Dr. O'Donoghue occasionally writes or co-authors articles for contribution to outstanding publications including "Cosmetic Dermatology" and "Cutis".

COSMETIC DERMATOLOGY MAY 2011 VOL 24 NO. 5

J Morgan O'Donoghue, MD and Kate Ross, MD

Dr J Morgan O'Donoghue is the medical director of O'Donoghue Dermatology in Sarasota, Florida, Kate Ross, MD is with the University of South Florida Department of Dermatology

The authors report no conflict of interest in relation to this article

Correspondence: J Morgan O'Donoghue, MD, 1952 Field Road Sarasota, Florida 34231

Erythema Multiforme majus (EMM) is a hypersensitivity reaction usually secondary to medications, viruses or other infections. Its presentation is fairly typical with a symmetrical distribution of vesicles, bullae or tagetoid lesions on the upper body arms, legs, palms, feet and oral mucosa. The authors present a case of EMM with a very unusual clinical presentation evolving over time into a unique, almost dermatomal distribution. Typical therapies were not initially helpful and intravenous antibody had to be administered.

Erythema multiforme majus (EMM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) were once believed to be on a spectrum of severe cutaneous adverse reactions. In the past few years, it has been debated that EMM is, in fact, a separate entity from SJS and TEN.¹

Auquier-Dunant et al¹ reported that EMM occurs most often in young male individuals, with a 10-fold higher rate of recurrence and a milder presentation than are found in patients with SJS or TEN. Herpes has been identified as the principal risk factor, occurring in 70% to 80% of cases of EMM.² Multiple target lesions are present, affecting less than 10% of the body surface area (BSA). It is often symmetric, with the distribution beginning acrally (dorsal surfaces of hands, feet, elbows, and knees).³ Oral lesions are found in 70% of cases but are not required for diagnosis.³

Cosmetic Dermatology April 2009 Volume 22 No. 4

The ability to perform surgery efficently and safely is a necessity to the dermatologic surgeon.

Sometimes, depending on various situations, the dermatologist may find themselves doing surgery without the luxury of an assistant. One of the most valuable services a surgical assistant provides is blotting excess blood in the field. We describe a novel technique for the dermatologic surgeon to use to provide temporary blotting and collection of blood when a surgical assistant is not readily available.

Cutis 2009;84:138-140,161-162

Report of a case and review of the literature

J Morgan O’Donoghue, MD - Yvana P. Céspedes, MD - Paul F. Rockley, MD - Thomas P. Nigra, MD

CASE REPORT 

A 26-year-old white female with a past medical history remarkable for systemic lupus erythematosus and vasculitis developed grand mal seizures, which were controlled with oral phenytoin 300 milligrams per day. Three weeks later, she noticed the onset of generalized pruritus and skin tenderness. The following day, she developed fever, chills, mucous membrane swelling and a symmetrical, erythematous, morbilliform eruption on the extensor aspects of the distal extremities. During the next 24 hours, the eruption slowly evolved from discrete, reddish macules and papules to confluent, necrotic blisters involving the extremities, trunk, head, neck, and mucosal surfaces

At the time of examination the patient had a temperature of 40 C, widespread tender erythema, hemorrhagic vesiculobullous lesions and seropurulent, crusted erosions. Approximately 20 percent of the body surface area was covered with necrotic epidermis. A positive direct Nikolsky sign was noted on lesional skin only. Mucosal surfaces contained some inflammatory bullous and erosive lesions. Conjunctival involvement was characterized by bilateral cheimosis, redness and lacrimation.

Cosmetic Dermatology October 2008 Volume 21 No.10

J. Morgan O'Donoghue, MD - Kevin M. Cronin, BA

The closure of some lower extremity surgical defects may challenge the dermatologic surgeon. This is especially the case with older patients who have severely atrophic, friable skin that makes suture placement difficult if there is any wound tension.

We describe the bilateral subcutaneous island pedicle flap as a suitable closure technique for lower extremity defects when primary linear or layered closure is not an option. In our case report, 2 triangular flaps on opposite sides of the defect were incised down to the subcutaneous tissue, advanced into the surgical defect, and sutured into place with buried subcutaneous sutures. 

This repair is an excellent consideration for thin skin resembling tissue paper in which minimal wound tension is necessary for sutures to hold properly. The bilateral subcutaneous island pedicle flap is a versatile, effective means of repairing many lower extremity defects when primary linear or layered closure is not an option. 

A variety of repairs has been described for closure of surgical lower extremity defects. These include second intention, full- and split-thickness skin grafts, rotation flaps, triangular flaps, and primary closures, side¬to-side layered closures, or simple closures. The bilateral sub¬cutaneous island pedicle flap, or bilateral V -Y advancement flap, is shown to be a versatile, effective means of repairing many facial defects following excisional surgery and has been widely described for defects of the ear, nasolabial fold, and lip area.  We demonstrate how this repair may also be considered for closure of lower extremity defects.