Single-stage nasal reconstruction with the islanded forehead flap.

BACKGROUND AND PURPOSES: Multi-staged forehead flaps are a well-recognised reconstructive workhorse for subtotal and total nasal defects. It carries the disadvantage of repeated trips to theatre for revisional surgery, which is not suited to all patient cohorts. The single-stage islanded forehead flap eliminates this need. We detail our indications and outcomes of using this flap to highlight the maintained versatility of the technique without significant compromise on reconstructive and patient outcome. SUBJECTS STUDIED AND METHODS: A prospective surgical database was collated where patients were categorised as partial or total reconstruction. We detail surgical technique and review of rationale of patient selection. Patient demographics, perioperative data and follow-up course were recorded. MAIN FINDINGS: A total of 22 patients were recorded from both the U.K. and Ethiopia via working with the charity Facing Africa. Defects occurred from a mixture of trauma, Noma and cancer resections. Thirteen were total nasal reconstructions and nine partial. The mean follow-up period was 2.25 years. We experienced two major complications which required minor revision in the theatre and two minor complications, all resolved satisfactorily. CONCLUSIONS: We demonstrate good outcomes and safety of the procedure in this first report of a varied cohort of nasal reconstructions in a heterogenous cohort of patients. We advocate the use of this flap in the multi-morbid patient where recovery can be expedited or those who have limitations from economical restraints.

Application of laser for treatment of cutaneous leishmaniasis: a review of literature.

Cutaneous leishmaniasis (CL) is a major health problem in developing countries with high economic and health impact. Despite suggested treatment for CL, there is still no definite therapy for this infection, and many of these treatments are associated with serious local and systemic side effects. In the current paper, use of different laser types including continuous and fractional CO2, argon, PDL, erbium glass, and Nd:YAG have been reviewed. Based on our review, given the high reported efficacy and low side-effect profile, use of laser can be considered as a good alternative to standard treatment of cutaneous leishmaniasis (CL). Performing more studies using different types of lasers is recommended to evaluate the efficacy of this method for treatment of CL.

[Axillary hidrosadenitis due to Leishmania: Case report and literature review]. / Hidrosadenitis axilar por Leishmania: presentación de un caso y revisión de la bibliografía.

BACKGROUND: Hidradenitis is a disorder where abscesses appear after the infection of the apocrine sweat glands. It is located normally in the axillae, groin, perineal region, and the scalp. CLINICAL CASE: A 37 year old male was referred by his GP to the General Surgery Department with axillary hidradenitis which had evolved over the years. The physical examination shows signs of hidradenitis in both axillae, with a noticeable suppurative hidradenitis in the right armpit. En bloc extirpation was performed to remove the whole affected area. The pathological examination revealed a cutaneous leishmaniasis. Subsequently, fucidin was administered topically, as well as local infiltrations of one millilitre of Glucantime™. DISCUSSION: Hidradenitis normally appears in intertriginous areas and its manifestation is accompanied by recurrent subcutaneous nodules. The incidence rate in females is three times higher than in males. The isolated Hidradenitis caused by Leishmania is a rare condition presented only in endemic areas or in immunocompromised patients, such as HIV-infected patients. Clinical manifestations can be different and the diagnosis can be confirmed through haematoxylin-eosin. The main pattern displays a disorganised granuloma without necrosis. Systemic or topical treatment can be applied. Immunotherapy treatment is the most common. CONCLUSIONS: Hidradenitis caused by Leishmania in HIV-negative patients is a rare condition. Therefore it is important to perform a good histological diagnosis and to administer the right treatment.

Paronychia-like cutaneous leishmaniasis.

Chronic paronychia is an inflammatory recalcitrant disorder affecting the nail folds. We report one patient with paronychia revealing ungueal leishmaniasis. A 34-year-old man, resident in the north of Morocco, presented with a 6-month history of an inflamed proximal nail fold of the left thumb, resistant to antibiotics and anti-fungal treatments. En bloc excision of the proximal nail fold was done. The histopathological exam showed epithelioid granulomas with giant cells and the presence of leshmania amastigotes, leading to the diagnosis of ungueal leishmaniasis. Clinical aspects of cutaneous leishmaniasis can be very misleading. The paronychial form is rarely described. In endemic areas it is necessary for the physician to be aware of atypical skin presentations of leishmaniasis.

Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource-poor country.

Leishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost-effective, simple, successful, and affordable option.

An unusual manifestation of a neglected disease.

We report on a 30-year-old man that was seen by dermatologist for a routine check of melanocytic nevi. During the examination he pointed out a lesion on his upper back, stating that he did not know how long it had been there. Excision was performed and the histopathologic examination showed a dense granulomatous infiltrate in the dermis without ulceration. It turned out to be cutaneous leishmaniasis, the incidence of which is increasing in our immediate vicinity, and therefore it is important to constantly keep it in mind during everyday work at the clinic.

Basal cell carcinoma in a full-thickness skin graft in the upper eyelid.

A 75-year-old woman presented with a nodular lesion on a skin graft in her left upper eyelid. The lesion had grown gradually over the previous 2 years. She had undergone multiple surgeries and full-thickness skin graft procedures 61 years previously, because of cutaneous leishmaniasis. The diagnosis of nodular basal cell carcinoma was made by means of an excisional biopsy of the lesion. During a follow-up period of 27 months, the tumor did not recur. Malignant tumors may rarely develop at the site of traumatic or surgical scar. To our knowledge, this is the first reported case of basal cell carcinoma arising in a skin graft in the eyelid.

Leishmaniasis of the lip : report of a case.

Leishmaniasis is a parasitic disease caused by a protozoan flagellate of the genus Leishmania. This parasite infects numerous mammal species including humans. It is transmitted through the infective bite of a sand fly called phlebotominae. Cutaneous Leishmaniasis is the most common form of Leishmaniasis. We present the case of a 47 years- old man who came to our Department of oral and maxillo-facial surgery, complaining about a painless lesion on his lower lip. After removal of the lesion and microscopic examination, the diagnosis of Leishmaniasis was made. This clinical case illustrates that the differential diagnosis of a nodular painless lesion of the lip must include rare diagnosis like a cutaneous Leishmaniasis, especially in patient from a geographic origin which represents an area at risk for Leishmaniasis.

Efficacy of CO(2) laser for treatment of anthroponotic cutaneous leishmaniasis, compared with combination of cryotherapy and intralesional meglumine antimoniate.

BACKGROUND: Cutaneous leishmaniasis (CL) is endemic in developing countries. Several types of treatments have been suggested, but none of them is completely effective and without side-effects. CO(2) laser has a specific thermolysis effect on infected tissues in CL. OBJECTIVES: To determine the efficacy and safety of CO(2) laser vs. combined cryotherapy and intralesional meglumine antimoniate (glucantime) in dry-type CL. METHODS: This is a prospective, randomized open trial study (Kerman, Iran) from November 2007 to August 2009. A total of 96 patients were randomly assigned to receive one session of CO(2) laser therapy and 95 patients on combined cryotherapy biweekly with intralesional meglumine antimoniate weekly until complete cure or up to 12 weeks, whichever is earlier. Clinical and laboratory cure, defined as complete re-epithelialization of 100%, complete flattening of induration and negative smear of lesions compared with baseline at weeks 2, 6, 12 and 16, and also at the time of complete cure (week 2, 6, 12 or 16). RESULTS: Of 191 participants, 80 patients with 95 lesions in group A and 80 patients with 95 lesions in group B completed the study. Complete cure was 93.7% (89/95 lesions) in group A and 78% (74/95 lesions) in group B. Complications were similar in the two groups and were limited to the ulcer sites. CONCLUSIONS: The CO(2) laser was more effective in treating dry-type cutaneous leishmaniasis than combined cryotherapy and intralesional glucantime and resulted in a shorter healing time (6 weeks vs. 12 weeks) with a single treatment session.

Reconstrução heminasal direita com rotação de retalho cutâneo bilobado: contribuição pessoal / Right heminasal reconstruction with bi-lobed skin flap rotation: personal approach

Deformidades adquiridas do nariz por trauma ou doença têm sido corrigidas mediante retalhos cutâneos em ilha, nasogenianos, frontais, tubulados, e ainda pelo uso de retalhos bilobados. O caso relatado, mediante modificação pessoal, ilustra este tipo de procedimento.

Acquired nasal deformity by trauma or sickness have been reconstructed by island skinflaps, nasal-labial, frontal, skin tube, and also with bi-lobed flap rotation. The present cases how a personal approach with the use of this bi-lobed flap.

Carbon dioxide laser for the treatment of lupoid cutaneous leishmaniasis (LCL): a case series of 24 patients.

We report the use of a carbon dioxide laser to vaporize local cutaneous leishmaniasis. We used CO2 laser for the treatment of 24 patients with lupoid cutaneous leishmaniasis in Isfahan. We identified 24 patients with lupoid cutaneous leishmaniasis (LCL) for evaluation. All of the patients had clinical signs of LCL and had the lesion for more than 1 year. LCL diagnosis was confirmed by both direct smear and biopsy. The efficacy of laser was determined on the basis of cure and lack of relapse after 1 year. Treatment was performed using a CO2 laser (Lasersonic LS500 machine). The maximum power was 100 Watts and the pulse width was 0.5-5 seconds. There were 21 patients, 13 females and 8 males, who were treated and followed for 1 year. Mean duration of the lesions was 4.1+/- 3.9 years. The treatment was well tolerated and complications were minimal, and included pain, xerosis, and mild erythema. Of these patients, 19 were disease free (90.47 % efficacy based on clinic and laboratory). Only 2 patients were treatment failures (9.5 %). Our results indicate that CO2 laser radiation is highly effective for treatment of lupoid cutaneous leishmaniasis.

Treatment of cutaneous leishmaniasis with cryosurgery.

BACKGROUND: The management of cutaneous leishmaniasis with topical methods, if effective, can spare patients from long and costly inpatient treatments. METHODS: Seventeen patients with cutaneous leishmaniasis were treated with cryosurgery using liquid nitrogen as the cryogen. Two cycles of 10-30 s freezing time were used and repeated at 3-week intervals. RESULTS: All patients responded well to therapy with excellent cosmetic results and no relapse in any case. Side-effects were rare. CONCLUSIONS: Cutaneous leishmaniasis can be successfully treated with a simple protocol of cryosurgery with minor side-effects.

Evaluation of CO laser efficacy in the treatment of cutaneous leishmaniasis.

BACKGROUND: Cutaneous leishmaniasis is a common disease in Iran, especially in the north-east, central and southern parts of the country. Many treatments have been suggested for this disease but none is completely effective and without side-effects such as pain, arthralgia and renal or cardiac complications. Lasers have been used for treatment of several skin diseases since 1970, and CO(2) lasers are now being used for treatment of leishmaniasis. In this study, a CO(2) laser (Sonic 500 machine) was used as a source of a continuous CO(2) laser wave. METHODS: A total of 123 patients (68 female and 55 male) with 183 lesions were treated with the CO(2) laser. The maximum power was 100 W and the pulse width was 0.5-5 s. For the control group, 110 patients (with 250 lesions) were treated with glucantime 50 mg/kg/day for 15 days and, after 15 days of rest, this treatment was repeated (Glucantime Amps, 1.5 g in a 50-mL solution, was used). For follow-up, the patients were visited 1, 3, 4, 8, 12 and 24 weeks after treatment and any complications, recurrences or other wound characteristics were recorded. In the second group, Finally, all collected data were analyzed statistically. RESULTS: Statistical analysis with the chi(2) test showed that treatment with the CO(2) laser was more effective than treatment with glucantime (P = 0.0007). Complications were also seen less often with the laser treatment than with glucantime and were limited to the ulcer site. The CO(2) laser was more effective in treating cutaneous leishmaniasis than glucantime (1.12 times), had fewer side-effects (4.5% vs. 24%) and resulted in a shorter healing time (1 month vs. 3 months), and treatment could be applied in a single session. CONCLUSIONS: The results of this and previous studies suggest that cutaneous leishmaniasis can be treated effectively with CO(2) laser if those providing the treatment are sufficiently experienced. Laser treatment is more cost-effective than other treatments and can be used as first-line therapy for cutaneous leishmaniasis (wet and dry types).

Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: recent experience in Turkey.

A total of 1,030 patients, 40.2% men and 59.8% women, identified during the period of October 1998 to November 2002 as having cutaneous leishmaniasis (CL), were studied; 1,431 lesions were identified in the 1,030 patients. One lesion was present in 80.7% of the patients. The size of the lesions (longest axis) was 13.6 mm (standard, 12.1 mm; range 3-150 mm). Most of the lesions were of the papular type (51.2%), although several atypical clinical presentations of CL were observed. The duration of the disease ranged between 1 and 72 mo (mean duration, 10.8 mo). The clinical suspicion of CL was confirmed by the observation of amastigotes on lesion tissue samples stained by Giemsa. The test was positive in 851 of 1,030 patients (82.6%). Intralesional meglumine antimonate solution (85 mg Sb/ml, 0.2-1 ml, depending on the size of the lesion) weekly until complete cure or up to 20 wk was used for first-line therapy of 890 patients (86.4%). We found that this regimen of intralesional Sb has an efficacy of 97.2% with a low relapse rate of 3.9% and no serious adverse side effects.

Juvenile acute cutaneous leishmaniasis: the first case report from north Scandinavia.

A case of juvenile acute cutaneous leishmaniasis is reported. Treatment with freezing with CO2 snow was beneficial in healing of cutaneous lesions and no relapses have occurred.