Intralesional cryosurgery for the treatment of basal cell carcinoma of the lower extremities in elderly subjects: a feasibility study.

BACKGROUND: Incidences of basal cell carcinoma (BCC) on the lower extremities in elderly patients are rising. Surgical approaches to the treatment of BCC are subject to possible difficulties in healing, failure of skin grafts, and wound infection. This study assessed the efficacy of intralesional cryosurgery in the treatment of BCC of the lower limbs in elderly patients. METHODS: This study included eight patients aged >60 years in whom a total of 10 nodular or superficial BCCs of the lower limbs were confirmed by biopsy. The patients' medical histories revealed comorbidities including hypertension, diabetes, hypercholesterolemia, venous insufficiency, and deep vein thrombosis of the legs, congestive heart failure, chronic renal failure, and ischemic heart disease. Using liquid nitrogen, an intralesional cryosurgery needle (CryoShape) was inserted into the tumor to facilitate its complete freezing. Treatment success was confirmed by biopsy taken approximately 3 months after complete healing of the cryo-wound. RESULTS: The average size of the lesions treated was 2.49 cm(2) (16.4 × 15.2 mm). Mean recovery time was 79.9 days. Biopsies were obtained at a mean of 85.3 days after the wound had healed. All 10 biopsies verified the complete destruction of the tumor. There was no evidence of wound infection or tumor recurrence over a follow-up period of 28 months. CONCLUSIONS: This study demonstrates that a single intralesional cryosurgery session can completely eradicate BCC on the lower extremities in elderly patients. This technique is associated with relatively minor complications, is well tolerated, and represents a safe and effective therapeutic modality for BCC of the lower limbs.

[TURNOVER CAPSULAR FLAPS FOR THE TREATMENT OF IMPENDING EXTRUSION OF SILICONE PROSTHESIS IN RECONSTRUCTED BREASTS].

Pressure necrosis which might be followed by skin necrosis and implant extrusion is a dreaded complication of breast reconstructive surgery. Over the years, several techniques have been introduced to address this challenging problem. We offer a novel surgical technique to confront this perplexing complication. By using the capsule of the implant as a turnover flap, the soft tissue coverage is enhanced thereby decreasing the pressure between the breast prosthesis and the over-laying skin. The technique is simply reproduced, requires no new incisions, and avoids further morbidity to the involved breast reconstructed patient.

Intraoperative muscle electrical stimulation for accurate positioning of the temporalis muscle tendon during dynamic, one-stage lengthening temporalis myoplasty for facial and lip reanimation.

BACKGROUND: Facial paralysis is a significant functional and aesthetic handicap. Facial reanimation is performed either by two-stage microsurgical methods or by regional one-stage muscle pedicle flaps. Labbé has modified and improved the regional muscle pedicle transfer flaps for facial reanimation (i.e., the lengthening temporalis myoplasty procedure). This true myoplasty technique is capable of producing a coordinated, spontaneous, and symmetrical smile. An intraoperative electrical stimulation of the temporal muscle is proposed to simulate the smile of the paralyzed side on the surgical table. METHODS: The intraoperative electrical stimulation of the temporalis muscle, employing direct percutaneous electrode needles or transcutaneous electrical stimulation electrodes, was utilized in 11 primary and four secondary cases with complete facial palsy. The duration of the facial paralysis was up to 12 years. Postoperative follow-up ranged from 3 to 12 months. RESULTS: The insertion points of the temporalis muscle tendon to the nasolabial fold, upper lip, and oral commissure had been changed according to the intraoperative muscle stimulation in six patients of the 11 primary cases (55 percent) and in all four secondary (revisional) cases. A coordinated, spontaneous, and symmetrical smile was achieved in all patients by 3 months after surgery by employing speech therapy and biofeedback. CONCLUSION: This adjunct intraoperative refinement provides crucial feedback for the surgeon in both primary and secondary facial palsy cases regarding the vector of action of the temporalis muscle and the accuracy of the anchoring points of its tendon, thus enhancing a more coordinated and symmetrical smile.

Contralateral internal mammary silicone lymphadenopathy imitates breast cancer metastasis.

This case report presents a unique, late complication of breast reconstruction surgery. A woman, who underwent left mastectomy and several reconstruction procedures with silicone implants presented with symptomatic enlarged internal mammary lymph nodes on her contralateral side. The nodes, which were suspicious for breast cancer metastasis on positron-emission tomographic computed tomography, were removed by thoracoscopy. The histopathologic result revealed silicone adenopathy. This report is particularly interesting because it presents a rare case in which silicone has migrated to the contralateral internal mammary nodes. This complication was not previously documented in the medical literature and serves as a possible differential diagnosis to metastatic breast cancer.

Brow lift for the correction of visual field impairment.

BACKGROUND: Eyebrow ptosis and hooding gives the eye a sad, heavy look that often disturbs the visual field. OBJECTIVE: A direct extended scalpel-shaped brow lift is proposed to correct this functional and aesthetic disfigurement. This manuscript reviews our experience with the presented technique and evaluates the clinical results in the light of ongoing concerns regarding the appearance of the postoperative scar. In addition, the indications and patient selection criteria are elaborated. METHODS: An incision was made along the superior border of the brow, extending laterally and downward, often within a "crow's feet" crease. The upper border of the incision joined the 2 extremities of the skin outline of the lower incision in a gentle convex curve. The general outline of the incision resembled the shape of a No. 20 scalpel blade, in which the maximal width is located laterally at the temple "crow's feet" area. RESULTS: Fourteen patients, including 8 males (48-74 yrs of age) and 6 females (67-71 yrs of age) underwent this procedure. The surgical scar was hardly noticeable after 6 to 9 months, and often fell within a preexisting crow's feet crease. Elimination of some of the crow's feet occurred in all the patients. Subjective and objective functional relief with respect to the vision field and the heavy-feeling brow and satisfaction with the aesthetic result were reported by all patients. CONCLUSIONS: The most appropriate candidates for the direct extended scalpel-shaped brow lift are patients older than 50 years of age, with eyebrow ptosis accompanied with lateral hooding, well developed crow's feet, and forehead skin laxity; long, dense eyebrows, and low transverse forehead wrinkles aid in concealment of the scar.

Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study.

Hypertrophic scars and keloids following aesthetic surgery, which ignite patient dissatisfaction, are difficult to handle. Intralesional cryosurgery for the treatment of such scars has been introduced. This study was designed to evaluate the efficacy of this technology in the treatment of such scars and to assess the reduction of dissatisfaction. Eleven scars (on 11 patients) were treated by intralesional cryosurgery, following breast surgery, otoplasty, face-lifting, and brachioplasty. Each patient scored the concern from the scar and the scar deformity (scale from 1 to 5) prior and following treatment (higher score represents least satisfaction and a severe deformity). The follow-up period was between 3 months and 8 years. The results demonstrated a significant reduction in concern and deformity scores compared with before the cryotreatment (P = .001). The intralesional cryosurgery technique provides the plastic surgeon with an effective instrument to treat hypertrophic scars and keloids following aesthetic surgery, thus reducing the dissatisfaction of patients.

A critical analysis of penile enhancement procedures for patients with normal penile size: surgical techniques, success, and complications.

CONTEXT: Most men who request surgical penile enhancement have a normal-sized and fully functional penis but visualize their penises as small (psychological dysmorphism). OBJECTIVES: The aim of this review is to describe the various reported techniques and to provide the available scientific data on the success and complication rates of penile enhancement procedures. EVIDENCE ACQUISITION: We performed an extensive systematic review based on a search of the MEDLINE database for articles published between 1965 and 2008. The following key words were used: penis, enhancement, enlargement, phalloplasty, reconstruction, girth, lengthening, and augmentation. Only English-language articles that were related to penile surgery and dysmorphobia were sought. We excluded articles in which fewer than five cases were described and articles in which the type of surgical treatment and the outcome were not clear. Of the 176 papers found, 34 were selected and critically analyzed. EVIDENCE SYNTHESIS: We found only a small number of well-designed and comprehensive studies, and most of the published articles reported data that were obtained from small cohorts of patients. The more recently published studies presented better methodologies and descriptions of the surgical techniques than did the older publications. In general, penile enhancement surgery can cause a 1-2-cm increase in penile length and a 2.5-cm augmentation of penile girth. Unwanted outcomes and complications, namely penile deformity, paradoxical penile shortening, disagreeable scarring, granuloma formation, migration of injected material, and sexual dysfunction were reported frequently in these studies. Disappointing short- and long-term patient satisfaction rates following these procedures were also reported in most studies. CONCLUSIONS: To date, the use of cosmetic surgery to enlarge the penis remains highly controversial. There is a lack of any standardization of all described procedures. Indications and outcome measures are poorly defined, and the reported complications are unacceptably high. In our opinion, until new, reliable, and more objective and reproducible data are available, these procedures should be regarded as investigational and patients should be discouraged from undergoing these invasive treatments.

Six tissue expansion sessions of the scalp for reconstruction of post-burn alopecia.

Postburn scalp alopecia has severe aesthetic and psychological implications. We describe herein a case of a 16-year-old girl suffering from postburn scalp alopecia consisting of approximately 70% of her scalp, with only some residual patches of hair in her left occipital and nuchal areas. The patient underwent six serial tissue expansions during a period of 8 years, thereby enabling coverage of a significant part of the scalp area, with advancement of the hair line laterally and anteriorly. The outcome of this case serves to reinforce the practice of multiple tissue expansion to the scalp, with minimal hair loss and some hair thinning, resulting in a satisfactory aesthetic outcome.

Oxygen saturation levels in the juxta-papillary retina in eyes with glaucoma.

Oxygen saturation (OS) levels in the juxta-papillary retina particularly inferotemporal retina were investigated in open-angle glaucoma (OAG) patients as well as normal subjects. Fifty-six eyes of 56 OAG Japanese patients and 20 eyes of 20 age-matched normal subjects were recruited for the study. OAG eyes (56) were subdivided into two groups: 15 eyes of low-tension (LT) subgroup and 41 eyes of high-tension (HT) subgroup. The average of age of the LT, HT subgroup and normal group were 60.5, 55.9 and 52.6 years, respectively. OS levels in the retina were measured using a Fourier transform-based spectral retinal imaging (SRI) system (Retinal Cube; ASI Co. Migdal Hemak, Israel), with which OS levels in the fundus could be computed at every pixel point of a 35 degrees fundus image. We calculated OS levels at five points in the retina near the optic disc and retinal arteries and veins in all eyes. The OS levels were also compared with the results analyzed using Humphrey visual field Analyzer with the program 30-2 SITA. At the superior and nasal juxta-papillary retinal points, OS level of the LT subgroup showed significant decrease as compared with the HT subgroup and the normal group (p=0.048-0.009). The LT and the HT subgroups were significantly lower than the normal group at the inferotemporal and the average of the retinal points (p=0.047-0.001). There were no statistically significant differences among the three groups in regards to the OS in the retinal artery. There was a statistical significant correlation between the mean of total deviation of the 17 points in the upper arcuate area and OS of the inferotemporal point (p=0.018), and between mean deviation and the average of OS of the inferotemporal and the superotemporal point (p=0.037) in the HT subgroup. However, there was no significant correlation in the LT subgroup. OS levels in the retina were especially decreased in the low-tension glaucoma subtype. There was a correlation between the visual field defect and OS in the HT eyes in the inferotemporal region. OS measurement may be a novel adjunct to study glaucoma patients.

Mobile phone-triggered thermal burns in the presence of supplemental oxygen.

In this case report, we present a patient who used a nasal cannula for oxygen supplementation and suffered deep, second-degree burns to his nose and left leg when an electrical spark shot out of the cable's connection socket while the cellular phone was ringing and the cable was, simultaneously, being disconnected from the socket. The cellular phone, a device commonly thought by many people to be both useful and safe, thus has the potential to serve as a heat source that might ignite and cause burns.

Retinal oxygen saturation levels in patients with central retinal vein occlusion.

PURPOSE: To validate the efficacy of Fourier transform-based spectral retinal imaging (SRI) in quantifying retinal ischemia. DESIGN: Prospective, observational case series. PATIENTS AND METHODS: Eleven eyes of 10 patients with central retinal vein occlusion (CRVO) and 4 fellow unaffected eyes of selected patients were examined by both fluorescein angiography and SRI. The fluorescein angiograms were correlated with oxygen saturation maps that were calculated from the SRI. RESULTS: Oxygen saturation levels in the fundus were shown as color grading in 35 degrees fundus images processed by SRI. This grading correlated well with the severity of CRVO, as estimated by fluorescein angiography. CONCLUSIONS: The severity of circulatory disturbances in CRVO may be graded by applying SRI.