Surgical Management of Plantar Melanoma: A Retrospective Study in One Center.

Cutaneous melanoma is a highly malignant skin tumor, and in China, the planta pedis is a commonly involved site. The sites of plantar melanomas are a challenge to reconstruct after wide excision. Our experience with surgical management of melanomas was based on the 4 different anatomic subunits of the planta pedis. From January 1, 2002 to December 31, 2016, 35 patients who had had plantar melanoma had undergone surgical treatment in our clinic. The tumor locations were as follows: the toe in 6, the ball of the foot in 5, the arch in 15, and the heel in 9. Surgical management involved extended resection of the tumor, repair of defects with skin grafts or flaps, and inguinal lymphadenectomy. The skin flaps included a residual toe flap, an anterograde or retrograde medial plantar flap, and a retrograde sural neurocutaneous vascular flap. Of the 35 cases of flaps and skin grafts, 33 (94.29%) survived, and the wounds had healed by first intention. After a follow-up period of 6 months to 7 years, 24 patients (68.57%) were free of local and systemic disease and 30 patients (85.71%) were ambulatory using shoes, and all the flaps and skin grafts showed a good appearance. The personalized surgical treatments we used for melanoma in the planta pedis resulted in overall satisfactory outcomes and adequate disease clearance, and allowed the patients to resume normal lives. The function of the foot was maintained or restored to the greatest possible degree, and the patients' quality of life improved postoperatively.

Surgical Management of Giant Scalp Neurofibroma After Ultra-Selective Embolization of Nutrient Artery.

OBJECTIVES: Neurofibroma, a common benign tumor in soft tissue, continues to grow, so it often appears to be giant. Surgical management of giant neurofibroma is a challenge due to the risk of excessive bleeding. Embolization of tumor's nutrient artery may reduce the blood loss in operation. This study introduces the surgical management of giant scalp neurofibroma with preoperative ultra-selective embolization of nutrient artery. METHODS: From January 2006 to December 2013, 9 patients with giant scalp neurofibroma were enrolled into the study. Digital subtraction angiography (DSA) showed tumor's nutrient artery. Ultra-catheter was inserted into the nutrient artery and its branches as close as possible to the tumor. Then ultra-selective embolization was performed with gelatin sponge particles. Surgical removal of tumor was performed in 3 days after embolization. The wound was repaired by skin graft. RESULTS: All of the 9 patients underwent successful DSA and ultra-selective embolization. Among them, occipital artery was embolized in 3 patients (left side in 1 patient and right side in 2 patients). Both occipital artery and superficial temporal artery were embolized in 6 patients (left side in 2 patients, right side in 3 patients, and both side in 1 patient). No complications, such as ectopic embolism, occurred in the patients. All of the tumors were resected completely without blood transfusion. The skin graft survived very well on the wounds. CONCLUSIONS: Preoperative ultra-selective embolization of nutrient artery is a feasible, safe, and effective method to reduce the blood loss in operation and facilitate the surgical management of giant scalp neurofibroma.

Liquid crystal elastomer actuator with serpentine locomotion.

A snake-mimic soft actuator composed of a bilayered liquid crystal elastomer ribbon and two serrated feet is reported in this work. Under repeated on/off near-infrared light irradiation, this actuator can move forward relying on a reversible shape morphing between S-curve structure and reverse S-curve structure, which is similar to the serpentine locomotion of snakes.

[Plastic treatment of Paget's disease of the scrotum and penis].

OBJECTIVE: To explore the clinical features and plastic treatment of Paget's disease of the scrotum and penis. METHODS: We analyzed 11 cases of Paget's disease of the scrotum and penis treated from 1997 to 2007. Extended excision of the focus of infection was performed and the skin absence was repaired by free skin grafting, local random skin flap, and island skin flap. RESULTS: Satisfactory wound healing was achieved in all but 1 case, which was delayed due to infection. All the patients were followed up for 1-4 years. One patient relapsed 2 years after the surgery and received a second operation, and another 1 died of lymphoma complicated by lung infection. The original shape and contractibility of the scrotum and penis were basically preserved and their appearance and function were fairly good. CONCLUSION: For patients with Pagets disease of the scrotum and penis, it is a desirable method to at once excise the lesion and repair the skin absence by plastic surgery.

Percutaneous sinus angiography and three-dimensional CT imaging showing morphological and draining features of venous malformations in soft tissue.

OBJECTIVE: Venous malformation (VM) is a common vascular malformation in soft tissue. Its morphological and draining features, relationship with main vein, and hemodynamics in the lesion are not completely clear till now. Above information is important for choice of treatment. METHODS: From January 2012 to December 2013, 23 patients were enrolled into this study. Percutaneous puncture into the lesion was made and contrast media was injected into venous sinus. Immediately after that CT scan was performed, and repeated several minutes later. Then three-dimensional imaging was performed to show the morphology and draining veins of VMs, and the relevant main veins. The hemodynamics in the lesion was also evaluated. RESULTS: All patients underwent successful examination. Three-dimensional imaging showed an irregular shape of VM. Based on the draining features, VMs were classified into three types: (1) Type I (7/23): malformation without visible draining vein; (2) Type II (10/23): malformation with normal draining vein; (3) Type III (6/23): malformation with abnormal dilated draining vein. The flow in type I VMs was slow. Contrast media retained in the lesion for more than 1 day. The flow in type III VMs was fast. Contrast media flowed away rapidly. The flow of type II VMs was between type I and type III. According to above information and adjacent anatomy, all patients received suitable treatment, including sclerotherapy with absolute ethanol and bleomycin A5, intralesional copper wires retention, surgical removal, and combinational therapy of the above methods. CONCLUSIONS: This procedure can clearly show the morphological and draining features of VM and its relationship with main vein, and further evaluate the hemodynamics in the lesion, which are helpful for the choice of treatment.

Surgical management of giant neurofibroma in soft tissue: a single-center retrospective analysis.

Neurofibroma, a common benign tumor in soft tissue, continues to grow, and often appears to be giant. In this study, we retrospectively analyzed the surgical treatment of 26 patients with giant neurofibromas in our clinic in the past 10 years from Jan. 2004 to Dec. 2013. The tumors were located in the head (n = 10), trunk (n = 9), limbs (n = 5), and multi-sites (n = 2). According to the location and extent of the lesion, as well as the adjacent anatomy, surgical management was performed to partially (n = 15) or almost completely (n = 11) resect the tumor. The wounds were repaired by skin flap or skin graft. Among them, one child with a giant tumor in the scalp underwent three times of skin expander treatment, and acquired complete removal of the tumor finally without baldness. Eleven cases underwent the interventional embolization of tumor's nutrient arteries, which successfully reduced the bleeding in operation. Most of the skin flap and skin graft survived well. After operation, the appearance of the patients and the function of the limbs were improved largely. In conclusion, for the giant neurofibroma, surgical treatment effectively reduces the tumor burden, rehabilitates the appearance and function, and so improves the quality of life. Skin expandor and interventional embolization of nutrient artery can be used when appropriate.

[Central wedge resection and asymmetric Z-plasty for minor labia reduction].

OBJECTIVE: To investigate the therapeutic effect of central wedge resection and asymmetric Z-plasty for minor labia reduction. METHODS: Based on the Giraldo procedure, the incision was designed and the redudent tissue was resected quantitatively. The Z-plasty was modified to rectangle flap with deviated incision. The incisions at the two surface of minor labia were designed in an opposited direction. The two rectangle flaps were inserted to form the free edge of minor labia. RESULTS: 11 cases of minor labia hypertrophy were treated with good results. CONCLUSIONS: The modified procedure is easily performed with precise design. It is suitable for all kinds of minor labia hypertrophy.

[Treatment of complicated cavernous venous malformation with retained copper wires combined with pingyangmycin injection].

OBJECTIVE: To evaluate the therapeutic effect of retained copper wires combined with pingyangmycin (PYM) injection for complicated cavernous venous malformation. METHODS: The location of venous malformation was detected by physical examination and MRI. The copper wires in 0.2 mm width were used to puncture the lesion repeatedly and retained in the lesion to form a net. After that, 8 mg PYM was injected into the residue malformed veins. 8-10 days later, the copper wires were taken out and necrotic tissue was squeezed out. The wounds of punctual holes healed through dressing. The patients received postoperative MRI to evaluate the therapeutic effect. RESULTS: From Jan. 2002 to Dec. 2008, 45 cases were treated. The patients were followed up for 1-3 years. 51.1% (23/45) of the lesions shrinked markedly or even disappeared. 42.2% (19/45) of the lesions reduced. 6.67% (3/45) of the lesions didn't change. There was no complication like invasive infection. CONCLUSIONS: It is very effective to treat complicated cavernous venous malformation with retained copper wires combined with pingyangmycin injection.

[The expression and role of glucose transporter-1 in infantile hemangioma].

OBJECTIVE: To investigate the expression and role of glucose transporter-1 (Glut1) in infantile hemangioma. METHODS: Fifty-two samples from infantile hemangioma, 25 in cavernous venous malformation, 9 in arteriovenous malformation, 2 in capillary malformation and 5 in normal skin samples were involved in this study. The EnVision immunohistochemical stain was used to investigate the expression of Glut1 protein in these samples. RESULTS: In the early proliferating stage, a number of endothelial cells expressed Glut1. In the middle proliferating stage, most of vascular endothelial cells and scattered endothelial cells expressed Glut1. In the late proliferating stage, the expression of Glut1 decreased quickly. In the involuting stage, all hemangioma samples didn't express Glut1. All of the samples from the cavernous venous malformations, arteriovenous malformations, capillary malformations and normal skin had no expression of Glut1. CONCLUSIONS: Glut1 may be one of the phenotypes of infantile hemangioma endothelial cells in their development, rather than the inherent character. The expression of Glut1 changes according to the metabolic need of infantile hemangioma cells.

[Allograft transplantation with compound tissue of two ears and skin of head and neck: A report of 1 case, China].

OBJECTIVE: To investigate the possibility and efficacy of allograft transplantation in treating patient with huge tissue defect after radical giant malignant melanoma resection. METHODS: A male person received blood type matching was chosen as donor. Immediately after the donor's brain death, allograft was excised with the depth to the layer intervenient between periosteum and epicranial fascia in calvaria, the superficial layer of deep temporal fascia in both sides of temporal regions, close to zygomatic bones and mandibles including masseter and auricles upon in face, and cervical soft tissues including sternocleidomastoid muscles, cervical and external jugular vessels of both sides were excised simultaneously. After being perfused with 4 degrees C UW solution through both common carotid arteries, the homograft was sheared and radiated with X-ray before being preserved in UW solution for further use. During the operation, both sides of external auditory meatus were anastomosed with ears firstly, and vessels were anastomosed end-to-end sequently, at last, the border of skin flap was sutured intermittently. Combined use of MMF, FK506, Prednisone and Zenopax was performed as post-operation immunosuppressive treatment. Clinical observations were made on the signs and symptoms of graft survival or rejection as well as blood FK506 concentrations and immunological indexes were tested in laboratory. Biopsies of graft were also made at 1 h, 4 h, 8 h, 7 d, 14 d and 30 d after operation. RESULTS: The circulation of the graft was satisfactory, and the temperature and color of skin were normal. Primary healing of suture and hair growth about 0.8 cm in a month were observed. Skin Biopsies of every time had no found of hyperacute or acute rejection. The concentration of FK506 was maintained 20 mg/ml 1 month after the operation. CONCLUSION: Allograft transplantation with compound tissue of head skin flap and ears is a kind of effective and safe treatment in repairing huge tissue defect. Good tissue matching and combined use of currently available immunosuppressants can prevent hyperacute and acute rejection efficiently.