Eyelid reconstruction following excision of cutaneous malignancy.

PURPOSE: With advancing age, cutaneous malignancy around the eye becomes more prevalent. Different kinds of malignant tumors of the eyelid have features particular to their subtype, and a diagnosis should be obtained before definitive treatment if possible. The aim of treatment is total tumor eradication with the smallest recurrence risk, using the most cost-effective method that is acceptable to the patient. Reconstruction of periocular defects following excision of eyelid malignancy can present difficulties, and various reconstructive procedures can be applied. METHODS: The retrospective study carried out has analyzed 173 patients submitted to surgery for skin cancers located in the eyelid region with particular reference to the period January 2005 to January 2012. We analyzed certain data (age, sex, histological types, affected portion of eyelid, incidence recurrence by histological type, incidence recurrent tumors previously treated by surgery [secondary], type of removal, type of reconstruction, and mean time elapsed between the demolitive act and disease recurrence) both individually and in correlation with each other. Multivariate analysis (Cox algorithm) was used to identify those variables that had a clear statistical significance. RESULTS: Melanoma and lentigo maligna have the highest tendency to relapse (33%), but squamous cell carcinoma has more rapid replicative capacity. CONCLUSIONS: Extensive demolition should always be followed by extensive reconstruction. Even through intervention with an extensive demolition in cases of large tumors in the eyelid and cantus, it has not been possible to avoid the recurrence of the disease. The average time of recurrence when compared with reconstruction varies between 28 (minimum) and 39 months (maximum).

Risk factors associated with relapse of eyelid basal cell carcinoma: results from a retrospective study of 142 patients.

Of skin cancers, 9% arise at the periocular level, constituting a significant threat due to the proximity to intracranial structures, such as the eyes, nerve endings and proximal tissues. Tumour recurrence can be frequent and represents a primary clinical challenge for the surgeon. To present a retrospective study on the treatment of eyelid tumours at a tertiary care centre in Italy over an eight-year period and, in particular, to underline the risk factors associated with tumour relapse. Among a cohort of 205 patients, a retrospective study was conducted on 142 basal cell carcinoma (BCC) patients with eyelid tumours treated with surgical excision. Relapse-free survival was assessed using univariate Kaplan-Meier and multivariate Cox regression analysis. Over an eight-year study period, we detected 23 cases of BCC recurrence, with tumour localization associating with tumour relapse, representing an independent risk factor. The extent of the area of excision was significantly associated with relapse, but not margin positivity which was associated with reduced relapse-free survival. To minimize relapse of basal cell carcinoma during patient management, relevant factors to consider before and after tumour excision include tumour localization, margin invasion, and extension of the excision, but not the surgical technique used.

Reconstructive head and neck surgery: oncological and functional results.

AIMS: The aim of this retrospective study is to review the experience in performing head and neck reconstruction surgery between 1989 and 2009 at the ENT Department of the University Hospital of Ferrara, Italy, considering the oncological as well as the functional and psychological outcome. METHODS AND STUDY DESIGN: Thirty-three consecutive patients were enrolled. Patients underwent flap reconstruction following primary or salvage surgery for squamous cell carcinoma of the oral cavity or oropharynx. Oncological results in terms of survival rate and disease-free interval, as well as functional and psychological results were evaluated. RESULTS: The oncological results, i.e. survival rate related to cancer stage and disease-free interval, were in agreement with those of the literature. Functional assessment, swallowing function and speech intelligibility were statistically poorer in patients affected by oropharyngeal malignancies than in patients affected by oral cancer. Quality of life was compromised in terms of reduced relationships and onset of depression or irritability. CONCLUSIONS: Reconstructive surgery can be considered a relatively standard procedure in the treatment of head and neck cancer. The main drawback is still related to the major impact on patients' quality of life and functional status.

Distally-based superficial sural flap: advantages of the adipofascial over the fasciocutaneous flap.

The distally-based superficial sural flap has proved to be an easy and reliable method of reconstruction in soft tissue cover of the distal third part of the leg. There are two ways to prepare this flap: as a fasciocutaneous flap, which includes the fascia with the subcutaneous tissue including the skin; or as an adipofascial flap, which is made up of both the fascia and the subcutaneous adipose tissue. In the latter case, the flap is covered with a partial thickness skin graft either immediately after or at a later stage. The aim of this study was to assess the advantages and disadvantages of the two flaps. The adipofascial flap seems to be better, as it is associated with less donor site morbidity, improved quality of reconstruction, and fewer complications.

Microsurgical latissimus dorsi flap in a case of breast aplasia caused by radiation therapy.

The use of ionizing radiation in the breast region while a patient is at developmental age is still responsible for most monolateral hypoplasias and iatrogenic-based breast asymmetries. These alterations often involve several anatomical structures, thus causing severe hypoplasia of the breast and muscle tissues and stiffness of soft tissues, with atrophic and cicatricial skin. Reconstruction methods vary from case to case, but most of the time reconstruction with a homolateral latissimus dorsi with or without a breast implant seems most suitable. In some cases, however, this is not a viable alternative due to particular general and local conditions, making it necessary to consider other solutions. We present the case of a young prepubertal patient who came under our observation due to a radiotherapy outcome in the right breast and thoracic region; she had been previously subjected to breast reconstruction elsewhere, with the fitting of a subcutaneous prosthesis. Due to the patient's particular general and local conditions and the pathological involvement of the homolateral thoracic musculature, to improve the clinical picture, we deemed it appropriate to use the microsurgical reinnervated contralateral latissimus dorsi muscle, which so far has enabled us to obtain considerable and lasting results.