Quantification of the surgical margin shrinkage in lip cancer: determining the relation between the surgical and histopathologic margins.

Lip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed. The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used. The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage.

Endoscopic repair of isolated anterior table frontal sinus fractures without fixation.

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

Islanded perforator flaps in the reconstruction of hidradenitis suppurativa defects.

Hidradenitis suppurativa is a recurrent, chronic, and suppurative cutaneous disease of unknown etiology. Radical excision of all affected skin followed by flap coverage of the defect is the treatment method of choice in severe and recurrent cases. This study discusses the use of local islanded perforator flaps in the reconstruction of defects following excision of hidradenitis suppurativa lesions in axillary, gluteal, and inguinal regions. Eleven male patients (mean age of 39.3 years) underwent reconstruction of hidradenitis suppurativa defects with 13 local islanded perforator flaps. Three patients (one being bilateral) had gluteal, two patients (one being bilateral) had inguinal, and six patients had axillary involvement. The defects in the gluteal region were repaired with superior gluteal artery perforator flaps, inguinal defects were repaired with medial circumflex femoral artery perforator flaps, and the axillary defects were repaired with thoracodorsal artery perforator flaps. There was no total flap loss in the postoperative period, but one marginal necrosis and two wound infections occurred. There was no recurrence of hidradenitis suppurativa or revision requirement during the mean follow-up period of 11.5 months.

Use of scalp flaps as a salvage procedure in reconstruction of the large defects of head and neck region.

AIM: Large defects of the scalp, head and neck region are often encountered by plastic surgeons. The repair of such defects is dependent upon their location, size and depth. This study describes the use of large scalp flaps as a salvage procedure in the reconstruction of large scalp, head and neck region defects in elderly patients with poor general condition or advanced malignancy. MATERIAL AND METHODS: The presented study includes 22 patients operated between 2007 and 2011 for the reconstruction of large defects of the hair-bearing skin and head/neck region with large scalp flaps. A defect exceeding 25 cm² area was classified as "large" as defined in the previous studies. The patients' medical records were analyzed. RESULTS: Scalp flaps provided a satisfactory and durable reconstruction in the late follow-up term. All flaps were completely survived except in one case in which a partial necrosis in the distal margin occurred. Major complications were recorded in 4.5% of patients while minor complications were recorded in 13.5% of them. CONCLUSION: In conclusion, large scalp flaps should be considered as a salvage procedure for reconstruction of large scalp, head and neck defects especially for palliative situations in elderly patients with significant comorbidities and advanced malignancies.

Use of deepithelialized medial sural artery perforator flap for the correction of postoncologic facial contour deformity.

We report a case of young patient with a postoncologic right buccomandibular defect in which the deepithelialized medial sural artery perforator flap was used to obtain a symmetric contour of the defective side. The aim of this study was to compare treatment strategies of facial contour deformities and to give detailed information about medial sural artery flap dissection with a clinical presentation.

Reconstructive procedure of lower lip defect due to ecthyma gangrenosum--a rare complication of acute lymphoblastic leukemia.

Ecthyma gangrenosum is a rare invasive cutaneous infection mostly caused by Pseudomonas aeruginosa in immunosuppressed patients, especially during neutropenic states. Embolic lesions usually accompanying with septicemia of P. aeruginosa are typically painless, round, and centrally necrotic with a surrounding erythematous halo. Facial involvement occurred only in 6% of the patients, which may result to complicated defects for reconstruction. In this article, we aimed to present a case with relapse of acute lymphoblastic leukemia presented to our clinic with 50% defect of the lower lip due to ecthyma gangrenosum and its late-term reconstruction.

Concentric-needle cannula method for single-puncture arthrocentesis in temporomandibular joint disease: an inexpensive and feasible technique.

Management of temporomandibular joint (TMJ) disorders presenting with pain, restricted mouth opening, or simply asymptomatic clicking can be challenging even to the experienced surgeon. Many conservative and invasive techniques are available, but most cases can be treated by arthrocentesis of the joint locally. A simple process of joint irrigation enables lysis of intra-articular adhesions, change in the joint viscosity, and clearance of various substances in the joint fluid. Classically, arthrocentesis of the TMJ has been performed with 2 needles: an infusion needle and an aspiration needle. Various devices and techniques have been described in the literature, each with its own benefits and drawbacks. We introduce our technique of TMJ lavage using 2 different gauge needles placed in a concentric manner; hence, besides a less traumatic and easier puncture of the joint capsule, the lavage and aspiration of the joint space can be performed efficiently, with minimal morbidity. The use of a concentric-needle cannula system is the least traumatic and perhaps the most cost-effective method for TMJ lavage described to date. We believe that this technique is applicable and can be performed by even the inexperienced surgeon.