A surgical approach to squamous cell carcinoma of penis that also resolved the psychological dysfunction of the patient.

In this case study, we present an unusual case with squamous cell carcinoma surrounding the penis involving foreskin and glans of penis. In addition, multiple satellite nodules were noted in the pubis. A 57-year-old circumcised heterosexual male patient presented with a penile lesion existing for 10 years. At the same time, he was referred to an outpatient memory clinic because of persistent subjective memory complaints associated with depression and anxiety. The patient was operated under general anaesthesia. The lesion was resected circumferentially with macroscopic clearance, resulting in complete degloving of the penile shaft. Neurovascular bundles were preserved. Histopathological analysis of the lesion revealed an invasive and poorly differentiated squamous cell carcinoma, and the surgical margins were free from tumour. The patient was followed for 18 months. He did not have voiding difficulty. Pelvic tomographic and physical examination findings did not reveal any episode of recurrence or metastasis. Treatment of carcinoma resulted in a simultaneous full recovery of his memory decline and he remained free of depression and anxiety symptoms over time.

Keystone Perforator Island Flap as an Alternative Reconstructive Option for Partial Thickness Alar Defects Up to 1.5 Centimeters.

INTRODUCTION: The ala is a unique landmark of the nose disposing aesthetic and functional properties. The head and neck area is the main site of appearance of nonmelanoma skin cancer. One third of them are located in the nose with an alar preponderance compared with other nasal subunits. Correction of alar defects is a challenging reconstructive task. The keystone perforator island flap (KPIF) was introduced as an alternative in nasal reconstruction by senior authors. In the present case series, KPIFs' application is introduced into the alar subunit as an alternative, versatile, and reproducible reconstructive option, even for the novice plastic surgeon. MATERIALS AND METHODS: From April 2014 to September 2015, patients presenting with partial thickness alar defects (≤1.5 cm) secondary to tumor extirpation sustained reconstruction with different types of KPIF. RESULTS: A total of 31 patients (mean age of 72 years) were treated with various types of KPIF. The mean diameter of the defect was 1.14 cm. The vast majority of reconstructions concerned a type IV KPIF (18/31 or 58.1%). Sometimes an upward alar retraction was noted. A minimal rim wedge excision was performed (≤0.3 mm) using counterbalancing correcting sutures. All flaps survived without any sign of venous congestion, whereas the rim healed uneventfully. The mean follow-up period was 6.5 months. CONCLUSIONS: KPIF was introduced as a single-stage alternative reconstructive option for partial thickness alar defects, completing author's experience with this flap into such a challenging and aesthetically critical anatomic area.

The Keystone Perforator Island Flap in Nasal Reconstruction: An Alternative Reconstructive Option for Soft Tissue Defects up to 2 cm.

The aim of this study was to present our experience with the use of the Keystone Perforator Island Flap (KPIF) in a case series of patients with small size (diameter ≤ 2 cm) nasal defects which will be useful prospectively to assist plastic surgeons in planning a reconstructive strategy that will work. The KPIF was utilized in 30 patients with nasal defects post tumor extirpation. More than one type of KPIF (type I or type III) was used following the nasal subunit principle or a modified version of it. The mean follow-up period was 10.5 months. Overall good outcomes were achieved, with no major complications encountered, except minor wound dehiscence in 3 cases. It is the first time that the utilization of this flap is reported in nasal reconstruction. The versatility of the KPIF makes it a safe technique even in the hands of inexperienced surgeons under guidance for nasal defects up to 2 cm in diameter.

Double scalping flap: a versatile technique in scalp reconstruction.

Scalp reconstruction is a challenging area in plastic surgery. The susceptibility of potentially exposed brain tissue is almost always a concern along with the provision of adequate soft tissue coverage in cases of full-thickness defects. The applied reconstructive strategy also affects efficiency in malignant disease treatment providing both local control of the disease and vigorous monitoring for recurrence or metastasis. The general condition of the patients presenting with malignant lesions of the scalp is often impaired because of old age or concomitant disease. Therefore, demanding, long-lasting, or multistage procedures may often be undesirable. The double scalping flap comprises a 1-stage procedure, which can be used in most full-thickness defects of the vertex of the scalp. Some of the primary advantages of the double scalping flap procedure are its versatility and arc of rotation, its minimal donor site morbidity, being relatively simple, and being a short technique. Disadvantages that may be considered are the loss of hair-bearing skin at the occipital region and the poor color and texture match between scalp skin and the split-thickness skin graft that is used on the donor site. We present 2 patients with exemplary case of neglected malignancy of the scalp and their successful treatment using the double scalping flap. Comparison and contrast of alternative reconstructive procedures are also included to further investigate scalp reconstruction.

Nonmelanoma skin tumors involving the craniofacial region: our 22 years of experience.

Skin tumors comprise the largest group of malignancies of the head. Despite the accessibility of such lesions, the treatment of neglected, far advanced cancers, many of which have extended deeply into the facial bones and skull, is often required. The key to the cure of malignant tumors of the head is an accurate diagnosis and evaluation of the margins of an excised tumor. Reconstructive surgery of the head after resection of tumors requires a complete understanding of the anatomy of this region. From January 1986 to December of 2005, 31 patients underwent reconstructive surgery for nonmelanoma skin tumors involving the craniofacial region. Preoperative evaluation of the patients was performed in all cases. The results were estimated from the oncologic and functional point of view. The reconstruction, which was performed, included local, regional, and free flaps. In our series, the 5-year disease-free survival rate was 87%. The primary goal of surgical treatment of skin tumors with invasion of craniofacial bone structure is three-dimensional tumor resection with histologically clear margins. This goal has to be balanced, however, with an acceptable functional and aesthetic result. Resections are planned according to pathologic considerations rather than according to the anatomy involved.

Divided naevus of the eyelid, seven cases.

Divided naevus of the upper and lower lids is an infrequent congenital naevus of the human eyelids. It is also known as kissing naevus or split ocular naevus. The histological types of divided naevi may be melanocytic, cellular or compound. Until now about 30 such cases have been reported in the literature. In our clinic, in the last 20 years we have seen seven patients with divided naevus, four female and three male. Three patients, two children of 10 and 11 years and a 77-year-old nun, did not accept any treatment. The remaining four patients, three female and one male, accepted surgical treatment. None of them had received any treatment in the past. Three of these divided naevi were cellular and one was melanocytic. Treatment included a two stage reconstruction in three cases and a single stage procedure in one case. The lower eyelid was usually treated first, and upper eyelid full thickness grafts were mostly used. Lid shortening was common, particularly in the cellular naevi. The results were aesthetically and functionally good. No major complications were observed.

Rat epigastric flap survival and VEGF expression after local copper application.

BACKGROUND: Copper has been used in wound healing since ancient times, and copper insufficiency seems to impair wound healing. Much less is known about the local effects of copper application on wound healing. METHODS: The authors studied 30 male Sprague-Dawley rats weighing between 250 and 350 g for 5 days. Full-thickness random skin flaps, measuring 1.5 x 7.5 cm, were elevated on the epigastric region. The rats were randomized into two groups according to the local treatment that was used. In group 1 (20 animals), 1 ml of copper ointment was applied on the flap bed after flap suturing. In group 2 (10 animals), 1 ml of placebo ointment (petroleum jelly) was used. Intraperitoneal injection of 30 mg/kg body weight of Hypoxyprobe-1 was performed in each rat on the fourth postoperative day and all animals were killed 3 hours later. Histologic examination of the distal end of the flaps was used for detection of hypoxic tissue changes. Expression, density, and extent of vascular endothelial growth factor activity was detected with the aid of immunocytochemistry. RESULTS: All rats survived throughout the study period. This experimental study showed that local application of copper at the random flap bed may promote wound-related angiogenesis by inducing vascular endothelial growth factor expression. The authors demonstrated statistically significant flap survival after local copper application at the flap bed. CONCLUSION: The marked benefits of copper application in flap survival in this experimental model may guarantee its clinical application in flaps with questionable viability.

Neglected squamous cell carcinoma of the frontal area: a clinical report.

Neglected skin carcinomas are not very often in our days. It is known that skin is the most common site of malignancy Squamous cell carcinoma (SCC) is the second most common malignancy of the skin. We report a combined surgical treatment in an unusual case of a squamous cell carcinoma (T4 n0 m0) localized on scalp, presented primarily as a frontal ulcerative bloody mass, with no palpable lymph nodes and a whole body negative computed tomography. Three months after the first surgical procedure, the tumour reappeared presenting left frontal lobe invasion. A combined surgical management (neurosurgery and plastic surgery) was realized, in order to remove the tumour and to cover the defect. Three months later the tumour recrudesced invading the left antrum, infiltration of remained parotid gland and an ipsilateral mandible osteolysis, besides a 2 cm size distal metastasis at the right upper lobe of the lung was revealed. This article, through case report and a brief review of the literature, offers criteria for the surgical treatment of SCC that arise on the scalp.

Orbitopalpebral repair after 835 excisions of malignant tumours.

Repair of any defect in the eyelid depends on its size and position and the state of the surrounding tissues. Basal cell carcinoma (BCC) is the most common malignant tumour of the eyelids, and squamous cell carcinoma (SCC), mixed carcinomas or basosquamous cell carcinomas (BSC), and cutaneous melanomas (CM), also invade the eyelids and periocular zones. Reconstruction of the eyelids and associated orbital structures after resection requires a complete understanding of the anatomy. The adequacy of the reconstruction is judged by the quality of functional restoration and the aesthetic appearance. The purpose of this study was to document various, simple or complex reconstructive procedures that may be used after excision of malignant tumours of the eyelids and to assess the outcome of surgical treatment.

Vertical trapezius musculocutaneous flap: a retrospective study.

From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.