Massive necrotizing fasciitis: a life threatening entity.

Necrotizing fasciitis (NF) is a complicated soft tissue infection frequently associated with severe sepsis if an early medical and surgical treatment is not performed. We report two postoperative cases of severe NF after oophorectomy and colorectal resection. Because of the similarity with more benign skin infections at the early steps, clinical suspicion is crucial. Surgical exploration and resection will provide both the diagnosis confirming necrotizing infection of the fascia with vessels and treatment. Also, empirical broad-spectrum antibiotics must be initiated as soon as possible. Regardless of the presence of risk factors, NF is a condition with a high mortality rate and only an expeditious and undelayed treatment may improve the patient's outcome. Surgical focus control requires wide and repeated resections, and planned reconstructive plastic surgery might be necessary.

Indications, reconstructive techniques, and results for total glossectomy.

BACKGROUND: The best treatment for advanced tongue tumors remains controversial. Total glossectomy with laryngeal preservation is considered a feasible option, despite its morbidity. METHODS: A retrospective analysis of 12 total glossectomies with laryngeal preservation was performed in order to assess the available reconstruction techniques and analyze survival and functional outcomes. RESULTS: One-year overall survival (OS) and disease-free survival (DFS) rates were 58.3% and 33.3%, respectively, both dropping to 25% after 3 years. Permanent gastrostomy was necessary in 10 patients, although videofluoroscopy revealed adequate tolerance to liquids. Speech intelligibility was satisfactory in 50% of the patients and severely impaired in the remaining 50%. CONCLUSION: Laryngeal preservation in the context of advanced tumors of the tongue without supraglottic invasion carried similar oncologic results to total glossectomy with laryngectomy, but offers a better phonatory function. However, it is usually associated with a higher gastrostomy dependency ratio. A scrupulous selection of candidates is mandatory. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2004-E2010, 2016.

Laparoscopic repair of a postadrenalectomy left-sided diaphragmatic hernia complicated by chronic colon obstruction.

Iatrogenic diaphragmatic hernias are a rarely reported complication of abdominal surgery. We present a case of an iatrogenic diaphragmatic hernia diagnosed 2 years after an adrenalectomy. Corrective laparoscopic surgery was performed, and the postoperative course was uneventful. The patient remained asymptomatic 6 months after the repair. To our knowledge, this is the first such case to be reported.

Postthyroidectomy Horner's Syndrome.

Horner's syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy.