Usefulness of Bone Wax in Surgery for Cutaneous Squamous Cell Carcinoma in Patients With High Surgical Risk

array:23 ["pii" => "S0001731022000515" "issn" => "00017310" "doi" => "10.1016/j.ad.2022.01.018" "estado" => "S300" "fechaPublicacion" => "2022-02-01" "aid" => "2902" "copyrightAnyo" => "2022" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:T216-T218" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:19 [ "pii" => "S0001731021003124" "issn" => "00017310" "doi" => "10.1016/j.ad.2021.02.015" "estado" => "S300" "fechaPublicacion" => "2022-02-01" "aid" => "2745" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:216-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "CARTA CIENTÍFICO-CLÍNICA" "titulo" => "Utilidad de la cera para huesos en la cirugía del carcinoma epidermoide cutáneo del cuero cabelludo en pacientes con alto riesgo quirúrgico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "216" "paginaFinal" => "218" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of Bone Wax in Surgery for Cutaneous Squamous Cell Carcinoma in Patients With High Surgical Risk" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1332 "Ancho" => 1750 "Tamanyo" => 395660 ] ] "descripcion" => array:1 [ "es" => "A) Tumoración cutánea mayor de 2cm localizado en cuero cabelludo. B) Defecto quirúrgico tras exéresis de la tumoración con exposición ósea. C) Aplicación de la cera de hueso moldeada en el defecto quirúrgico. D) Apósito compresivo oclusivo con agrafes metálicos. E) Granulación completa tras retirada de la cera para huesos a los 30 días de la intervención. F) Cicatrización completa del defecto quirúrgico." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ortiz-Prieto, A. Padial-Gómez, J. Márquez-Enríquez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ortiz-Prieto" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Padial-Gómez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Márquez-Enríquez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003124?idApp=UINPBA000044" "url" => "/00017310/0000011300000002/v1_202203040527/S0001731021003124/v1_202203040527/es/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S0001731021003124" "issn" => "00017310" "doi" => "10.1016/j.ad.2021.02.015" "estado" => "S300" "fechaPublicacion" => "2022-02-01" "aid" => "2745" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2022;113:216-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "CARTA CIENTÍFICO-CLÍNICA" "titulo" => "Utilidad de la cera para huesos en la cirugía del carcinoma epidermoide cutáneo del cuero cabelludo en pacientes con alto riesgo quirúrgico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "216" "paginaFinal" => "218" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Usefulness of Bone Wax in Surgery for Cutaneous Squamous Cell Carcinoma in Patients With High Surgical Risk" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1332 "Ancho" => 1750 "Tamanyo" => 395660 ] ] "descripcion" => array:1 [ "es" => "A) Tumoración cutánea mayor de 2cm localizado en cuero cabelludo. B) Defecto quirúrgico tras exéresis de la tumoración con exposición ósea. C) Aplicación de la cera de hueso moldeada en el defecto quirúrgico. D) Apósito compresivo oclusivo con agrafes metálicos. E) Granulación completa tras retirada de la cera para huesos a los 30 días de la intervención. F) Cicatrización completa del defecto quirúrgico." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ortiz-Prieto, A. Padial-Gómez, J. Márquez-Enríquez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ortiz-Prieto" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Padial-Gómez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Márquez-Enríquez" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021003124?idApp=UINPBA000044" "url" => "/00017310/0000011300000002/v1_202203040527/S0001731021003124/v1_202203040527/es/main.assets" ] ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "Case and Research Letter" "titulo" => " Usefulness of Bone Wax in Surgery for Cutaneous Squamous Cell Carcinoma in Patients With High Surgical Risk" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "T216" "paginaFinal" => "T218" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Ortiz-Prieto, A. Padial-Gomez, J. Márquez-Enríquez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Ortiz-Prieto" "email" => array:1 [ 0 => "ale.ortizprieto@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Padial-Gomez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Márquez-Enríquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario de Jerez, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la cera para huesos en la cirugía del carcinoma epidermoide cutáneo del cuero cabelludo en pacientes con alto riesgo quirúrgico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1332 "Ancho" => 1751 "Tamanyo" => 384860 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A, Skin tumor measuring >2 cm on the scalp. B, Surgical defect after removal of a tumor involving exposure of the bone. C, Application of bone wax molded into the surgical wound. D, Occlusive compressive dressing with metal staples. E, Complete granulation on withdrawal of bone wax 30 days after the surgery. F, Complete healing of the surgical wound." ] ] ] "textoCompleto" => "Cutaneous squamous cell carcinoma is the second most common tumor in humans. Its incidence is growing and remains underestimated. In Spain, the gross incidence is estimated at 38.16 cases per 100 000 persons per year<a class="elsevierStyleCrossRef" href="#bib0005">1</a>. Cutaneous squamous cell carcinoma is the second most common cause of death from skin cancer after melanoma and is responsible for most deaths from skin cancer in persons aged >85 years<a class="elsevierStyleCrossRef" href="#bib0010">2</a>.In dermatologic surgery, second-intention healing is an alternative to reconstruction via direct closure, flaps, or grafts. In surgical treatment of skin cancer, second-intention healing has the advantage of not involving movement of adjacent planes and facilitating detection of recurrence at deeper levels. The main disadvantage of this technique is the longer time to wound healing. Second-intention healing may be a useful option in the surgery of squamous cell carcinomas located on the scalp of elderly patients with comorbid conditions that increase the risks associated with surgery.Bone wax is a biologically inert material that does not cause skin allergy or irritant dermatitis. It is not absorbed and remains in the wound without adhering to it. It is also very malleable after heating with the hands before application. These qualities make it effective as a sterile dressing for the formation of granulation tissue in surgery involving exposure of bone and cartilage<a class="elsevierStyleCrossRef" href="#bib0015">3</a>.We analyzed a series comprising 6 elderly patients with cutaneous squamous cell carcinoma measuring between 2 and 4 cm on the scalp. The tumors were removed, with exposure of the bone, including the periosteum, in all 6 cases. Closure was by second intention and compression with gauze attached to the skin using staples (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patients’ age varied from 79 to 91 years. All 6 patients had cardiovascular comorbidity (American Society of Anesthesiologists III-IV). Free margins were achieved in all cases, and no subsequent procedures for definitive coverage with a skin graft were necessary. Surgery took less than 15 minutes in all cases. The mean score on the visual analog scale for pain (0 to 10) on withdrawal of the bone wax at 2 and 3 weeks after surgery was 1.5. Moist wound healing was performed every 72 hours with mupirocin ointment after cleaning the wound with saline solution and applying a silicone mesh dressing (Mepitel). The mean time to complete scarring was 54.6 days. As for postsurgical complications, no patients required the compressive dressing to be removed early, and no bleeding was recorded. Infection of the surgical bed by Staphylococcus aureus was recorded in only 1 patient. This was treated satisfactorily with oral antibiotics (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In conclusion, we would like to highlight that second intention healing with bone wax as a sterile dressing could be an alternative for removal of cutaneous squamous cell carcinoma in elderly patients for whom surgery may be high-risk. This approach reduces the duration of surgery and obviates the need for more complex techniques with potentially greater morbidity.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ortiz-Prieto A, Padial-Gomez A, Márquez-Enríquez J. Utilidad de la cera para huesos en la cirugía del carcinoma epidermoide cutáneo del cuero cabelludo en pacientes con alto riesgo quirúrgico. Actas Dermosifiliogr. 2022;113:216–218." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1332 "Ancho" => 1751 "Tamanyo" => 384860 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "A, Skin tumor measuring >2 cm on the scalp. B, Surgical defect after removal of a tumor involving exposure of the bone. C, Application of bone wax molded into the surgical wound. D, Occlusive compressive dressing with metal staples. E, Complete granulation on withdrawal of bone wax 30 days after the surgery. F, Complete healing of the surgical wound." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviation: VAS, visual analog scale." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VAS score at withdrawal of bone wax \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time to complete healing, d \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postsurgical complications \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Need for additional procedure \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Infection of surgical bed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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Tan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jso.23731" "Revista" => array:6 [ "tituloSerie" => "J Surg Oncol." "fecha" => "2014" "volumen" => "110" "paginaInicial" => "876" "paginaFinal" => "882" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25088537" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cera para huesos en la cirugía dermatológica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Alegre" 1 => "J.R. Garcés" 2 => "L. Puig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2013.03.001" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." 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Case and Research Letter

Usefulness of Bone Wax in Surgery for Cutaneous Squamous Cell Carcinoma in Patients With High Surgical Risk

Utilidad de la cera para huesos en la cirugía del carcinoma epidermoide cutáneo del cuero cabelludo en pacientes con alto riesgo quirúrgico

A. Ortiz-Prietoa,

Corresponding author

ale.ortizprieto@gmail.com

Corresponding author.

, A. Padial-Gomezb, J. Márquez-Enríquezb

a Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, Spain

b Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario de Jerez, Cádiz, Spain

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            "entidad" => "Unidad de Gesti&#243;n Cl&#237;nica de Dermatolog&#237;a M&#233;dico-Quir&#250;rgica y Venereolog&#237;a&#44; Hospital Universitario Puerta del Mar&#44; C&#225;diz&#44; Spain"
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            "entidad" => "Unidad de Gesti&#243;n Cl&#237;nica de Dermatolog&#237;a M&#233;dico-Quir&#250;rgica y Venereolog&#237;a&#44; Hospital Universitario de Jerez&#44; C&#225;diz&#44; Spain"
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      "es" => array:1 [
        "titulo" => "Utilidad de la cera para huesos en la cirug&#237;a del carcinoma epidermoide cut&#225;neo del cuero cabelludo en pacientes con alto riesgo quir&#250;rgico"
      ]
    ]
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        "etiqueta" => "Figure 1"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Skin tumor measuring &#62;2&#8239;cm on the scalp&#46; B&#44; Surgical defect after removal of a tumor involving exposure of the bone&#46; C&#44; Application of bone wax molded into the surgical wound&#46; D&#44; Occlusive compressive dressing with metal staples&#46; E&#44; Complete granulation on withdrawal of bone wax 30 days after the surgery&#46; F&#44; Complete healing of the surgical wound&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Cutaneous squamous cell carcinoma is the second most common tumor in humans&#46; Its incidence is growing and remains underestimated&#46; In Spain&#44; the gross incidence is estimated at 38&#46;16 cases per 100 000 persons per year<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Cutaneous squamous cell carcinoma is the second most common cause of death from skin cancer after melanoma and is responsible for most deaths from skin cancer in persons aged &#62;85 years<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In dermatologic surgery&#44; second-intention healing is an alternative to reconstruction via direct closure&#44; flaps&#44; or grafts&#46; In surgical treatment of skin cancer&#44; second-intention healing has the advantage of not involving movement of adjacent planes and facilitating detection of recurrence at deeper levels&#46; The main disadvantage of this technique is the longer time to wound healing&#46; Second-intention healing may be a useful option in the surgery of squamous cell carcinomas located on the scalp of elderly patients with comorbid conditions that increase the risks associated with surgery&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Bone wax is a biologically inert material that does not cause skin allergy or irritant dermatitis&#46; It is not absorbed and remains in the wound without adhering to it&#46; It is also very malleable after heating with the hands before application&#46; These qualities make it effective as a sterile dressing for the formation of granulation tissue in surgery involving exposure of bone and cartilage<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We analyzed a series comprising 6 elderly patients with cutaneous squamous cell carcinoma measuring between 2 and 4&#8239;cm on the scalp&#46; The tumors were removed&#44; with exposure of the bone&#44; including the periosteum&#44; in all 6 cases&#46; Closure was by second intention and compression with gauze attached to the skin using staples &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The patients&#8217; age varied from 79 to 91 years&#46; All 6 patients had cardiovascular comorbidity &#40;American Society of Anesthesiologists III-IV&#41;&#46; Free margins were achieved in all cases&#44; and no subsequent procedures for definitive coverage with a skin graft were necessary&#46; Surgery took less than 15 minutes in all cases&#46; The mean score on the visual analog scale for pain &#40;0 to 10&#41; on withdrawal of the bone wax at 2 and 3 weeks after surgery was 1&#46;5&#46; Moist wound healing was performed every 72 hours with mupirocin ointment after cleaning the wound with saline solution and applying a silicone mesh dressing &#40;Mepitel&#41;&#46; The mean time to complete scarring was 54&#46;6 days&#46; As for postsurgical complications&#44; no patients required the compressive dressing to be removed early&#44; and no bleeding was recorded&#46; Infection of the surgical bed by <span class="elsevierStyleItalic">Staphylococcus aureus</span> was recorded in only 1 patient&#46; This was treated satisfactorily with oral antibiotics &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; we would like to highlight that second intention healing with bone wax as a sterile dressing could be an alternative for removal of cutaneous squamous cell carcinoma in elderly patients for whom surgery may be high-risk&#46; This approach reduces the duration of surgery and obviates the need for more complex techniques with potentially greater morbidity&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ortiz-Prieto A&#44; Padial-Gomez A&#44; M&#225;rquez-Enr&#237;quez J&#46; Utilidad de la cera para huesos en la cirug&#237;a del carcinoma epidermoide cut&#225;neo del cuero cabelludo en pacientes con alto riesgo quir&#250;rgico&#46; Actas Dermosifiliogr&#46; 2022&#59;113&#58;216&#8211;218&#46;</p>"
      ]
    ]
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      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#44; Skin tumor measuring &#62;2&#8239;cm on the scalp&#46; B&#44; Surgical defect after removal of a tumor involving exposure of the bone&#46; C&#44; Application of bone wax molded into the surgical wound&#46; D&#44; Occlusive compressive dressing with metal staples&#46; E&#44; Complete granulation on withdrawal of bone wax 30 days after the surgery&#46; F&#44; Complete healing of the surgical wound&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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          0 => array:3 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; VAS&#44; visual analog scale&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age&#44; y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VAS score at withdrawal of bone wax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time to complete healing&#44; d&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Postsurgical complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Need for additional procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infection of surgical bed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information

ISSN: 00017310
Original language: English

DOI:10.1016/j.ad.2022.01.018

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Year/Month	Html	Pdf	Total

2024 November	17	10	27
2024 October	131	52	183
2024 September	121	37	158
2024 August	138	56	194
2024 July	99	47	146
2024 June	108	47	155
2024 May	108	40	148
2024 April	68	31	99
2024 March	84	42	126
2024 February	75	38	113
2024 January	103	30	133
2023 December	73	27	100
2023 November	60	30	90
2023 October	63	26	89
2023 September	64	27	91
2023 August	49	16	65
2023 July	80	32	112
2023 June	72	24	96
2023 May	47	28	75
2023 April	35	26	61
2023 March	88	31	119
2023 February	39	30	69
2023 January	62	44	106
2022 December	63	43	106
2022 November	44	41	85
2022 October	66	36	102
2022 September	46	52	98
2022 August	51	40	91
2022 July	56	39	95
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