Can a Single-Stage Approach Using a Dermal Regeneration Template Lead to Satisfactory Scalp Defect Reconstruction After Skin Cancer Excision?

BACKGROUND: Large-defect reconstructive surgeries for skin cancer can be performed using different approaches. Integra Dermal Regeneration Template (DRT, Integra Life Sciences, Princeton, New Jersey, the United States) is a membrane utilized to fill skin defects, followed by second-stage surgery with a full-thickness skin graft or flap. PURPOSE: To evaluate the frequency of success of the single-stage scalp reconstructive surgeries using the DRT membrane without second-stage surgery and its feasibility in practice. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective case series study was conducted to investigate the outcomes of patients with skin cancer scalp defects, reconstructed using DRT, from June 2019 to June 2022, in the Oral and Maxillofacial Department at Ashford and St. Peter's Hospitals, United Kingdom. The patients who underwent further surgery were excluded. PREDICTOR VARIABLE: Not applicable. MAIN OUTCOME: This study aimed to evaluate the achievement of complete re-epithelialization solely using the DRT membrane along with appropriate dressing management, scored as a "yes" or "no." COVARIATES: Patient's age, defect size, timing of bolster, DRT silicone layer, and dressing removal; anticoagulation, antibiotics, complications, and appointments until complete healing. ANALYSES: Descriptive statistics were computed for each variable. RESULTS: Forty patients were included in this study and 90% re-epithelialized without complications. Two cases of infection and three bleeding events were recorded. The mean patients' age was 81.5 ± 7.7 years, and the average defect size was 14.7 ± 10 cm2. The bolster and silicone layers were removed at 9.1 ± 3.2 and 29.2 ± 12.9 days, respectively. The average number of appointments until healing was 7.8 ± 4.8. Healing time was 3.8 ± 2.1 months, frequency of failure was 10, and 40% received antibiotics. CONCLUSIONS: In our experience, the DRT membrane can be used as a successful single-stage approach in minimizing the need for further surgery. Further studies are needed.

Sight preserving orbital decompression: a novel multidisciplinary approach to managing severe proptosis in neurofibromatosis type 2.

We describe the importance of collaboration between multiple surgical specialties in managing a complex case of sight-threatening severe proptosis in a young woman with type 2 neurofibromatosis (NF2) complicated by pre-existing contralateral blindness. Trans-nasal and lateral orbital surgical approaches were aided by stereotactic navigation to debulk a large frontal/sphenoid wing meningioma, which had been exerting pressure onto the right globe and optic nerve. The patient made an excellent postoperative recovery along with preserved residual visual acuity, normal neurology and a good aesthetic outcome.

Argument for the conservative management of mandibular ameloblastomas.

Ameloblastoma is a rare, benign, odontogenic tumour that affects the mandible more commonly than the maxilla. Solid or multicytic variants are often resected and the defects reconstructed with a free flap. To establish the outcome after enucleation and application of Carnoy's solution, irrespective of histological subtype, we used the hospital's histology database to identify all the patients treated between 2001 and 2014 by one surgeon. Variables included patients' characteristics, histological subtype, radiological appearance, follow-up period, and incidence of recurrence. A total of 27 patients (13 male) were included, mean age 41 years (range 12-79). Fifteen (56%) had solid multicystic lesions, and there was an overall predominance of the follicular or plexiform variant, or both. Of the 23 preoperative radiographs that were available, 17 lesions were unicystic, 5 multilobular and scalloped with no septa, and one had aggressive features of multilocularity and a poorly defined peripheral margin. The mean duration of follow up was 38 months (range 3-156). Three patients had recurrence at 20, 27, and 35 months postoperatively, and each had repeat enucleation and application of Carnoy's solution. Reconstruction was not necessary, and to date none has recurred. This study shows the potential benefits of conservative surgery and sterilisation of the cystic cavity with Carnoy's solution. Recurrence is low, and with vigilant surveillance, similar repeat procedures have been effective when necessary. A longer follow-up period and larger numbers of patients are now needed to corroborate these findings.

Single stage treatment of ankylosis of the temporomandibular joint using patient-specific total joint replacement and virtual surgical planning.

Ankylosis of the temporomandibular joint (TMJ) is a debilitating condition that can result in pain, trismus, and a poor quality of life. It can be caused by injury, infection, and rheumatoid disease. Current management includes gap arthroplasty, interpositional arthroplasty, and reconstruction. Traditionally, joints are reconstructed using stock implants, or the procedure is done in two stages with an additional computed tomography (CT) scan between the resective and reconstructive procedures and use of stereolithographic models to aid the design of the definitive prostheses. We describe a technique for the resection of ankylosis and reconstruction of the joint in a single operation using virtually designed custom-made implants. Five patients with ankylosis of the TMJ had a single stage operation with reconstruction between 2010 and 2012. All had preoperative high-resolution CT with contrast angiography. During an international web-based teleconference between the surgeon and the engineer a virtual resection of the ankylosis was done using the reconstructed CT images. The bespoke cutting guides and implants were designed virtually at the same time and were then manufactured precisely using computer-aided design and manufacture (CAD-CAM) over 6 weeks. After release of the ankylosis and reconstruction, the patients underwent an exercise regimen to improve mouth opening. Follow-up was for a minimum of 6 months. Four patients had one operation, and one patient had two. Median/Mean maximum incisal opening increased from 0.6mm before operation to 25 mm afterwards (range 23-27), and there was minimal surgical morbidity. This new method effectively treats ankylosis of the TMJ in a single stage procedure. Fewer operations and hospital stays, and the maintenance of overall clinical outcome are obvious advantages.