[Postoperative complications after recrossectomy of the saphenofemoral junction]. / Postoperative Komplikationen nach inguinaler Re-Krossektomie.

The surgical procedure for recurrences at the saphenofemoral junction represents a great challenge for the surgeon due to the complex anatomic variability, the broad range of causes and the mostly extreme scar tissue. The incidences of postsurgical minor and major complications after recrossectomy in the groin area are determined and the clinical outcomes are analysed in this article. After specific and precise presurgical clinical and sonographical diagnoses having been undertaken a cutaneous incision is performed in the groin with the aid of tumescent local anaesthesia combined with total intravenous anaesthesia. From the proximal site any scar tissue exsisting is meticulously removed, the femoral vein is set free and the still remaining stump of the long saphenous vein or of the neovasculate as well as all left over varicose side branches of the saphenofemoral junction are removed. Within this special surgical procedure the stump of the long saphenous vein or the neovasculate are completely removed and, thereafter, a continuous longitudinal suture of the femoral vein is performed. Uncomplicated minor bleeding complications (haematoma in large extension or disseminated) appear quite frequently, lymphatic minor complications (conservatively treatable lymph oedema, lymphatic fistulae or lymphatic cysts) occur from time to time; major complications such as bleeding complications with the necessity of surgical reintervention occur only in sporadic cases and can be avoided by exact presurgical diagnosis, by meticulous special surgical technique matching the operation site as well as by regular and frequent postsurgical follow-ups. Absolute preconditions to achieve the very best results in the long run are the exact procedures of diagnosis and surgical technique. Performed by experienced phlebosurgeons or vascular surgeons, the recrossectomy of the saphenofemoral junction represents a low-risk surgery for the patient and is a singular and possibly time-consuming challenge for the surgeon.

[Cutaneous metastases from a leiomyosarcoma of the testicular tunica albuginea]. / Kutane Metastasen eines Leiomyosarkoms der Hodenhüllen.

Cutaneous metastases from a leiomyosarcoma of the testicular tunica albuginea are very rare. Primary leiomyosarcomas in this site are uncommon and furthermore cutaneous metastases develop only in 1,4% of all malignant tumors of the internal organs [10]. A 71 year old patient with such a sarcoma underwent primary excision. Nine months later multiple, firm, nodules were identified as cutaneous metastases. Further staging revealed already extensive, diffuse pulmonary and bony metastases without contiguous or regional lymph node involvement.