Versatility of composite grafts for nasal defects - a case series.

This retrospective study describes the reconstruction of 18 nasal defects with chondrocutaneous (composite) grafts. Composite grafts are versatile one-stage options for defects ≤2.5 cm at the lower third of the nose and are particularly useful in reconstruction of small full-thickness defects and superficial defects bordering or involving the alar rim.

Routine X-ray of the chest is not justified in staging of patients with primary breast cancer.

INTRODUCTION: Chest X-rays (CXRs) are performed routinely as part of staging of primary breast cancer patients in most breast units in Denmark. However, several international studies have found exceedingly low detection rates for occult pulmonary metastatic disease among breast cancer patients. Even so, no data have previously been published on Danish patients. METHODS: A retrospective study was conducted of all breast cancer patients undergoing CXRs at the Department of Breast Surgery, Herlev Hospital, from April 2016 to December 2017. The primary outcome was detection of pulmonary metastases on CXRs at the time of the patient's breast cancer diagnosis. The follow-up period was 12 months. RESULTS: A total of 1,014 patients were included in this study. Among these, 11 (1%) had a positive CXR and 1,003 (99%) had a negative CXR. Three (0.3%) patients were diagnosed with lung metastases but had false negative CXRs. The sensitivity was 0%, the specificity was 98.9%, the positive predictive value was 0% and the negative predictive value was 99.6%. CONCLUSION: Routine preoperative CXR did not impact staging or lead to changes in the treatment of breast cancer patients. Therefore, routine CXR cannot be justified and should be omitted. FUNDING: none. TRIAL REGISTRATION: The study was approved by the local hospital legal department (Herlev and Gentofte Hospital) as quality assurance research (workzone number: 19000557).

Excellent outcome of healing by secondary intention after wide local excision of the weight-bearing heel.

Background: Plantar defects are difficult to manage due to several reasons. The challenges of plantar reconstructions include lack of abundant local tissue, the requirement of the skin to be sensate, as well as the mechanical demand of the reconstruction to be able to withstand shearing forces and weight-bearing. Although rare, these defects are encountered following infections, trauma, and burns in addition to surgical oncological resections. Case presentation: This case report describes the management of a plantar defect, measuring 45 × 55 mm, after surgical resection of a melanoma on the weight-bearing heel. The defect was managed with negative pressure wound therapy (NPWT) for 4 weeks, until granulation tissue was flush with the surrounding skin. Conservative treatment with wound care was conducted for another 12 weeks, until the wound, at 16 weeks, was completely healed. The patient tolerated the lengthy time of healing well and experienced no problems with the scar, and the functional and aesthetic outcome of conservative treatment of the plantar defect was excellent. Conclusion: Healing by secondary intention is an excellent treatment option for the closure of large plantar defects, despite often being an overlooked reconstructive option.

Surgical management of rhinocerebral mucormycosis: A case series.

Rhinocerebral mucormycosis (RCM) is a rare and rapidly progressive, destructive, angioinvasive fungal infection, which primarily affects immunocompromised patients. A high suspicion is required to diagnose RCM as initial clinical manifestations are often nonspecific. A cornerstone of the management is early diagnosis and radical surgery, which often requires complex reconstructive procedures. The optimal timing of reconstructive surgery is controversial. This case series presents the reconstructive perspective on four RCM cases treated with aggressive debridement, targeted antifungal treatment, and hyperbaric oxygen therapy followed by an early local flap or microsurgical reconstruction - to enable adequate local blood perfusion, antifungal treatment, and to decrease the risk of secondary infection. In all four patients, the early reconstructive surgery was successful without relapse of RCM or flap failure. We suggest aggressive surgical debridement till clear resection margins are obtained based on histopathology and/or microbiology, at a point which reconstructive surgery can be performed safely.

Danish translation and linguistic validation of the BREAST-Q.

INTRODUCTION: The primary purpose of reconstructive and cosmetic breast surgery is to improve patients' quality of life, and patient-reported outcome measurements are important in outcome assessment of breast surgery. The BREAST-Q questionnaire measures changes in quality of life and patient satisfaction in patients undergoing breast surgery. The aim of this work was to translate and linguistically validate all BREAST-Q modules for use in Denmark. METHODS: The Danish version of the BREAST-Q was developed through forward translation, back translation and cognitive debriefing following the guidelines from the MAPI Research Trust Foundation and approved by the developers. The aim was to achieve a conceptually equivalent Danish version using colloquial language rather than undertaking a simple literal translation. RESULTS: A conceptually equivalent Danish version of all five BREAST-Q modules was achieved. The cognitive debriefing revealed good content validity. A cultural difference regarding the Satisfaction with Office Staff Scale was discovered. CONCLUSIONS: The BREAST-Q can now be used for patients undergoing breast surgery in Denmark to measure change in quality of life and patient satisfaction as part of the outcome assessment. The BREAST-Q may be used for both individual and group measurements in clinical and research settings alike. Data collection with BREAST-Q can provide valuable information for use in clinical counseling of women undergoing breast surgery. A psychometric validation of the Danish version of the BREAST-Q is currently underway. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Metastases from melanoma after a latency period of 34 years].

In this case report, two patients with metastases from melanoma after a disease-free period of 34 years are presented. In 1983, both patients were treated for melanoma on the lower extremity with wide local excision. In 2017, they experienced unnecessary waiting time and examinations before being diagnosed. A follow-up time of many years for all melanoma patients may not be feasible, however, both patients and physicians must be aware of the potential for late metastases. In the case of new tumours of unknown origin we suggest a diagnostic approach: once melanoma, always melanoma, until the opposite has been proven.

Routine X-ray of the chest is not justified in staging of cutaneous melanoma patients.

INTRODUCTION: The incidence of cutaneous melanoma is increasing in Denmark and worldwide. However, the prevalence of distant metastases at the time of diagnosis has decreased to 1%. We therefore questioned the value of routine preoperative chest X-ray (CXR) for staging asymptomatic melanoma patients and hypothesised that routine CXR is not justified. METHODS: A retrospective study was conducted on patients undergoing wide local excision and sentinel lymph node biopsy for cutaneous melanoma in the period from 2010 to 2014. RESULTS: A total of 603 patients were included. The mean time of follow-up was 34 months (range: 13-75 months). Of the 603 patients, 25 (4%) had a positive CXR and 578 (96%) had a negative CXR. Four (0.7%) patients had lung metastases of whom two had a true positive and two a false negative CXR, respectively. The sensitivity was 50%, specificity was 96%, the positive predictive value was 8%, and the negative predictive value was 100%. CONCLUSION: Our results suggest that CXR cannot be justified in the initial staging of cutaneous melanoma patients. The guideline for the treatment of melanoma in Denmark is under revision: The use of CXR has been omitted. FUNDING: This study received funding from the Department of Plastic Surgery, the Research Council at Herlev Gentofte Hospital and the Danish Cancer Society. TRIAL REGISTRATION: The Danish Regional Committee on Biomedical Research Ethics (r. no.: H-4-2014-127), the Danish Data Protection Agency (2012-58-0004, local record no.: HEH-2015-003, I-Suite no.: 03436) and the Danish Melan-oma Group.