Banker AS, Mahadevia BM, Shah H
… +1 more, Banker AA
J Cutan Aesthet Surg
· 2024 · PMID 38736866
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A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly slipped over the plastic sheet that had been placed t...A 25-year-old aesthetician was operating Q-switch pulse (SPECTRA) cosmetic laser machine of 1,064 nm wavelength, for the purpose of skin bleaching. The probe suddenly slipped over the plastic sheet that had been placed to avoid COVID-19 exposure after which she complained of sudden loss of vision. She was diagnosed as having vitreous hemorrhage in her right eye and was treated conservatively for one month. She then complained of central scotoma and was diagnosed to have developed a full-thickness macular hole, for which she was advised vitrectomy surgery. The purpose of this case report is to emphasize the importance of taking precautions during the COVID-19 era and while doing that making sure how to handle the machines so as not to inflict any accidental injury to the operating physician. Macular Holes following skin bleaching with Nd:YAG laser occurring in operating aesthetician is rare as compared to that occurring in the patients.
Vaghasia A, Kamat S, Kansara K
… +2 more, Dharmender J, Shah BJ
J Cutan Aesthet Surg
· 2024 · PMID 38736865
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BACKGROUND: The unappealing appearance of skin in macular amyloidosis (MA) interferes with the patient's quality of life, and treating the condition has been challenging. AIMS AND OBJECTIVES: To compare the efficacy and...BACKGROUND: The unappealing appearance of skin in macular amyloidosis (MA) interferes with the patient's quality of life, and treating the condition has been challenging. AIMS AND OBJECTIVES: To compare the efficacy and safety of 15% trichloroacetic acid (TCA) peel, 35% glycolic acid (GA) peel, and Q-switched Nd-YAG Laser in MA. MATERIALS AND METHODS: Open, prospective study was conducted over 2 years, where after fulfilling the criteria, randomization was done into three groups. Group A: 15% TCA peel; Group B: 35% GA peel; Group C: Q-switched Nd-YAG Laser. Procedures were repeated at monthly intervals for six sittings. On each visit, patients were scored on the following parameters: color score, visual analog score (VAS), physician global assessment (PGA) scale, subjective improvement, and adverse effects. RESULTS: A total of 75 patients (25 patients in each group) completed the treatment. The mean age of study-population was 35.68 ± 9.8 years, with female to male ratio of 11.5:1. The mean change in color score (1.68) was more by Group A, followed by Group C (1.4), followed by Group B (1.16). Similar results were noted by subjective improvement, VAS, and PGA. Adverse events were more in Group A, followed by Group C, followed by Group B. No patient showed permanent adverse events. CONCLUSION: TCA-peel showed superior results over Nd-YAG laser and glycolic-acid peel. TCA-peel being cost-effective with excellent acceptability should be considered a treatment modality.
J Cutan Aesthet Surg
· 2024 · PMID 38736864
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INTRODUCTION: Seborrheic keratosis (SK) are benign lesions with cosmetic concerns. Role of TCA and erbium YAG laser has already been described individually in the literature. However, there is a scarcity of data on the c...INTRODUCTION: Seborrheic keratosis (SK) are benign lesions with cosmetic concerns. Role of TCA and erbium YAG laser has already been described individually in the literature. However, there is a scarcity of data on the comparative evaluation of these two modalities in SK. AIM: The aim of this study was to compare the efficacy and safety profile of Erbium YAG laser ablation with 70% TCA for the treatment of facial SK. MATERIALS AND METHODS: A total of 50 cases of facial SK were included in the study. Group A included SK lesions on the right side of face treated with Erbium YAG laser ablation while Group B included SK lesions on the left side of face treated with topical 70% trichloroacetic acid. Repeated sessions of laser and TCA application were given at 2-week intervals till cure was achieved or up to a maximum of three sessions. Grading of response to treatment was assessed as complete response (100% clearance), partial response (>50 to 99% improvement), and inadequate or no response (<50% improvement). RESULTS: Complete clearance was observed in 40 (80%) and 29 (58%) cases in Groups A and B, respectively. There was a statistically significant difference in clearance rates between the two groups ( 0.019). Number of sessions was significantly lesser in laser group (mean ± SD = 1.24 ± 0.43) than in the 70% TCA group (mean ± SD = 1.88 ± 0.79) ( 0.001). Statistically significant lesser downtime was observed in group A ( 0.001). Patient satisfaction rate was much higher in group A. Hyperpigmentation was more common in group B (TCA). CONCLUSION: Although both the treatment modalities achieved good results, erbium YAG laser ablation showed superior results than 70% TCA with better patient satisfaction rates but more downtime. Also, no major adverse effects were observed in the two groups.
J Cutan Aesthet Surg
· 2024 · PMID 38736863
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BACKGROUND: Facial rejuvenation procedures have been in existence for over a century. Since its first introduction, it improved anatomical understanding and clinical implications and gave rise to numerous techniques and...BACKGROUND: Facial rejuvenation procedures have been in existence for over a century. Since its first introduction, it improved anatomical understanding and clinical implications and gave rise to numerous techniques and re-ideations of the original face-lift. The increase in popularity of face-lift procedures attracts patients of various ages and with different medical comorbidities. In this paper, we describe the less-invasive facelift procedure, termed the "Micro-Face-lift," with minimal complications, a short recovery period, and few contraindications. MATERIALS AND METHODS: The authors retrospectively analyzed the medical files of 51 patients who underwent the "Micro-Face-lift" procedure between 2014 and 2019 by three independent surgeons. RESULTS: Fifty-one patients met the inclusion criteria for the procedure. Forty-nine patients were women (96.1%) and the remainder were men (3.9%). The mean age at the time of the procedure was 60.8 years (range 45-87). Complications were encountered in five patients (9.8%): two hypertrophic scars (3.8%), one hematoma (2%), one surgical wound infection (2%), and one edema (2%), persistent for more than 2 weeks postoperatively. All complications resolved within 6 weeks of postoperatively. Thirty-five patients (68.6%) underwent additional procedures to maximize the aesthetic outcome. Thirty patients (58.8%) underwent submental liposuction and five patients (9.8%) underwent mid-face lipo-filling. The average satisfaction score on the self-reported "Likert" scale was 4.27 (range 1-5). All patients were followed for a minimum period of 18 months. CONCLUSIONS: The "Micro-Face-lift" is a less-invasive procedure that can be performed under local anesthesia and sedation in the outpatient setting. Complication rates and mortality are low, contraindications are rare, and the recovery period is short. In our experience, patient satisfaction is high with the Micro-Face-lift procedure, and the learning curve for the experienced practitioner is short.
Bandopadhyay A, Kapoor A, Kundu K
… +2 more, Jagtap M, Chattopadhyay D
J Cutan Aesthet Surg
· 2024 · PMID 38736860
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BACKGROUND: Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study wa...BACKGROUND: Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study was to translate and validate the PSAS to Hindi. MATERIALS AND METHODS: We did forward and backward translation of the English PSAS together with its validation. In total, 64 patients with postburn facial scars were included. The validation committee consisted of 6 bilingual members. RESULTS: The PSAS-Hindi showed good internal consistency with Cronbach's of 0.86. Test-retest reliability showed good correlation with intra class coefficient being 0.94 (95% confidence interval: 0.83-0.97). CONCLUSION: The PSAS was successfully translated to Hindi, and cross-cultural adaptation was made.
J Cutan Aesthet Surg
· 2024 · PMID 38736859
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INTRODUCTION: Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. MATERIALS AND METHODS: Thirty patients (or...INTRODUCTION: Peeling has withstood the test of time as a simple, minimally invasive method to renew the skin, despite the introduction of more advanced procedures like lasers. MATERIALS AND METHODS: Thirty patients (or 60 sites) with age ranging from 15 to 45 years with mild-to-moderate acne vulgaris were included in the study. Assessment at baseline was done by the global acne grading system score for including mild and moderate acne patients. RESULTS: On grading the improvement according to the 5-point Global Assessment Scale (GAS), it was found that in area A (black peel), 6.7% of patients showed excellent improvement, 86.7% of patients showed good improvement, and 6.7% of patients showed fair improvement. In area B (25%TCA peel), 6.7% of patients showed excellent improvement, 80% of patients showed good improvement, and 13.3% of patients showed fair improvement. DISCUSSION: None of the patients showed poor or worse outcomes in any of the areas. The difference between the groups was not significant ( 0.688). CONCLUSION: There is a paucity of data in the literature regarding the comparison of black peel with other conventional peels in the treatment of acne vulgaris. To the best of our knowledge, this is the first study comparing black peel with TCA peel in the treatment of acne vulgaris.
Rafi S, Budania A, Bhardwaj A
… +7 more, Singh S, Bains A, Benny B, Alam A, Karthick K, Agarwal A, Pathania Y
J Cutan Aesthet Surg
· 2024 · PMID 38736858
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BACKGROUND: Hirsutism is the presence of excessive terminal hair on androgen-dependent sites of the body. Lasers like Alexandrite, diode, and Nd:Yag lasers have been used for hair reduction with varying efficacy. Trichos...BACKGROUND: Hirsutism is the presence of excessive terminal hair on androgen-dependent sites of the body. Lasers like Alexandrite, diode, and Nd:Yag lasers have been used for hair reduction with varying efficacy. Trichoscopy of hair is a simple noninvasive method of hair assessment. However, it has not been used in the assessment of diode laser hair reduction. OBJECTIVES: This study aimed to assess the efficacy and safety of diode laser hair reduction in skin color with the help of clinical and trichoscopic assessment. MATERIALS AND METHODS: This prospective observational study included 73 patients of hirsutism recruited in 18-month period. All participants received sessions of 805 nm diode laser at monthly intervals up to six sessions. Clinical and trichoscopic evaluation along with photographs were obtained at each visit. Side effects, if any, were noted in every sitting. RESULTS: All patients were females of Fitzpatrick skin types III-V. All clinical parameters showed statistically significant hair reduction when compared with baseline. Trichoscopic parameters of hair reduction like total hair count, terminal hair count, and terminal/vellus hair ratio showed reduction compared to baseline which was statistically significant ( < 0.05). The most common side effect noted in our study was pain followed by erythema and perifollicular edema. CONCLUSIONS: Diode laser is an effective and safe procedure for the reduction of unwanted facial hair, even in darker skin types. We also wish to emphasize that trichoscopy for the assessment of laser hair reduction is a recent, noninvasive, simple, and underutilized tool. No serious adverse events were noted in our study.
J Cutan Aesthet Surg
· 2024 · PMID 38736857
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BACKGROUND: Skin wrinkles are generated as a result of the aging process. Dermal thickness underneath a wrinkle decreases absolutely. Approximately 20% of dermal thickness disappears as people become elderly. In recent t...BACKGROUND: Skin wrinkles are generated as a result of the aging process. Dermal thickness underneath a wrinkle decreases absolutely. Approximately 20% of dermal thickness disappears as people become elderly. In recent times, people have attempted to reduce wrinkles using various procedures. Currently, available picosecond lasers in dermatology can create mechanical stress and the energy can be fractionated via diffractive lens arrays (DLA). An emerging indication for the picosecond laser includes photorejuvenation. Non-ablative laser skin rejuvenation therapy demonstrates the dermis can be safely reconstructed by only irradiating the skin surface with a laser. The clinical effects of picosecond pulse laser have been frequently reported, but few studies have included histological investigation. AIMS AND OBJECTIVES: This study aimed to evaluate wrinkle and dermal thickness in the forearm before and after picosecond laser therapy. MATERIALS AND METHODS: Twenty healthy male and female subjects between 36 and 55 years old with wrinkles in the forearm who met the sample requirements and were willing to participate were recruited in this study. Clinical examination and biopsy for histopathological examination were carried out before and 4 weeks after therapy, then treatment was carried out using a picosecond laser. RESULTS: At 1-month follow-up, a significant improvement was noted in wrinkle and dermal thickness ( < 0.05). CONCLUSIONS: This picosecond 755 nm alexandrite laser with DLA was found to be very effective in treating wrinkles, which was confirmed by a dermatologic assessment from forearm photographic assessment scaled and dermal thickness improvement.
Chigurupati VS, Khanna S, Kumar S
… +1 more, Khanna R
J Cutan Aesthet Surg
· 2024 · PMID 38736856
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INTRODUCTION: Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-inten...INTRODUCTION: Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. AIMS AND OBJECTIVES: To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. MATERIALS AND METHODS: In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. RESULTS: Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. CONCLUSION: The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.
J Cutan Aesthet Surg
· 2024 · PMID 38736855
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The Fordyce spots are ectopic sebaceous glands, located at the lip's vermilion border or the oral mucosa. Clinically presents as tiny, discrete, white or yellowish, focally grouped papules. It is a common cosmetic disord...The Fordyce spots are ectopic sebaceous glands, located at the lip's vermilion border or the oral mucosa. Clinically presents as tiny, discrete, white or yellowish, focally grouped papules. It is a common cosmetic disorder and is significantly associated with emotional stress. Herein, we describe three cases that showed satisfactory cosmetic results after the treatment of Fordyce spots using a CO laser. Patients were 21-year-old, 25-year-old, and 28-year-old males with Fordyce spots on the upper lip. They were treated with the CO laser and after 4 months of treatment, no recurrence was noted. Treatment with pinhole ablation with CO laser improves cosmetic results, reduces downtime, and minimizes side effects. To the best of our knowledge, no such case series have been reported to date from the Indian subcontinent.
Arora A, Mohta A, Mehta RD
… +6 more, Ghiya BC, Soni P, Jangir VK, Yadav MK, Khokhar R, Mangava V
J Cutan Aesthet Surg
· 2024 · PMID 38736854
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UNLABELLED: Xanthelasma palpebrarum (XP) is a benign cosmetic condition. Although the role of CO laser is well described, there are only a few studies on Erbium: YAG in XP. Similarly, trichloroacetic acid (TCA) is common...UNLABELLED: Xanthelasma palpebrarum (XP) is a benign cosmetic condition. Although the role of CO laser is well described, there are only a few studies on Erbium: YAG in XP. Similarly, trichloroacetic acid (TCA) is commonly used in XP. However, there are only a few studies comparing these modalities in the treatment of XP. AIM: To evaluate the effectiveness and safety of Erbium: YAG laser and 50% TCA in the treatment of XP with the role of dermoscope in the evaluation of lesions. MATERIALS AND METHODS: A total of 20 subjects were randomly allocated into two groups: group A (TCA) and group B (laser). All patients were subcategorized into three grades viz. I (mild), II (moderate), and III (severe) using a self-devised scoring system. RESULTS: About 25% and 70% of patients achieved complete clearance in groups A and B, respectively ( = 0.017). The rate of recurrence was 40% and 15% in groups A and B. Dyspigmentation and erythema were the most common side effects. Pretreatment dermoscopic evaluation of the lesion showed a network of brown streaks on a background of a yellowish structureless area and was used to assess the area and margins of the lesion where the adipose tissue was found during the procedure and serial assessment of the lesion.
J Cutan Aesthet Surg
· 2024 · PMID 38736853
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INTRODUCTION: Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated wi...INTRODUCTION: Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA. AIMS AND OBJECTIVES: To assess and compare the efficacy and safety of fractional CO laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA. MATERIALS AND METHODS: A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting. RESULTS: Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B. CONCLUSION: This study showed that fractional CO laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events.
J Cutan Aesthet Surg
· 2024 · PMID 38736851
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Acne keloidalis nuchae is a chronic inflammatory condition affecting the occipital area or nape of the neck characterized by fibrotic papules, firm pustules, and nodules that coalesce into keloid like mass or plaques. It...Acne keloidalis nuchae is a chronic inflammatory condition affecting the occipital area or nape of the neck characterized by fibrotic papules, firm pustules, and nodules that coalesce into keloid like mass or plaques. It was first described by Kaposi in 1969. It is also known as lichen keloidalis nuchae, dermatitis papillaris capillitia, and folliculitis nuchae scleroticans. If not treated in the early stages of the disease it tends to be refractory to conventional methods like topical, intralesional steroids with antibiotics or retinoids. Surgical interventions remain the only choice in such cases. Various surgical modalities including surgical excision with primary or secondary closure, split-thickness skin grafts, and laser-assisted treatments have been tried. Most surgical methods have longer downtime with a higher chance of relapse. We studied the results of a combined treatment option carbon dioxide laser ablation followed by intralesional triamcinolone injection in the same sitting. This outpatient procedure has shown good results with no relapse and less downtime.
J Cutan Aesthet Surg
· 2023 · PMID 38314374
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BACKGROUND: Facial acne scars are perceived negatively by society; in an era where everyone wants to look their best, acne and its sequelae are a great source of stress driving down self-worth and elevating the risk of d...BACKGROUND: Facial acne scars are perceived negatively by society; in an era where everyone wants to look their best, acne and its sequelae are a great source of stress driving down self-worth and elevating the risk of depression and anxiety. It affects over 95% of acne patients, particularly in nodulocystic, conglobate, and fulminans varieties. Various treatment modalities are available, but no single modality is 100% curative. Microneedling produces controlled skin injury, releasing various growth factors and setting up a healing cascade, and laying down collagen as a result. Hyaluronic acid plays an important role in wound healing by creating physiological conditions in the extracellular matrix for the proliferation, migration, and organization of dermal cells. AIMS AND OBJECTIVES: To compare the therapeutic efficacy and safety of microneedling alone and microneedling with hyaluronic acid in acne scars. MATERIALS AND METHODS: Sixty patients of age 18-40 years with clinically diagnosed acne scars were recruited and randomly divided into two groups of 30 each. Three sittings were done at an interval of 3 weeks of microneedling alone to Group A and microneedling with hyaluronic acid to Group B and followed up with two visits 4 weeks apart. Scoring was done with Goodman Quantitative Global Scarring Grade System. Side effects, patient satisfaction score, and pre and postprocedure Dermatological Life Quality Index (DLQI) were also recorded. RESULTS: The female:male ratio was 3:2, mean age was 26.90 ± 4.90 years in Group A and 24.43 ± 5.39 years in Group B. Overall, 60% patients had a duration of 2-5 years, and unmarried patients outnumbered married ones in both groups. The combination morphology of the scars was the most common finding. In Group A mean Goodman Quantitative Global Scarring Grade System score reduced from baseline 24.13 ± 7.96 to 16.3 ± 7.2, and in Group B, from 27.73 ± 7.86 to 18.20 ± 7.12 at 17 weeks, this decrease was gradual and statistically significant. The patient satisfaction score for Group B (6.20 ± 1.45) was only slightly higher than that of Group A (5.73 ± 1.31). DLQI for Group A decreased from 7.77 to 4.10 and in Group B from 7.63 to 5.00. Both procedures were safe, with over 80% patients experiencing no side effects. CONCLUSION: The majority of patients showed "moderate" improvement in both groups; however, more patients in microneedling with hyaluronic acid group showed "good" and "very good" results at the end of the treatment completion. These are easy, office-based procedures not requiring training or any high-end machine, especially useful in resource-limited setups; the use of hyaluronic acid can enhance the efficacy of microneedling alone.
Saini S, Sharma D, Yadav C
… +3 more, Singrodia R, Chouhan C, Kachhawa D
J Cutan Aesthet Surg
· 2023 · PMID 38314373
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BACKGROUND: Noncultured epidermal cell suspension (NCES) and Jodhpur technique (JT) are two treatment options in vitiligo, in which the basic principle is the transfer of melanocytes from uninvolved skin to stable vitili...BACKGROUND: Noncultured epidermal cell suspension (NCES) and Jodhpur technique (JT) are two treatment options in vitiligo, in which the basic principle is the transfer of melanocytes from uninvolved skin to stable vitiligo patch in the form of either tissue graft or cellular graft. OBJECTIVES: The aim of this study was to evaluate effectiveness of two different treatment methods (NCES and JT) in stable vitiligo. MATERIALS AND METHODS: This was a randomized comparative study, which included 45 patients with 153 stable vitiligo patches. Cases were randomly divided into two groups. Appropriate statistical analysis was done. A value of < 0.05 was considered statistically significant. RESULTS: Of 45 cases, female-to-male ratio was 1.36:1. Mean duration of disease and stability were found to be 10.44 ± 5.24 and 3.83 ± 2.31 years, respectively. Mean size of treated area for NCES and JT was 10.11 ± 10.31 and 10.13 ± 10.29 cm, respectively. Earliest repigmentation was found at 3 weeks in NCES and 6 weeks in JT. At 6 weeks, repigmentation was better in NCES, whereas later JT showed better pigmentation. Follow-up was done at 8 days and 6, 10, 14, and 24 weeks. With respect to color match at 6 weeks, JT was found superior; however, at 24 weeks both showed similar efficacy. Mean reduction in daily life quality index was significantly decreased post-surgery. LIMITATIONS: This was a single-center, small sample size study. CONCLUSION: Melanocyte plus keratinocyte cell transfer is very effective in the treatment of stable vitiligo. On the basis of the results, JT may show significant contribution in vitiligo.
J Cutan Aesthet Surg
· 2023 · PMID 38314372
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The fingers are highly vascular sites which bleeds profusely during procedure. Penrose drain and gasket are not readily available in the clinic. For this problem, we advocated the use of hand gloves and cotton gauze to a...The fingers are highly vascular sites which bleeds profusely during procedure. Penrose drain and gasket are not readily available in the clinic. For this problem, we advocated the use of hand gloves and cotton gauze to achieve haemostasis at the site of finger.