Radiation therapy for squamous cell cancer of the skin in a patient with xeroderma pigmentosum.

Xeroderma Pigmentosum is an autosomal recessive disease characterized by increased sensitivity to ultraviolet radiation. Adjuvant radiotherapy (RT) is an important locoregional treatment modality for high-risk skin squamous cell cancers (SCCs). We present a case of an adult with high-risk skin SCC treated with standard adjuvant RT and followed-up for >4 years with acceptable side effects.

Anatomical Landmarks of the Beard Region.

BACKGROUND: With recent advancements in hair restoration techniques, hair can be transplanted into nonscalp areas, such as the beard region, and the result looks natural. Although scalp zones and landmarks have been available for planning and designing the hairline, landmarks that will determine the beard lines are yet to be presented and made known for clinical practice. OBJECTIVE: This study aimed to determine and analyze the beard lines and anatomical boundaries of the beard area to provide a more natural restoration/reconstruction appearance. MATERIALS AND METHODS: The soft-tissue landmarks of the face that will enable physicians to create natural-looking beard lines were determined. Based on these important points, beard lines were analyzed with anthropometric methods by using the photographs of 32 male volunteers. RESULTS: The ideal upper and lower beard lines and the anatomical boundaries of the beard area were determined using these landmarks. CONCLUSION: These lines ensure that beard restoration/reconstruction provides a more natural appearance.

A Distinct Technique of Intermaxillary Fixation Screw Application to Condylar Process to Fracture Reduction in Open Approach of Condylar Fracture Treatment.

ABSTRACT: The aim of this letter is to present the surgical experience obtained from a patient, in whom the proximal segment was better manipulated for precise alignment after application of the intermaxillary fixation screw.

Traumatic Avulsion of Upper Eyelid Skin Following Surgery in a Patient With Multiple Myeloma and Amyloid Light-chain Amyloidosis.

Multiple myeloma (MM) is a common hematologic malignancy. Primary systemic amyloidosis or amyloid light-chain (AL) amyloidosis is a rare disease. PURPOSE: This article presents the case of a patient with MM and AL amyloidosis who experienced a severe case of medical adhesive-related skin injury. CASE STUDY: A 64-year-old man with MM, AL amyloidosis, and diabetes presented with a necrotic wound on his left heel that required surgical debridement. The patient experienced a traumatic avulsion of the right upper eyelid skin during the removal of the corneal abrasion preventive tape as well as traumatic avulsion of the left upper eyelid skin while the patient's face was being cleansed. The avulsed right upper eyelid skin above the tarsus was repaired with a full-thickness skin graft. The partly avulsed left upper eyelid skin was repositioned, and an excisional biopsy was taken. Both upper eyelids healed uneventfully. The biopsy specimen revealed increased amyloid deposition in the dermis, subcutaneous tissue, and areas surrounding the veins and sweat glands. CONCLUSION: This case illustrates the increased risk of medical adhesive-related skin injury and other skin damage in patients with MM and AL amyloidosis. In these patients, the use of tape should be avoided to prevent intraoperative corneal abrasion.

Correction of Brassiere Strap Grooves with Fat Injections.

BACKGROUND: The size and weight of hypertrophied breast can cause both physical and psychological problems. Although the majority of these problems can be solved with breast reduction surgery, the particular problem of development of brassiere strap grooves on the shoulders due to the weight of the breasts cannot be corrected with this method. OBJECTIVES: Breast reduction surgery focuses only on the increased dimensions of breasts: fullness of the thoracic wall lateral to the breasts, as well as the appearance of brassiere strap grooves, need to be taken into consideration to obtain a better upper body image. Therefore, we present a series of 10 female patients who were treated with fat injections for the correction of brassiere strap grooves. METHODS: Reduction mammaplasty and fat injections into the brassiere strap grooves were performed during the same session. RESULTS: Dramatic changes are obtained with judicious placement of fat into the bra strap grooves. CONCLUSIONS: A more aesthetic and harmonious look can be obtained with using these combined aesthetic procedures in appropriately selected patients. LEVEL OF EVIDENCE: 4 Therapeautic.

Brassiere strap groove deformity: definition and classification.

UNLABELLED: Brassiere strap grooves develop mostly on the shoulders of women with hypertrophied breasts. Varying degrees of the deformity are observed in such cases. To date, there is no universally accepted definition and classification for brassiere strap groove deformity. In this study, we aimed to define and classify the deformity in order to inform consultants and future surgeons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis.

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

Surgical treatment of giant pyogenic granuloma of the upper eyelid.

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign acquired vascular lesion of the skin and mucous membranes. Diagnosis is aided by history of surgery, trauma or inflammation and characteristic clinical appearance, whereas, definitive diagnosis is made by histopathologic findings. PG is most often located on the head, neck, extremities, and upper trunk. From an ophthalmic perspective, a PG may be located on the eyelids, conjunctiva or rarely on the cornea. We present a case of surgically treated giant pyogenic granuloma of the upper eyelid, and we describe a technique of reconstruction of the upper eyelid skin by bilateral advancement flaps that allows the coverage of small- to medium-sized defects of this region with satisfactory esthetic and functional results.

Ear deformity due to neurofibromatosis type 1.

Neurofibromatosis is an autosomal dominant neurogenetic disorder. It is associated with significant morbidity and results in substantial loss of function as well as significant cosmetic problems. Elephantiasis neurofibromatosa is the most impressive manifestation of the disease because of its size. In this setting, the lesion leads to massive overgrowth of both the skin and the associated soft tissue, causing disturbing deformities. The reported patient had huge plexiform neurofibromas involving both the external right ear and neck regions. Deformed external ear and neck regions were restored surgically with satisfactory cosmetic results.

Giant verruca vulgaris.

BACKGROUND: Common warts (verrucae vulgares) are hyperkeratotic papulonodules that are most often seen on the hands, arms, and legs, but they can be seen anywhere on the glabrous skin. Common warts represent the most frequent clinical lesions produced by the human papillomavirus (HPV). OBJECTIVE: Although they are diagnosed easily, giant, chronic, isolated, solitary, recalcitrant verruca vulgaris involving nail and nail bed on the digits can be misdiagnosed, and the differential diagnosis should be made carefully and verified by biopsies. METHOD: A 50-year-old male patient had a giant periungual verruca vulgaris on his left second finger. It was present for 2 years, was unresponsive to any treatment modality, and was treated by surgical excision. RESULTS: After 18 months of follow-up, there was no evidence of recurrence, and both aesthetic and functional results were quite satisfactory. CONCLUSION: Lesions of long duration generally lose their characteristic histopathologic features, and HPV cannot be detected in these lesions by polymerase chain reaction. Therefore, multiple sections should be examined histopathologically, and extreme care should be taken in order to avoid misdiagnosis.

Effects of granulocyte macrophage colony stimulating factor on random flap healing and immune profile in rats with impaired wound healing by glucocorticoids.

Wound healing involves inflammation, cell proliferation, matrix deposition, and tissue remodeling. Priming the tissue to be incised with proinflammatory cytokines offers a new approach to wound healing. This has been studied mostly in incisional wounds till now. This study was designed to investigate the role of granulocyte macrophage colony stimulating factor (GM-CSF) priming of planned incision lines in random flaps in rats with impaired wound healing due to glucocorticoid administration, and immune profiles of rats were also evaluated. GM-CSF priming of incision lines in immunosuppressed rats was shown to improve the wound healing parameters, hydroxyproline levels, breaking strength, flap survival, and immune profile, although all of the parameters were somewhat lower than those of control group. The findings of this study suggest that wound healing can be accelerated and thus morbidity lowered by making use of the immunomodulator effects of GM-CSF in cases where wound healing is impaired due to systemic disease or drug use and flap reconstruction is necessary.

Eyebrow transplantation.

The eyebrow has a powerful influence on the appearance of the orbital region. Because the person without eyebrows has an unnatural look, drawing everyone's attention, eyebrow restoration/reconstruction should be viewed as an esthetic surgery performed to improve the patient's appearance and self-esteem. Although hair-bearing pedicled flaps and free composite strip grafts have been the most widely used approaches in clinical practice formerly, follicular unit transplantation (FUT) has gained more and more importance nowadays in eyebrow restoration because of its more rewarding results. The process and results of FUT have been greatly improved thanks to advances in hair transplantation techniques, instrumentation, and practice. In this article, we discuss the restoration of 14 eyebrows in 8 patients (5 males and 3 females) using FUT. The procedure and the results also are discussed here under in light of literature.

Giant condyloma acuminatum.

BACKGROUND: Giant condyloma acuminatum is a warty lesion that is characterized by its large size and propensity to infiltrate into deeper tissues contrasting with its microscopically benign pattern. It is proposed that giant condyloma represents an intermediate lesion between condyloma acuminatum and verrucous carcinoma. OBJECTIVE: A primary therapeutic option of giant condyloma is radical surgery with or without adjunctive chemotherapy. Because of the tumor's large extent in this case, curative therapy would have been achieved by wide surgical excision. METHOD: We present a morphologically and histologically classic example of giant condyloma with respect to origin from common genital warts. The reason for extensive exophytic growth was due to delay in therapy because of the patient's self neglect but not due to immune deficiency. The patient was treated with wide surgical excision. RESULTS: The postoperative period was uneventful, allowing satisfactory functional and cosmetic results. CONCLUSION: This case is an interesting case because of its exceptionally huge size without any deep tissue involvement and tissue atypia. This suggests that giant condyloma is an intermediate condition that exhibits a continuous tendency for growth.

Reconstruction of the labiomental region with local flaps.

BACKGROUND: Reconstruction of the labiomental area presents certain difficulties, especially in the assessment and selection of the incision lines to obtain the best cosmetic result. Among the factors influencing the selection of a reconstruction technique are the presence of natural folds and creases, skin laxity, and the size, shape, and orientation of the wound. Many operative techniques have been described for the reconstruction of this region. OBJECTIVE: To describe a combination of reconstruction techniques which restore the form, preserve sensation, and provide function of the labiomental region after ablative surgery. METHODS: We present two patients with reconstruction of the labiomental area where it was possible to preserve the vermilion of the lower lip after wide excision. The method of reconstruction constitutes a of modification of the Bernard method and Schuchardt procedure. RESULTS: Satisfactory results were obtained with preservation of the sensitivity of the lower lip, competent lip seal, and avoidance of microstomia, in addition to a good aesthetic appearance. CONCLUSION: The described technique is a preferable technique in patients for whom vermilion of the lower lip should be preserved after wide excision. The technique restores the form, preserves sensation, and provides function-the principles of a successful reconstruction.