Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap-a case report.

BACKGROUND: Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation. CASE PRESENTATION: We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot. CONCLUSIONS: Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.

[Squamous cell carcinoma developing in necrobiosis lipoidica in a diabetic patient]. / Recidiverende tilfælde af spinocellulær karcinom i necrobiosis lipoidica-sår hos en patient med diabetes.

The development of squamous cell carcinoma in chronic and/or non-healing ulcers associated with necrobiosis lipoidica (NL) is rare, but should be considered in diabetic patients. NL is a non-infectious granulomatous degenerative skin disease. The prevalence of NL in diabetic patients is estimated to 0,3-1,2%. Awareness of malignant transformation potential within a plaque of NL is crucial for early diagnosis and easy radical treatment. A case from our outpatient diabetes clinic is presented.

Fractional CO2 laser: a novel therapeutic device for refractory necrobiosis lipoidica.

Necrobiosis lipoidica diabeticorum is a granulomatous skin disease of uncertain pathogenesis. Many therapeutic approaches have been reported in the literature, but none of them can be considered the gold standard. Fractional CO(2) laser treatment shows peculiar effects in the skin, mainly due to its ability of modulating cytokine pathways of tissue-repairing mechanisms. Thus, we propose fractional CO(2) laser in the management of refractory necrobiosis lipoidica in selected recalcitrant patients.

Does pancreas transplant in diabetic patients affect the evolution of necrobiosis lipoidica?

BACKGROUND: Necrobiosis lipoidica (NL) is a non-infectious granulomatous skin disorder, with average age of onset is between 30 to 41 years, and female : male ratio of 3 : 1. The strongest systemic disease associated is diabetes mellitus (DM). Many treatment options are used for NL with variable success. To verify if reversal of the diabetic state is related to improvement of NL, we compared the evolution of NL lesions in patients who received a pancreas transplant with those who received a kidney. METHODS: Retrospective chart review of diabetic patients with NL who underwent transplant. RESULTS: A total of fifteen patients were identified and divided into two groups: group I (n = 11) consisted of patients who underwent pancreas only or pancreas plus kidney transplant, group II (n = 4) underwent kidney only transplant. Of the eleven patients in Group I, five had NL lesions at the time of transplant and all achieved resolution of these lesions. One patient experienced recurrence of NL associated with transplant rejection. In group II, one patient who had NL lesions at the time of transplant had persistent lesions after the transplant. Resolution of NL was observed in 45% (five/eleven) of the cases in the pancreas +/- kidney transplant group, whereas the one patient who had active NL and kidney transplant failed to demonstrate improvement of the lesion after the procedure, despite the concomitant use of immunosuppressant therapy. CONCLUSIONS: Patients experienced improvement of NL within 2-8 weeks following pancreas transplantation. Metabolic changes, improvement of the microcirculation and normalization of blood glucose levels may be playing a role in the resolution of NL.

Periorbital necrobiosis lipoidica diabeticorum: case report.

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.

Healing of chronic necrobiosis lipoidica lesions in a type 1 diabetic patient after pancreas-kidney transplantation: a case report.

Necrobiosis lipoidica (NL) is a degenerative disease of dermal connective tissue of unknown etiology characterized by erythematous plaques preferentially localized to distal extremities. Skin lesions show a chronic relapsing nature. NL is often associated with diabetes mellitus and satisfactory treatment options are lacking. We describe the spontaneous healing of NL lesions after pancreas and kidney transplantation in a Type 1 diabetic patient with chronic NL recalcitrant to a variety of standard treatments. The 31-yr-old male patient had experienced NL lesions for more than 15 yr; despite various systemic and topical treatments, the skin lesions had pregressively enlarged. Because of end-stage renal disease, a simultaneous pancreas and kidney transplantation was performed and immunosuppressive therapy with tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone was started. Pancreatic transplantation maintained satisfactory metabolic control with no need of exogenous insulin. After transplantation, skin lesions slowly healed without any specific treatment, leaving residual areas of fibrotic scars. A skin biopsy confirmed the absence of typical NL lymphocytic and histiocytic inflammatory response. Clinical remission of NL lesions may probably be explained by the concomitant effect of multiple-drug regimen for immunosuppression (TAC, MMF, and prednisone) and improved skin microcirculation secondary to the good metabolic control provided by pancreas transplantation.

[Successful therapy of ulcerated necrobiosis lipoidica non diabeticorum with cyclosporine A]. / Erfolgreiche Therapie einer exulzerierten Necrobiosis lipoidica non diabeticorum mit Ciclosporin.

Necrobiosis lipoidica is an inflammatory granulomatous skin disease of unknown etiology which is associated with diabetes mellitus in about 60% of the patients. In 15-35% of the affected patients painful ulcerations may occur after minimal trauma which can be extremely refractory to therapy. Because of the unknown pathomechanisms, current therapeutic options are limited. We report on a 68-year-old patient with an 18 year history of ulcerated necrobiosis lipoidica non diabeticorum of both lower limbs, which responded to systemic cyclosporine A. Based on this case, we discuss the role of cyclosporine A in patients with necrobiosis lipoidica in the context of the disease etiology.

[Vacuum therapy in a pre- and postsurgical ulcera crurum]. / Vakuumtherapie in der prä- und postoperativen Versorgung von Ulcera crurum.

Chronic wounds are often a diagnostic as well as a therapeutic problem. Three case reports depi important differential diagnoses. The importance and efficacy of vacuum assisted closure in a presurgical treatment as well as after mesh graft transplanation will be described.

Squamous cell carcinoma developing in necrobiosis lipoidica.

We describe a case of squamous cell carcinoma arising in long-standing necrobiosis lipoidica in a type 1 female diabetic patient. The tumour and the skin lesion were successfully excised and repaired with full thickness skin graft. The development of squamous cell carcinoma in association with this skin disorder is rare (only four cases reported in literature since 1966), but should be considered in chronic, non-healing and recalcitrant ulcers developing within areas of necrobiosis lipoidica.

Necrobiosis lipoidica diabeticorum treated with the pulsed dye laser.

BACKGROUND AND OBJECTIVE: Different treatment modalities have been advocated for necrobiosis lipoidica diabeticorum but clinical response is unpredictable. The purpose of this study was to evaluate the usefulness of pulsed dye laser (Candela SPTL, Irvine, MA, USA) in the treatment of an area of necrobiosis lipoidica of 4 cm in diameter on the anterior aspect of the leg in a non-diabetic patient. MATERIALS AND METHODS: A spot test was made at 6.0, 6.5 and 7.0 J/cm(2) energy fluences and the best energy fluence was selected after a 2-month postoperative evaluation. The patient received three treatment sessions with a fluence of 6.5 J/cm(2), 585-nm wavelength, 5-mm spot size, and 450 micro(s) pulse duration at 8-week intervals. The patient was given routine skin care advice with emollient cream and sunscreen (SPF 15) until the following session. RESULTS: Overall cosmetic improvement was achieved, with a decrease of erythema and telangiectasis, and stabilization in terms of progression (size) in the left half of the lesion, with no modification of atrophy or pigmentary changes. The right upper quadrant of the lesion showed an erythematous peripheral halo with minimal reduction in the erythema and telangiectasia, and discrete size increase. CONCLUSION: Pulsed dye laser may be a useful treatment for improving the telangiectasia and erythematous component of necrobiosis lipoidica.

Granuloma anular elastolítico de células gigantes diseminado / Disseminated giant cell annular elastolytic granuloma

Presentamos el caso de un paciente de sexo masculino de 71 años, afectado de granuloma anular elastolítico de células gigantes diseminado. Utilizamos para su tratamiento criocirugía, obteniendo la remisión total de las lesiones. Para facilitar la comprensión de la entidad confeccionamos tablas con las características clínicas e histopatológicas de los principales diagnósticos diferenciales y con su tratamiento

Granuloma anular elastolítico de células gigantes diseminado / Disseminated giant cell annular elastolytic granuloma

Presentamos el caso de un paciente de sexo masculino de 71 años, afectado de granuloma anular elastolítico de células gigantes diseminado. Utilizamos para su tratamiento criocirugía, obteniendo la remisión total de las lesiones. Para facilitar la comprensión de la entidad confeccionamos tablas con las características clínicas e histopatológicas de los principales diagnósticos diferenciales y con su tratamiento (AU)

Subcutaneous palisading granuloma of the scalp in childhood.

Subcutaneous palisading granulomas, lesions characterized by collagen necrosis and chronic inflammatory changes, may present as ill-defined, immobile, nontender masses of the scalp. They are frequently multiple and may vary in size over time. Imaging studies rarely show involvement of the calvarium. The histological pattern of palisading histiocytes around necrobiotic granulomas is seen in association with a variety of systemic illnesses but more commonly occurs as an isolated entity in childhood. They are unlikely to herald rheumatological disease unless the erythrocyte sedimentation rate is elevated. In the presence of juvenile rheumatoid arthritis, histological confirmation is usually not indicated. If the lesions are not associated with any other clinical symptoms excisional biopsy may be indicated to establish a diagnosis. The nodules need not be removed as they will spontaneously regress.

Necrobiosis lipoidica diabeticorum: revisäo e análise de 24 casos / Necrobiosis lipoidica diabeticorum: review and analysis of 24 cases

Com base em uma revisäo crítica de literatura pertinente, säo feitas consideraçöes sobre a "necrobiosis lipoidica diabeticorum", incluindo a etiopatogenia, quadro clínico epidemiologia e o tratamento. De modo especial é abordada a associaçäo com o diabetes. Säo analisados os dados de 24 pacientes, sendo três pessoais e os demais obtidos através de questionário enviado a dermatologistas de diferentes regiöes do país