Objective To evaluate the efficacy and safety of pimecrolimus for oral lichen planus (OLP). Methods We searched The Cochrane Library, MEDLINE (1990 to 2007), EMBASE (1990 to 2007), and the Chinese Biomedicine Database (1990 to 2007) to collect parallel group randomized controlled trials (RCTs) and cross-over trials comparing pimecrolimus with triamcinolone acctonide or placebo. The Cochrane Collaboration’s RevMan 4.2 software was used for data analyses. Results Three RCTs were included. Meta-analyses showed that pimecrolimus did not improve oral cavity ache measured by VAS (visual analogue scale) (WMD –0.5, 95%CI –9.77 to 8.77), OHIP (oral health impact profile) (WMD 0.9, 95%CI –0.6 to 2.4) and CSS (clinical status score) (WMD 0.00mm2, 95%CI –0.40 to 0.40); compared with triamcinolone acctonide. In comparison to placebo, pimecrolimus did not improve oral cavity ache measured by VAS (WMD –3.30, 95%CI –20.20 to 13.92) or CSS (WMD –56.57, 95%CI -134.02 to 20.88) and did not reduce burning sensations (OR 4.98, 95%CI 0.49 to 50.22) as well. Conclusion Pimecrolimus should not be regarded as a better choice than triamcinolone acctonide or placebo for improving the VAS, OHIP or CSS of patients with oral lichen planus. Since the RCTs available for this systematic review are too small, further high-quality large-scale RCTs with standard clinical evaluation are required to provide more reliable evidence.
ObjectiveTo investigate the clinical application of the modified bilobed flap in the reconstruction of zygomatic-facial massive defect after resection of skin cancer. Methods Between August 2009 and October 2011, 15 patients with skin cancer in the zygomatic-facial region underwent defect reconstruction using modified bilobed flaps after surgical removal. There were 12 males and 3 females, aged 52-78 years (mean, 64.1 years). The disease duration was 1-14 months (mean, 4.6 months). Among the patients, there were 11 cases of basal cell carcinoma and 4 cases of squamous cell carcinoma; 1 patient had infection and the others had no skin ulceration; and tumor involved the skin layer in all patients. According to TNM staging, 13 cases were rated as T2N0M2 and 2 cases as T3N0M3. The defect size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm after cancer resection. The modified bilobed flaps consisting of pre-auricular flap and post-auricular flap was used to repair the defect after cancer resection. The size ranged from 4.0 cm × 2.5 cm to 6.5 cm × 4.0 cm of the first flap and from 3.0 cm × 2.0 cm to 5.0 cm × 3.0 cm of the second flap. ResultsPartial incision dehiscence occurred in 1 case, and was cured after dressing change; the flaps survived and incision healed primarily in the other cases. Fourteen patients were followed up 12-24 months (mean, 18.7 months). No recurrence was found, and the patients had no obvious face asymmetry or skin scar with normal closure of eyelid and facial nerve function. At last follow-up, the results were very satisfactory in 5 cases, satisfactory in 7 cases, generally satisfactory in 1 case, and dissatisfactory in 1 case. ConclusionThe pre- and post-auricular bilobed flaps could be used to reconstruct the massive defects in the zygomatic-facial region after resection of skin cancer.