The association between cigarette smoking and necrosis of flaps and full-thickness grafts was analyzed in 220 patients. Review of a series of 916 flaps and full-thickness grafts revealed 44 patients in whom some degree of tissue necrosis occurred. These patients with necrosis were age and gender matched with 176 controls randomly selected from the remaining 872 patients. Current high-level smokers, that is those smoking one or more packs per day, had necrosis develop approximately three times more frequently than never smokers, low-level smokers (less than one pack per day), or former smokers (95% confidence interval, 1.2 to 8.2). Former smokers (relative risk, 1.4; 95% confidence interval, 0.6 to 3.2) and low-level smokers (relative risk, 1.1; 95% confidence interval, 0.2 to 6.1) were at a negligible increased risk for necrosis that was not significantly different from never smokers. Once tissue necrosis developed, the median percent of the visible flap or graft tissue that necrosed was approximately threefold greater among current smokers (regardless of the number of packs per day smoked) than never smokers.
Malignancies of the nail unit are relatively uncommon, with squamous cell carcinoma (SCC) representing most of the reported cases. Squamous cell carcinoma of the nail unit, although commonly considered to be a curable malignancy, can and does kill. Review of the literature as well as a personal series confirm that Mohs micrographic surgery is an ideal treatment for periungual and subungual SCCs without osseous involvement. In addition, the anatomy and histology of nail unit SCC, as well as prognostic factors and perioperative evaluation as they relate to performing Mohs micrographic surgery, are reviewed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.