Contralateral internal mammary silicone lymphadenopathy imitates breast cancer metastasis.

This case report presents a unique, late complication of breast reconstruction surgery. A woman, who underwent left mastectomy and several reconstruction procedures with silicone implants presented with symptomatic enlarged internal mammary lymph nodes on her contralateral side. The nodes, which were suspicious for breast cancer metastasis on positron-emission tomographic computed tomography, were removed by thoracoscopy. The histopathologic result revealed silicone adenopathy. This report is particularly interesting because it presents a rare case in which silicone has migrated to the contralateral internal mammary nodes. This complication was not previously documented in the medical literature and serves as a possible differential diagnosis to metastatic breast cancer.

Intralesional cryosurgery for the treatment of basal cell carcinoma of the lower extremities in elderly subjects: a feasibility study.

BACKGROUND: Incidences of basal cell carcinoma (BCC) on the lower extremities in elderly patients are rising. Surgical approaches to the treatment of BCC are subject to possible difficulties in healing, failure of skin grafts, and wound infection. This study assessed the efficacy of intralesional cryosurgery in the treatment of BCC of the lower limbs in elderly patients. METHODS: This study included eight patients aged >60 years in whom a total of 10 nodular or superficial BCCs of the lower limbs were confirmed by biopsy. The patients' medical histories revealed comorbidities including hypertension, diabetes, hypercholesterolemia, venous insufficiency, and deep vein thrombosis of the legs, congestive heart failure, chronic renal failure, and ischemic heart disease. Using liquid nitrogen, an intralesional cryosurgery needle (CryoShape) was inserted into the tumor to facilitate its complete freezing. Treatment success was confirmed by biopsy taken approximately 3 months after complete healing of the cryo-wound. RESULTS: The average size of the lesions treated was 2.49 cm(2) (16.4 × 15.2 mm). Mean recovery time was 79.9 days. Biopsies were obtained at a mean of 85.3 days after the wound had healed. All 10 biopsies verified the complete destruction of the tumor. There was no evidence of wound infection or tumor recurrence over a follow-up period of 28 months. CONCLUSIONS: This study demonstrates that a single intralesional cryosurgery session can completely eradicate BCC on the lower extremities in elderly patients. This technique is associated with relatively minor complications, is well tolerated, and represents a safe and effective therapeutic modality for BCC of the lower limbs.

[Our experience with two stage ear reconstruction of typical microtia].

One of the most difficult reconstructive procedures is the reconstruction of the auricle, since it has a very difficult form to imitate. During the last four decades there have been numerous reconstructive attempts throughout the world especially for cases of microtia. The principle is to build a framework from cartilage that will be used for the reconstruction. A prominent personality in this field is Dr. Burt Brent, who is identified with this challenge. Dr. Brent has established the method of reconstruction in four stages. In order to limit the operative stages Dr. S. Nagata suggested doing the reconstruction in two stages, using a different cartilage framework and elevating the auricle using temporo-parietal fascial flap and skin graft. His method was improved further by Dr. Francoise Firmin. The first stage is conducted at the age of 9-10, during which the ipsilateral rib cartilage is harvested, carved and put together into a cartilage framework and than inserted into a skin pocket in the area awaiting reconstruction. Half a year later, the auricle is elevated by inserting a wedge cartilage behind it, covering with temporo-parietal fascial flap and skin graft. Our experience using this method in ten microtia cases proves that it is a good choice in total auricle reconstruction for microtia patients.

[Chest wall deformity following rib cartilage harvesting for auricular reconstruction].

Chest wall deformity is one of the potential complications of rib cartilage harvesting for auricular reconstruction. An eight year old boy underwent two stage microtia reconstruction using the 6th-9th costal cartilage for the 3-D cartilage framework. One year later an anterior chest wall deformity was noticed with bulging of the 5th rib, asymmetry of the lower rib cage line and deviation of the lower part of the sternum. The anterior chest wall is made of ribs, sternum and respiratory muscles forming a dynamic structure. By using these pieces of rib cartilage an imbalance is created in which the respiratory muscles pull the edges of the remaining ribs, thereby creating the deformity. It is especially critical during the growth phase. The 3-D CT scan demonstrates the chest deformity. We present a literature review and recommendations on how to reduce the complications when using rib cartilage for auricular reconstruction are presented.

Six tissue expansion sessions of the scalp for reconstruction of post-burn alopecia.

Postburn scalp alopecia has severe aesthetic and psychological implications. We describe herein a case of a 16-year-old girl suffering from postburn scalp alopecia consisting of approximately 70% of her scalp, with only some residual patches of hair in her left occipital and nuchal areas. The patient underwent six serial tissue expansions during a period of 8 years, thereby enabling coverage of a significant part of the scalp area, with advancement of the hair line laterally and anteriorly. The outcome of this case serves to reinforce the practice of multiple tissue expansion to the scalp, with minimal hair loss and some hair thinning, resulting in a satisfactory aesthetic outcome.