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PXE Skin Applications
by Robert J. Hoehn, MD, FACS
Clinical Professor of Plastic
Surgery
University of Colorado
(from Volume 6, Issue 4, 1998)
Dr. Neldner
sent me my first PXE patients in the 1970’s. The patients
were requesting plastic surgery to remove some of the
wrinkles and redundant skin folds from their necks, axillae
(armpits) and groin areas. Several basic questions had to
be answered before surgery could be considered. The first
was obvious – could plastic surgery improve the appearance
of PXE skin? What were the risks? Doe PXE affected skin
heal well? Do individuals with PXE bleed more easily or
scar worse than normal?
Most of these questions were soon answered. PXE-affected
skin does heal well, with no additional risk factors from
the underlying PXE, and they do not bleed any more easily
than normal. The resulting surgical scars are generally
comparable to those in patients without PXE.
I learned early on that the neck is the site most commonly
requested for plastic surgery because it is obviously the
most cosmetically visible affected area. Another important
lesson was that simple excision of affected skin from the
neck could easily remove much of the objectionable skin, but
would leave a linear scar around the neck that could be more
cosmetically apparent than the original PXE-affected skin.
So I developed a new technique called a “neck lift,’ which
is based on surgical methods similar to a face lift, but
performed on the lateral neck. An incision is made behind
the ears in the hairy scalp. The affected neck skin is
freed up and pulled up and back and excised behind the ears
and above the hairline. The wound is then closed in the
scalp hairy area where the scar cannot be seen. This
technique has produced excellent results such that the new
tightened skin on the lateral neck shows immediate
improvement in addition to long-term improvement because new
wrinkles do not seem to form readily in the treated areas.
The axilla (armpit) is the second most requested area for
surgical removal of the folded, baggy skin that is prone to
develop in this area. There are additional problems here
because even in individuals without PXE axillary skin is
more likely to scar with healing. I tried various Z-type
incisions and can obtain good improvement in the axilla, but
with a somewhat longer healing time and more tendency to
scar formation. Nonetheless, most patients who have had
axillary surgery for PXE are eventually happy with the
results.
The groin is the third most common area for possible
redundant skin folds due to PXE. Therefore, it is a
candidate for plastic surgery. This area actually turns out
to be the easiest to treat surgically because it is possible
to simply excise a linear strip of affected skin from the
inguinal crease area and directly close the surgical defect
with a linear closure that is hidden in the normal inguinal
crease between the lower abdomen and the thigh.
Skin grafts are possible in PXE skin and will heal well,
though with considerable scarring around the graft site.
This, however, is true for skin grafts on anyone. For this
reason, skin grafts are usually reserved for such problems
as badly burned areas or large surgical defects resulting
from excisions on large tumors from the skin.
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