Complex Scalp Reconstruction with Super Thin DIEP Free Flap.

Scalp reconstruction provides a unique challenge to the reconstructive surgeon, especially in terms of matching skin color and contour. We present a case of a 67-year-old man with a chronic scalp wound requiring soft tissue coverage after major debridement and coverage of a skull defect. We chose to use a super thin deep inferior epigastric perforator (DIEP) flap to provide good skin coverage along with good contour to the scalp. The use of a super thin DIEP flap, dissected above the superficial fascial plane, is a newer technique in the realm of free tissue transfers that has shown improved outcomes in wound contour. Although the DIEP flap has been popularized for breast reconstruction, the authors believe that it has the ability to provide good soft tissue and skin coverage to other areas of the body, including in head and neck reconstruction.

Imaging Delay Following Liver-Directed Therapy Increases Progression Risk in Early- to Intermediate-Stage Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related deaths in the world. Patients with early-stage HCC are treated with liver-directed therapies to bridge or downstage for liver transplantation (LT). In this study, the impact of HCC care delay on HCC progression among early-stage patients was investigated. Early-stage HCC patients undergoing their first cycle of liver-directed therapy (LDT) for bridge/downstaging to LT between 04/2016 and 04/2022 were retrospectively analyzed. Baseline variables were analyzed for risk of disease progression and time to progression (TTP). HCC care delay was determined by the number of rescheduled appointments related to HCC care. The study cohort consisted of 316 patients who received first-cycle LDT. The HCC care no-show rate was associated with TTP (p = 0.004), while the overall no-show rate was not (p = 0.242). The HCC care no-show rate and HCC care delay were further expanded as no-show rates and rescheduled appointments for imaging, laboratory, and office visits, respectively. More than 60% of patients experienced HCC care delay for imaging and laboratory appointments compared to just 8% for office visits. Multivariate analysis revealed that HCC-specific no-show rates and HCC care delay for imaging (p < 0.001) were both independently associated with TTP, highlighting the importance of minimizing delays in early-stage HCC imaging surveillance to reduce disease progression risk.