Comparison of the clinical characteristics of benign and malignant eyelid lesions: an analysis of 1423 eyelid lesions, compared between ophthalmology department and plastics department.

PURPOSE: Oculoplastic surgeons excise and reconstruct eyelid tumors, although plastic surgeons have traditionally managed these cases. Current demand of this surgery is growing, and planning referral services is a health management necessity. This pilot study retrospectively reviewed same population eyelid specimens excised by both disciplines comparing data. METHODS: Clinical and epidemiologic features of 1423 eyelid lesions biopsied between 2015- 2020 in Emek Medical Center (EMC), Israel were reviewed. RESULTS: Among 1423 specimens, 1210 (85.0%) were benign and 213 (15.0%) were malignant/pre-malignant. Mean age at diagnosis was significantly higher in malignant tumors than in benign tumors (76 and 59 years respectively, p value < 0.001). The most common benign eyelid lesions were soft fibroma (20.1%), seborrheic keratosis (11.0%) and melanocytic nevus (10.3%). The most common malignant/pre-malignant eyelid tumors were basal cell carcinoma (BCC) (9.2%), actinic keratosis (2.6%) and Bowen's disease (1.9%). Ophthalmology removed 37 malignant/pre-malignant lesions (5.4%) out of 683 compared to plastics removing 142 malignant/pre-malignant lesions out of 740 (19.2%) specimens. Eyelid malignancy in the plastics department was significantly higher than in the ophthalmology department (p value < 0.001). 270 (70.0%) lesions caused by UV exposure were removed by plastics and 116 (30.0%) were removed by ophthalmology (p value < 0.001). CONCLUSIONS: Eyelid lesions in patients aged 76 or older are more likely to be malignant. Ophthalmology eyelid specimens in younger patients are more commonly benign and related to inflammation. Specimens from the plastics department are more commonly malignant, related to UV-exposure, and are from older patients. This difference may be due to a misconception that plastic surgeons have more eyelid cancer reconstruction experience than oculoplastic surgeons, or less awareness of the oculoplastic expertise available today.

In Situ Fenestration: A Simple Technique for Fenestration of Acellular Dermal Matrix During Breast Reconstruction.

BACKGROUND AND AIM: Acellular Dermal Matrices (ADMs) were first described for use in breast surgery in 2001, and in 2005 it was first described to be used in breast reconstruction. However, ADMs are also associated with increased postoperative complications. Fenestration of the ADM may reduce the incidence of postoperative complications. METHODS: We fenestrate the ADM in-situ, after attaching it to the lower pole of the planned pocket using absorbable sutures. CONCLUSIONS: using this technique enables to achieve a fan-shaped ADM mesh within less than a minute; Demonstrating a fast, easy and most importantly sterile method to fenestrate the ADM.

An Unusual Complication following Gluteal Fat Grafting: A Case Report.

Subfascial abscess of the lateral thigh is a relatively uncommon complication following gluteal fat grafting due to their subclinical presentation. Despite its rarity, subfascial abscesses can be dangerous and life-threatening when diagnosis is delayed. In this case report, we present a 28-year-old woman who presented to our hospital with swelling and erythema following a gluteal fat grafting procedure performed abroad. Our initial treatment which included transcutaneous drainage and systemic antibiotics was unsuccessful. This conservative approach was influenced by the patient's initial procedure and attempt to conserve aesthetic appearance. The severity of the complication was not entirely known until advanced radiological imaging (computer tomography imaging) was performed several days after hospitalization and revealed large subfascial abscess. Surgical drainage with fasciotomy was required due to a persisting high fever and fluid accumulation in the lateral thigh. Approximately 1 L of purulent fluid was collected, containing large bulks of fat particles and blood clots that drained from the subfascial space. The wound was left open and treated with vacuum-assisted closure. Direct penetration of cannula through fascial layer, insertion of harvested fat that exceeds intrinsic properties of fascia, or unknown intercompartment connections can lead to deep subfascial migration of fat. Aggressive measures that include immediate advanced radiological imaging should be performed when the severity of damage and migration of injected fat are unknown. Transcutaneous drainage is not effective for subfascial abscesses due to formation of large fat particles and blood clots that cannot be drained. Immediate incision and drainage should be considered for similar cases.

Topical Erythropoietin Accelerates Wound Closure in Patients with Diabetic Foot Ulcers: A Prospective, Multicenter, Single-Blind, Randomized, Controlled Trial.

The diabetic foot ulcer (DFU) is a major disabling complication of diabetes mellitus. Growing evidence suggests that topical erythropoietin (EPO) can promote wound healing. The aim of this study is to clinically assess the efficacy of a proprietary topical EPO-containing hydrogel for treating DFUs. We conducted a randomized, controlled trial in 20 patients with DFUs. After a 14-day screening period, the DFUs of 20 eligible participants who fulfilled the inclusion criteria were randomly assigned (1:1) to either a 12-week of daily treatment with topical EPO and standard-of-care (SOC) or SOC treatment alone. The DFUs were assessed weekly until week 12. The primary outcome was 75% ulcer closure or higher. After 12 weeks of treatment, 75% ulcer closure was achieved in 6 of the 10 patients whose DFUs were treated with topical EPO and in one of the 8 patients whose DFUs were treated with SOC alone. The mean area of the DFUs that were treated with topical EPO and SOC was significantly smaller than those treated with SOC alone (1.2 ± 1.4 cm2 vs. 4.2 ± 3.4 cm2; p = 0.023). Re-epithelialization was faster in the topically EPO-treated DFUs than in the SOC-treated DFUs. There were no treatment-related adverse events. We conclude that topical EPO is a promising treatment for promoting the healing of DFUs. Clinical Trial Registration number: NCT02361931.

Biplanar Technique for Breast Implant Replacement through Mastectomy Scar.

BACKGROUND: Implant-based breast reconstruction is the most commonly used modality for breast reconstruction. A 2-stage reconstruction is employed when the skin envelope is insufficient. In the first stage, a tissue expander is placed in a pocket created beneath the pectoralis major muscle and an acellular dermal matrix (ADM). In the second stage, the expander is replaced with a permanent implant. Though the second stage is safer, some studies have published an immediate complication rate of up to 11.4%, and even higher in the event of prior radiotherapy. METHODS: We present a novel biplanar technique for implant replacement through the mastectomy scar. The goal of our technique is to make incisions of the skin and the incorporated ADM in 2 separate planes, hopefully lowering the risk for dehiscence, deep infection, and reconstruction failure. We conducted a retrospective review of patients who underwent tissue expander or implant replacement surgery using the biplanar technique between January 2012 and January 2018 by the senior author. RESULTS: Eleven consecutively presenting patients underwent 8 tissue expanders and 6 silicone implant replacement surgeries. Three patients had received prior radiation therapy in the operated breast. None of the patients had complications nor needed a revision surgery. CONCLUSIONS: The biplanar technique for implant or tissue expander replacement through the mastectomy scar following breast reconstruction shows promising results in our series of patients and may prove useful in reducing postoperative incisional dehiscence, deep infection, and implant exposure. Nonetheless, further large-scale studies are required to evaluate the effectiveness of this technique.

Interim Results of the Remede d'Or Study: A Multicenter, Single-Blind, Randomized, Controlled Trial to Assess the Safety and Efficacy of an Innovative Topical Formulation of Erythropoietin for Treating Diabetic Foot Ulcers.

Objective: To inform on the interim results of the Remede d'Or study, which is a prospective, multicenter, single-blind, randomized, controlled clinical study on the safety and efficacy of RMD-G1, a topical carbopol-based hydrogel with a fibronectin matrix whose active pharmaceutical ingredient is erythropoietin (EPO), for treating diabetic foot ulcers (DFU). Approach: The trial will comprise 20 patients with type 2 diabetes mellitus with neuroischemic DFUs who will be randomized into two groups: (1) a control group in which standard-of-care (SOC) will be used to treat the DFUs, and (2) a test group in which SOC and RMD-G1 will be used to treat the DFUs. On day 0, all participants will be randomized to receive either RMD-G1 and SOC treatment or SOC alone. The primary endpoint of the study is complete closure of the DFU within the 12-week study period following daily treatments and dressing changes. Results: Interim results reveal that those DFUs which were treated with RMD-G1 responded positively: there was a significant reduction in the wound areas. In contrast, the condition of those DFUs which were treated with only SOC deteriorated. Innovation: To date, no topical therapies with proven efficacy for treating DFUs exist. Topical application of EPO-based RMD-G1 in conjunction with SOC to a DFU accelerates their healing and closure. Conclusions: The interim results of this trial indicate that topical RMD-G1 is a safe adjunctive therapy to SOC, which accelerates the closure of a DFU. RMD-G1 is safe pharmaceutical because EPO has a proven safety profile.

Debride and See: Use of Uterine Curette for Wound Bed Debridement before Skin Grafting.

Supplemental Digital Content is available in the text.

Unusual presentation of epidermoid cyst mimicking breast cancer involving the areola-Case report.

INTRODUCTION: Epidermoid cyst is very common benign lesion of the skin. And may appear anywhere on the surface of the body. Diagnosis is made in most cases by clinical examination, but histological evaluation may be needed in unusual cases. PRESENTATION OF CASE: We report a rare case of a 44 year-old woman who presented with a rapidly growing inflamed mass localized to the left areola, which grew to 4 cm in diameter within a few months. The diagnosis of malignancy was ruled out following pathology examination consistent with epidermoid cyst. After a course of antibiotics, she underwent surgery with nipple sparing and reconstruction of the areola. DISCUSSION: Preoperative diagnosis based on biopsy enable limited surgical excision and preservation of the nipple. Reconstruction of the areola by local areolar flap enable good aesthetic result. CONCLUSION: It is important to be aware of this entity of epidermoid cyst mimicking breast cancer, and the treatment options available in these cases.

Mycetoma of the foot caused by Cylindrocarpon lichenicola in an immunocompetent traveler.

Cylindrocarpon is a cosmopolitan soil fungus, which rarely causes human disease. It has infrequently been reported as causing keratitis, mycetoma, osteomyelitis and peritonitis in chronic peritoneal ambulatory dialysis patients and disseminated infection in leukemic neutropenic hosts. This report describes a case of invasive infection caused by Cylindrocarpon lichenicola, localized in the right foot of an otherwise immunocompetent traveler.

[Vacuum assisted closure--a new method for wound control and treatment].

UNLABELLED: Despite the numerous advances in wound healing research, the treatment of chronic non-healing wounds still presents a challenge. Vacuum assisted closure is a new technique for wound treatment using negative pressure. The method can be used for the treatment of a wide variety of wounds, including pressure sores, diabetic ulcers, venous ulcers, surgical traumatic wounds and radiated wounds. With the aid of this method pressure is distributed on the wound by using a foam with a specific pore size. The foam is placed over the wound and the wound is covered with an adherent, occlusive dressing thus converting the open wound to a controlled closed wound. The mechanism that stands for the positive effect of the negative pressure dressing is obtained by removing the third space fluids from the area immediately adjacent to the wounds, thus decreasing the pressure on small vessels and improving the blood supply to the wound with positive consequences for this increment. CONCLUSIONS AND RECOMMENDATIONS: A new method is presented for the treatment of chronic wounds using negative pressure. The application of the negative pressure to wounds can promote the healing of a variety of chronic non-healing wounds with significant increase in granulation tissue formation.

Full-thickness skin necrosis after arginine extravasation--a case report and review of literature.

The arginine test is highly useful in the evaluation of short-stature children and adolescents. Extravasation of arginine can cause full-thickness skin necrosis that requires serious surgical intervention with aesthetic and functional sequellea. The authors describe a case of distal forearm skin necrosis caused by arginine extravasation that was treated by wide debridement and a combination of groin flap and later with split-thickness skin graft. The authors emphasize the need for early and active management of arginine extravasation injuries.