about the risk involved in the procedure. Since the tumescent technique was described by Jeffrey Klein, surgeons from around the world have contributed to the development of the technique, making liposuction with microcannulas and local anesthesia a safe and effective procedure that achieves its objective. Nevertheless, severe complications and deaths are described in the literature when the procedure is performed under general anesthesia or with IV drugs, or when there is a breach of the protocols recommended for local tumes- cent anesthesia. Therefore, it is necessary to establish protocols for liposuction procedures that use local tumescent anesthesia, to promote safety.
Objective:To demonstrate that using local tumescent anesthesia in liposuction is safe.
Methods: Retrospective study of medical records of 568 patients who underwent 1,107 liposuction procedures assisted by local tumescent anesthesia between 1998 and 2004.
Results: There were no deaths or complications that required hospitalization.
Conclusions: When standardized protocols are observed, liposuction assisted exclusively by local tumescent anesthesia was shown to be a safe procedure.

Keywords: LIPECTOMY, ANESTHESIA, LOCAL, SAFETY

The present study introduces an advancement and rotation flap that can be used for the reconstruction of surgical defects located in the malar region. The design is essentially a triangle containing the defect, where one line runs parallel to the lateral part of the nose along the nasolabial fold, while another starts at the same point and follows the dynamic lines of the malar region. In order to complete the geometrical shape of the flap, a Burow’s triangle is performed at the end of the fold. The final tension force occurs on the nasal wall, preventing ectropion. The repositioning of the malar fat restores the contour of the region.

Keywords: MOHS SURGERY, SURGICAL FLAPS, ZYGOMA

Dermatofibrosarcoma protuberans is a spindle cell neoplasm of intermediate malignancy, nonetheless it presents a high risk of local recurrence. It mainly affects the trunk and limbs, and is rare on the face. The treatment of the tumor can be carried out using conventional surgery with wide surgical margins or Mohs micrographic surgery. Radiation and chemotherapy can be indicated in selected cases. The present article reports the case of a 39-year-old male patient with a 0.7cm yellowish papule on the forehead, whose biopsy and immunohistochemistry confirmed the tumor's diagnosis. The lesion was treated through Mohs micrographic surgery with good aesthetic results.

Keywords: DERMATOFIBROSARCOMA; SARCOMA; MOHS SURGERY

True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.

Keywords: GYNECOMASTIA; AMBULATORY SURGICAL PROCEDURES; DERMATOLOGY; ANESTHESIA, LOCAL.

Deep phenol chemical peeling with the Baker-Gordon formula is indicated for the treatment of severe facial aging. A review of pertinent literature on its main limiting factor-pain-was carried out with searches on two databases (PubMed and Cochrane Library) using the following keywords: chemexfoliation, peel, peeling, and phenol, also cross-referencing with the terms anesthesia and analgesia. The search resulted in 151 articles that contributed little to clarifying what would be the ideal approach for managing pain when using a deep chemical peel with the Baker-Gordon formula. As a result, for this procedure, the authors basically relied on the expert experience-in this case, that of the anesthesiologist-which has been described. Therefore, further studies should be carried out in order to achieve a higher level of scientific evidence.

Keywords: CHEMEXFOLIATION; PHENOL; ANESTHESIA; ANALGESIA.

Introduction: In the dermatologic surgery practice, Mohs micrographic surgery is of great value in the excision of cutaneous neoplasias. Nevertheless, in certain types of neoplasia, immunohistochemistry can increase diagnostic accuracy.
Objective: To describe the use of Mohs micrographic surgery associated to immunohistochemistry and evaluate their effectiveness regarding traditional methods.
Method: Mohs micrographic surgery was performed in 5 cases of diverse cutaneous neoplasias. Tissue evaluation with hematoxylin-eosin and immunohistochemistry were carried out intraoperatively.
Results: There was greater prevalence of elderly female patients with higher frequency of recurred basal cell carcinomas in the face. In all cases it was possible to perform immunohistochemistry in the frozen specimen. In most cases, primary closure was carried out in the first stage of the Mohs surgery, without postoperative complications.
Conclusion: The combination of the two techniques can increase the procedure's sensitivity, guaranteeing the presence of free margins, leading to fewer recurrences and allowing the preservation of a greater amount of neoplasia-free tissue.

Keywords: MOHS SURGERY, IMMUNOHISTOCHEMISTRY, SKIN NEOPLASMS

To accurately interpret intraoperative findings in Mohs Micrographic Surgery, it is essential to know the normal tissue histology of different anatomical sites. The freezing sections evaluated by the technique are obtained horizontally, unlike the vertical sections of conventional anatomopathological analysis. According to the literature review, the frozen sections of interest in topographic histology were digitized and detailed from a training Dermatology service case collection.

Keywords: Histology; Mohs Surgery; Skin Neoplasms

We report the case of a 13-year-old girl with a diagnosis of extra-abdominal desmoid fibromatosis, a neoplasm of benign origin but uncommon in the soft tissues. This study aims to expose the rarity of the tumor and its challenging therapeutic approach due to its high frequent local recurrence rates. For the treatment, Mohs micrographic surgery was performed in two stages to obtain a free margin.

Keywords: Fibromatosis, Aggressive; Mohs Surgery; Neoplasms

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

Sarcomas são neoplasias mesenquimais malignas, raras, que acometem, principalmente, crianças e adolescentes. O rabdomiossarcoma, subtipo oriundo da musculatura esquelética, é condição incomum em adultos, acometendo sítios de localização não habitual, crescimento rápido e de difícil tratamento. Apresenta-se caso de adulto jovem com nodulação em lóbulo auricular esquerdo, cuja análise histopatológica e imuno-histoquímica confirmou tratar-se de rabdomiossarcoma alveolar, o qual foi conduzido em conjunto com a Oncologia.

Keywords: Rabdomiossarcoma Alveolar; Miogenina; Desmina; Excisão de Linfonodo