Glomangiosarcoma of the hypothenar eminence: a case report.

Glomangiosarcoma is an exceptionally rare soft tissue tumor. It tends to appear as a painful nodule located in the subcutaneous tissue. There are only two cases described on the hand before instead of the benign glomus tumor is usually located at this level. Histochemically the glomangiosarcoma shows features that remind a benign glomus tumor, except for the malignant glomus tumor arising de novo. This neoplasm is considered a low grade malignant tumor with tendency to local recurrence, though metastasis have been reported. We report the case of a 36 year-old -woman with a glomangiosarcoma in a glomus tumor in the hypotenar eminence. The treatment was a local complete excision and there was no signs of recurrence after 18 months.

[Fascia lata transplant from cadaveric donor in the reconstruction of abdominal wall defects in children]. / Injerto de fascia lata de donante cadáver en la reconstrucción de defectos de pared abdominal en niños.

INTRODUCTION: Abdominal wall closure is not possible in large congenital defects, even after extensively stretching in to enlarge its capacity. The skin coverage is usually adequate but the aponeurotic defect has to be closed temporally using synthetic patches. The use of these materials leads to increase complication such as infection, fistula formation and extrusion. In addition a second operation is required to remove the material and to perform a definitive closure. The role of fascia lata in reconstruction of abdominal wall is well established as free grafts, pedicled flaps or free flaps. Bank cadaveric fascia lata is used extensively in neurosurgical, ophtalmological, orthopaedic and urogynecological procedures. This is the first description of the use of cadaveric fascia lata for the closure of large abdominal wall defects. CASE REPORTS: We present two cases of congenital diaphragmatic hernia. The first patient was a newborn who presented the impossibility to close the fascia, that was salvaged by a teflón patch. Five months later the wound opened, leaving the mesh exposed that had to be removed. A cadaveric fascia lata patch was used to cover the defect, closing the skin satisfactorily. The second case was a two days newborn. We performed the diaphragmatic closure, and the aponeurotic defect was closed using cadaveric fascia lata. RESULTS: Cosmetic and functional appearance are satisfactory in both cases and no complications have been seen. CONCLUSION: Fascia lata patches are revascularized in the abdominal wall and incorporates into receptor tissue. They have the following advantages with respect to synthetic materials: First, the risk of complications is lower. Second, their removal is not necessary. Finally, no intraperitoneal adhesions occur. The risks of disease transmission and rejection are minimized by the Centro Comunitario de Transfusiones donor selection and processing of the cadaveric fascia lata.

[Etiology and treatment of penoscrotal skin defects]. / Etiología y tratamiento de las pérdidas cutáneas penoescrotales.

OBJECTIVE: The influence of the type and extent of debridement on survival of patients with Fournier's gangrene and the efficacy of reconstruction with grafts and residual skin are analyzed. METHODS: The study comprised 43 patients; 35 Fournier's gangrene, 7 trauma and one tumor. The patients with gangrene were treated by debridement, drainage, amputation and antibiotics. Cutaneous grafts and residual skin were used to repair the defect in a second stage procedure. No testicular avulsion was found in the trauma cases. The penile and scrotal injuries were sutured. One burial and one local flap were performed in two penoscrotal avulsions. Skin from the penis was used to repair partial scrotal defects and grafts were applied on the penis. RESULTS: Mortality (21%) was high in partially debrided Fournier's gangrene, penis amputation and in cases undergoing only drainage. Skin grafts for total loss of penoscrotal cover and penile skin flaps for partial scrotal defects achieved good results. Tension suture was unfavorable in the penis, but was well-tolerated in the scrotum. Burial and local skin flaps were not good solutions. Poor results were obtained by conserving residual skin and grafting only the defect. CONCLUSIONS: Early, wide and repeated debridement procedures reduced the mortality in patients with gangrene, and the best results of reconstruction were obtained with split-thickness skin grafts for total loss of penoscrotal cover and penile skin flaps for partial defects of the scrotum.