Publications

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

Below are some of the more recent articles - please click on the "read more" button to view the entire article.

To view a PDF Version of the following articles - please click on the following links:

 

 

PRACTICE POINTS

  • The use of a full thickness posterior deltoid scoop graft can be used for large difficult to close Mohs defects.
  • The site of excision of the graft does not need to be sutured; this will heal by
    secondary intention.
  • The graft technique is simple and easy to perform and has shown effective
    healing with minimal scarring.

A novel method of skin closure using a full thickness posterior deltoid scoop graft is described for large difficult to close Mohs defects. The ease of use and success of healing of this type of graft is particularly of note. A case is presented with clinical photographs to demonstrate the benefits and results when performing this technique.

Patients who have had Mohs surgery may be left with sizeable defects that cannot be closed primarily. These defects may prove especially challenging when a surgeon is faced with a large defect in a patient who is elderly with fragile skin. Surgeons may find defects on the lower leg defects or dorsal foot to be exceptionally difficult to close and may also take a lengthy amount of time to heal. The surgeon will most likely consider various surgical options.

Surgeons may consider this novel method of using posterior deltoid skin grafts as an effective surgical closure in such instances of sizeable Mohs defects. This article will describe a novel and simple graft technique that will be demonstrated by a case. The area where the graft is excised will not need sutures and will heal by secondary intention resulting in a minimal scar. This procedure can be performed using a DermaBlade, Xeroform Occlusive Gauze Patch, Nylon black monofilament nonabsorbable 4-0, Surgical Suture Absorbable Plain gut 5-0, 2 small bolsters, and Lidocaine HCl 1% and Epinephrine 1:100,000 Injection (Figure 1).

Graft and Closure Technique

The skin is first cleansed with a topical antiseptic, such as Hibiclens, where the graft will be taken from on the posterior deltoid area of the arm. The excision area is measured by outlining the area of the mohs defect with a sterile pen. The area is injected with Lidocaine HCl 1% and Epinephrine 1:100,000. The excision can be performed in one large scoop movement using a DermaBlade. The graft donor site from the posterior deltoid area of the arm will then heal by secondary intention without the need for suturing (Figure 2). The graft excision site will then resemble somewhat of a small vaccination scar. The surgeon will then cut four 2mm slits in the graft to allow exudate to come through. The graft will then be placed on the area of the Mohs defect with the occlusive gauze patch. The 2 small bolsters will then be sutured to the sides of the graft. An advantage of using this procedure is that the surgeon can control the depth and thickness of the graft easily using the DermaBlade. This procedure requires a minimal amount of time and the use of a few large movements make it quite simple to perform.

Figure 1. From left to right the supplies include 2 small bolsters, Surgical Suture Absorbable Plain Gut 5-0, Nylon black monofilament nonabsorbable 4-0, DermaBlade, and a Xeroform Occlusive Gauze Patch.


Figure 2. Graft excision site of posterior deltoid area of the patient’s arm healing by secondary intention without the bandage (A) and with the bandage (B).

Figure 3. Patient’s dorsal right foot where the skin was to be removed (A). The patient’s right dorsal foot is shown partially healed (B) and fully healed (C).

Case Report

The procedure described was performed on a patient’s dorsal right foot (Figure 3) where the Mohs defect was located. This defect following Moh’s surgery was so
large that it could not be sutured primarily, which is why this novel procedure was considered. The graft was taken from the posterior deltoid area of her right arm,
which was not sutured. Both the posterior deltoid area of the arm and the dorsal right foot displayed efficient healing throughout the entire process.

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.

Technique:

In our clinic multiple small surgical procedures are performed daily. These wounds are often dressed with a sterile 3x3 4 ply cotton ultra-gauze by crosstex covered by Hypafix Conformable Retention Tape. Hypafix is a low allergy adhesive, non woven dressing retention sheet. Hypafix is easily conformable, increasing adhesion to a variety of body parts, while allowing freedom of movement. It comes in a broad size range to give complete coverage of any wound. Hypafix is indicated for post-operative wound dressing, gauze retention, securing catheter and drainage tubes, and patello-femoral positioning techniques.

We suggest a novel use for the Hypafix dressing which will allow the dermatologist freedom to perform surgical procedures solo. We suggest leaving Hypafix attached at the base, in a gravitationally dependent position. (Fig 1) It can then function to catch any blood or debris that might drip from your surgical field. (Fig 2) This same dressing can then be reused after the procedure to cover the wound site. This simple technique can save time for the dermatologist as well as provide a successful way to perform surgery without an assistant.

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

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.

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O'Donogue Dermatology
1952 Field Road
Sarasota FL 34231

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