Reconstruction for extensive groin hidradenitis suppurativa using a combination of inferior abdominal flap and medial thigh-lift: a case report.

UNLABELLED: Various methods for reconstructing hidradenitis suppurativa of the groin have been reported. However, it is difficult to attain favorable results both aesthetically and functionally. This report describes a case in which a defect was reconstructed using a combination of inferior abdominal flap and medial thigh-lift after radical excision of extensive groin hidradenitis suppurativa. A 37-year-old woman patient underwent radical excision of bilateral groin hidradenitis suppurativa. After the excision, an inferior abdominal flap and bilateral medial thigh flaps were created and advanced to close the defect. The operative procedure was simple and did not require a donor site. The postoperative scar coincided with the inguinal folds and was concealed by undergarments. No functional disorder remained. Reconstruction for extensive groin hidradenitis suppurativa using this method can attain good aesthetic and functional results. The combination of inferior abdominal flap and medial thigh-lift is potentially a useful option for reconstruction of extensive groin hidradenitis suppurativa. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Free jejunal flap transfer for pharyngoesophageal reconstruction in patients with intestinal malrotation: two case reports.

Intestinal malrotation results from failure of intestinal rotation and fixation during fetal life. We report two cases of esophageal reconstruction with free jejunal flaps following total laryngopharyngectomy of hypopharyngeal and cervical esophageal carcinoma in which intestinal malrotation was detected during the jejunal flap harvesting. In both cases, the ligament of Treitz was absent, and the laparotomy incision was thus extended to identify the jejunum. In case 1, harvesting an adequate length of the vascular pedicle of the flap was impossible because of the abnormal position of the pancreas; thus, a jejunal flap of maximal length was harvested for optimal pedicle positioning in the recipient site. In case 2, Ladd's ligament prohibited the release of the jejunum from the ascending colon and required its dissection. Both patients underwent successful reconstruction. When the ligament of Treitz is absent during jejunal flap harvesting, investing the whole bowel by extended laparotomy incision is recommended. When anatomical abnormality caused by intestinal malrotation is detected, releasing an adhesion of the jejunum from circumferential organs and identifying the adequate vascular pedicle of a jejunal flap are necessary. If harvesting the long vascular pedicle is impossible, a jejunal flap of maximal length should be harvested for optimal positioning for vascular anastomosis at the shortest distance in the recipient site.

Reconstruction of lateral mandibular defect: a comparison of functional and aesthetic outcomes of bony reconstruction vs soft tissue reconstruction - long-term follow-up.

CONCLUSION: Reconstruction with a vascularized bone flap provided superior postoperative outcomes compared with reconstruction with a soft tissue free flap. However, patients obtained acceptable long-term functional outcomes even with a soft tissue free flap and this method is an option in selected patients. A multidisciplinary approach involving dental treatments and nutrition education is important to improve postoperative function. OBJECTIVE: To assess the postoperative outcomes of two different options for reconstruction of the lateral mandible using bony or soft tissue reconstruction. METHODS: We divided 25 patients into 2 groups on the basis of the type of reconstruction following lateral mandibulectomy. Twelve patients underwent reconstruction using a vascularized fibular flap and 13 patients received a soft tissue free flap. We compared the postoperative functional and aesthetic outcomes and examined the time-dependent change in functional outcomes in both groups. RESULTS: Reconstruction with a vascularized bone flap was significantly superior to reconstruction with a soft tissue free flap in deglutition and aesthetic results. There was no significant difference in speech function between the groups. Deglutition in both groups improved markedly over time and all but one patient tolerated a normal or soft diet, including those in the soft tissue reconstruction group. Denture fabrication and recreating occlusion explained the improved deglutition.

Mid-arm lymph nodes dissection for melanoma.

An interval node in the upper limb termed the mid-arm node was recently identified. However, its surgical anatomy remains unclear. We report a patient with metastatic melanoma of the mid-arm node and the epitrochlear node at 10 years after removal of the primary tumour from the forearm and therapeutic axillary lymph node dissection. The mid-arm node is located halfway up the upper arm on the medial intermuscular septum, at the site where the brachial vessels, the median nerve and the ulnar nerve run adjacent to each other. The mid-arm node lies adjacent to the basilic vein where lymphatic vessels ascend and converge. This is the first report regarding the surgical anatomy of the mid-arm node.

Prefabricated scalping forehead flap with skeletal support.

It is difficult to reconstruct a nose with adequate shape, color, and texture in patients who have full-thickness nasal defects with extensive loss of skeletal support. The scalping forehead flap is a reliable technique for nasal reconstruction. To our knowledge, however, there have been no reports about a prefabricated scalping forehead flap with a bone graft as skeletal support. In the case reported here, a prefabricated scalping forehead flap combined with an iliac bone graft as skeletal support was used to successfully reconstruct a full-thickness defect of the nose associated with partial frontal bone loss and complete loss of the nasal bones. Acceptable functional and aesthetic results were achieved. This method may be a good alternative for reconstruction of full-thickness nasal defects with extensive loss of skeletal support.

Sentinel lymph node detection in skin cancer patients using real-time fluorescence navigation with indocyanine green: preliminary experience.

BACKGROUND: Sentinel lymph node (SLN) biopsy has become the most widely used procedure to determine the regional lymph node status of patients with cutaneous malignant melanoma, and its application has spread rapidly to other malignancies such as squamous cell carcinoma of the skin, breast cancer and gastric cancer. OBJECTIVE: SLN detection was performed in skin cancer patients using a newly developed real-time fluorescence navigation system with indocyanine green (ICG). METHODS: SLN biopsy was performed by this method in 10 skin cancer patients (seven with melanoma and three with squamous cell carcinoma). After ICG was injected intradermally around the tumours, the lymphatic drainage was detected and the SLNs were identified by real-time fluorescence imaging. RESULTS: The SLNs and their associated subcutaneous lymphatics were successfully identified in all patients. Fluorescence from SLNs was detected by this system for at least 3 hours after the injection of ICG. CONCLUSION: SLN biopsy using ICG fluorescence achieves a high identification rate and allows effective observation for several hours. This method may become a useful option for the detection of SLNs in patients with skin cancer.