Management of giant congenital nevi in infants by excision under local anesthesia

Self Cite

Summary Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long‐lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia‐associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long‐lasting pain control.

Section: Introductionmentioning

confidence: 99%

Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants

Roerden

Neunhoeffer

Götz

et al. 2021

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“…Embryonalentwicklung eintritt, umso intensiver ist das klinische Bild des KMN und kann zur Beteiligung anderer Organsysteme führen. Unterschieden werden oberflächliche (wie Dermabrasio und ablativer Laser) von tiefen Interventionen (serielle Exzisionen mit power-stretching, Lappenplastik sowie Spalthauttransplantationen) [56][57][58]. Hierbei müssen die Aspekte der Notwendigkeit einer histologischen Beurteilung, Schmerzen und Infektionsrisiko, Dauer der Hospitalisierung, kosmetisches Ergebnis, Rezidiv-Risiko und Melanom-Prävention individuell beurteilt und gegeneinander abgewogen werden [56].…”

Section: Je Früher Die Somatische Mutation In Derunclassified

Das Spektrum melanozytärer Nävi und deren klinische Bedeutung

Frischhut

Zelger

André

et al. 2022

Zusammenfassung Die Größe der Thematik melanozytärer Nävi (MN) steht in einem direkten Verhältnis zur Relevanz in der alltäglichen klinischen Arbeit. Die klinische Präsentation ist hochgradig variabel und verschiedene MN haben unterschiedliche prognostische Bedeutung in Bezug auf Komorbidität und mögliches Entartungsrisiko. Relevante Kriterien in der Einschätzung eines MN sind neben den Kriterien der ABCDE‐Regel der Zeitpunkt des Auftretens des MN, die Wachstumstendenz, die Verteilung und der Vergleich mit anderen MN des jeweiligen Individuums. Es soll hier eine Übersicht gegeben werden, welche Erkenntnisse in Bezug auf die Entwicklung und genetischen Hintergründe MN und ein gegebenenfalls bestehendes Entartungsrisiko gewonnen werden konnten. Zudem können gewisse klinische und/oder dermatoskopische Merkmale dem Kliniker eine Entscheidungshilfe im Management unterschiedlicher MN liefern.

“…In this context, the clinical and organizational benefits of surgery and re‐excision under local anesthesia with epinephrine supplementation represent a solution that is applied as standard procedure in large centers [2]. Important features are an operating room with less bleeding, shorter interventions and changing times, good intra‐ and postoperative analgesia, as well as rapid mobilization of older patients after surgery [2, 35, 53].…”

Section: Local Anesthesia With Epinephrine Supplementation On Acral Areas and Penis In Clinical Practicementioning

confidence: 99%

Use of local anesthetics with an epinephrine additive on fingers and penis – dogma and reality

Schnabl

Ghoreschi

Scheu

et al. 2021

Self Cite

Summary Epinephrine supplements in local anesthetics are regularly used for surgery in areas with terminal vessels. According to the pharmaceutical guidelines, the use of epinephrine as an additive to local anesthetics is contraindicated for these areas. This review provides an overview of the current scientific data as well as new clinical developments in various fields. It also reviews the current legal situation. A literature research was carried out to survey the current status of relevant data. Written inquiries to several German institutions (Institute for Quality and Efficiency in Health Care, National Association of Statutory Health Insurance Physicians, Center for Clinical Studies Tübingen, Federal Institute for Drugs and Medical Devices) were made to determine the legal situation. No evidence was found in the literature for a causal relationship between the use of epinephrine as a vasoconstrictor and necrosis of the finger or penis. Studies and reviews show that the use of local anesthetics with epinephrine on the fingers or penis is a safe procedure with many clinical and economic advantages. In routine clinical practice, the WALANT method (Wide Awake Local Anesthesia No Tourniquet) as well as the increasing incidence of skin tumors in acral areas has led to a tendency towards increasing use. However, its use is still legally contraindicated, and the pharmaceutical companies show no interest in supporting a drug study. Further clinical trials – regardless of the strength of the evidence – would not change the current legal contraindication.