The star approach, a surgical approach for skin sparing mastectomy and central lumpectomies.

When preservation of the nipple-areolar complex (NAC) is not possible in oncologic breast surgery, the traditional approaches are either a horizontal incision centered on the NAC resulting in visible scars and breast distortion, or a round block with risk of healing difficulties. To address these concerns, the authors propose a star approach technique for skin sparing mastectomies and lumpectomies of central breast tumors. During the oncologic surgery, the NAC is removed with four cutaneous extensions, which can be closed as a cross-shaped scar. The scarring is similar in size to the original NAC diameter and can easily be covered by the NAC reconstruction. This technique offers good exposure during surgery, a good aesthetic result with limited scarring, no breast deformity, correction of breast sagging, and high-quality healing.

Muscle sparing latissimus dorsi flap for reconstruction of a large chemo-necrosis of the chest wall: A case report.

BACKGROUND: Extravasation of chemotherapeutic agents is a common complication in cancer centers. In severe cases involving large tissue necrosis, surgery may be needed to resect necrotic tissues and to cover the exposed areas. CLINICAL CASE DESCRIPTION: A 71 years old women was referred to our unit two month after extravasation of epirubicin from an implanted port-a-cath with a large chemonecrosis of the anterior chest wall. She presented an evolutive tissue necrosis extending from the upper anterior thoracic region to the right breast. Surgical debridements and negative wound pressure therapy were necessary in order to obtain clean areas. The final chest wall defect was covered using a Muscle Sparing Latissimus Dorsi pedicled flap. This surgical management have permitted a satisfying wound healing and functional recovery without any complication. CONCLUSION: Chemotherapeutics' extravasations can be a severe complication of oncologic treatment and have to be discussed between oncologists and plastic surgeons to find the most effective and suitable solution with consideration of the specificities of cancer therapy. In chest wall skin defect, the use of muscle sparing latissimus dorsi pedicled flap is a robust solution with low morbidity of the donor site.

Radiation-induced bullous pemphigoid after surgery for soft tissue sarcoma: About a rare case.

INTRODUCTION: Radiation therapy may cause a range of side effects of the skin within the irradiated area. Not of all the reactive effects of the skin induced by radiation therapy have to be related to some forms of radiodermatitis, and when non-standard clinical presentations overcome, it may be necessary to undertake appropriate diagnostic tools to not be in trap of wrong diagnosis. CLINICAL CASE DESCRIPTION: A 76 years-old man undertook resection surgery after a neoadjuvant radiation therapy for a soft tissue sarcoma of his groin region. After surgery, he developed an acute skin reaction comparable with a severe form of radiodermatitis. Despite cares, his clinical status got worse. Only skin biopsies guided us to the right diagnosis: it was a form of a bullous pemphigoid induced by radiation therapy. The consequent appropriate treatment was finally resolute. CONCLUSION: These forms have to be recognized in time, to undertake skin biopsies as soon as an evocative clinical presentation appears. The appropriate treatment, which consists in local or systemic corticotherapy, is resolute in most cases.

Innovative adaptation of the "spare tissues concept" applied for olecranon coverage of a severe burn patient: A case report.

BACKGROUND: The management of bone exposure in patients with extensive burns could be a challenge due to the lack of healthy tissue. In such cases, it could be interesting to use any still healthy tissue initially destined for amputation and use it to cover up another site. We present the case of a sever burn patient for whom we used the only healthy palmar hand skin to cover an olecranon exposure. CLINICAL CASE DESCRIPTION: A 38-year-old man has been admitted in burn victim unit with extensive deep burns on 60% of the total body surface. An exposure of the left olecranon was appeared occurring on a burned area, with absence of healthy local tissues available for coverage. Concomitantly a trans-radial amputation was indicated because of severe digits burns leading to an impossibility to preserve the function of the hand. A palmar skin area was healthy leading to harvested this palmar skin flap pedicled on ulnar vessels. Early post-operative healing was satisfactory and no vascular suffering of the flap has been observed with a total healing at three weeks. CONCLUSION: In any patient the spare tissues concept should be keep in mind when amputation is indicated simultaneously with a problematic of loss of substance coverage to a proximity area. In this case of severe burn patient, we used a palmar skin flap pedicled on the ulnar vessels to cover an olecranon exposure.

BCGitis of the wrist after intravesical BCG therapy: A case report.

Septic arthritis of the wrist can result in joint destruction, making timely diagnosis crucial for initiating empiric antibiotics and surgical intervention. Mycobacterium is a rare cause of this disorder. A 47-year-old man with bladder cancer was treated surgically and received BCG intravesical therapy. Eleven months later, this patient developed severe carpal BCGitis requiring total carpal resection. The first step was addition of a cement spacer and radiometacarpal stabilisation (Masquelet technique). Secondary infections occurred aggravating the prognosis. This case emphasises the importance of taking into account the patient's medical history. Tuberculosis of the wrist is a rare etiology for septic arthritis; delayed treatment leads to severe complications and functional sequelae.

Reconstruction of a dorsal thoracic wall defect with a dorsal intercostal artery perforator flap after removal of a bulky cutaneous squamous cell carcinoma: a case report.

INTRODUCTION: Surgical reconstruction of large soft tissue defects of the upper back is challenging. Although the usefulness of free perforator flaps has been demonstrated, local options remain limited. The dorsal intercostal artery perforator flap was recently described but its use is still uncommon. CASE REPORT: An 88-year-old Causasian woman presented with a large, ulcerated, left prescapular cutaneous squamous cell carcinoma (T3N0M0). Complete excision was performed, and the resulting defect was reconstructed with a dorsal intercostal artery perforator flap based on two perforators. Postoperative recovery was uncomplicated and adjuvant radiotherapy commenced 10 weeks later. CONCLUSION: Compared to conventional muscle flaps, the dorsal intercostal artery perforator flap offers greater protection of muscle function, is less invasive, and lowers donor site morbidity. Based on these advantages, this flap should be considered a useful local option for reconstructing large cutaneous defects of the upper back.

Magnetic-Order Crossover in Coupled Spin Ladders.

We report a novel crossover behavior in the long-range-ordered phase of a prototypical spin-1/2 Heisenberg antiferromagnetic ladder compound (C_{7}H_{10}N)_{2}CuBr_{4}. The staggered order was previously evidenced from a continuous and symmetric splitting of ^{14}N NMR spectral lines on lowering the temperature below T_{c}≃330 mK, with a saturation towards ≃150 mK. Unexpectedly, the split lines begin to further separate away below T^{*}∼100 mK, while the linewidth and the line shape remain completely invariable. This crossover behavior is further corroborated by the NMR relaxation rate T_{1}^{-1} measurements. A very strong suppression reflecting the ordering, T_{1}^{-1}∼T^{5.5}, observed above T^{*}, is replaced by T_{1}^{-1}∼T below T^{*}. These original NMR features are indicative of the unconventional nature of the crossover, which may arise from a unique arrangement of the ladders into a spatially anisotropic and frustrated coupling network.

Quasiparticle Scattering off Defects and Possible Bound States in Charge-Ordered YBa_{2}Cu_{3}O_{y}.

We report the NMR observation of a skewed distribution of ^{17}O Knight shifts when a magnetic field quenches superconductivity and induces long-range charge-density-wave (CDW) order in YBa_{2}Cu_{3}O_{y}. This distribution is explained by an inhomogeneous pattern of the local density of states N(E_{F}) arising from quasiparticle scattering off, yet unidentified, defects in the CDW state. We argue that the effect is most likely related to the formation of quasiparticle bound states, as is known to occur, under specific circumstances, in some metals and superconductors (but not in the CDW state, in general, except for very few cases in 1D materials). These observations should provide insight into the microscopic nature of the CDW, especially regarding the reconstructed band structure and the sensitivity to disorder.

Dichotomy between Attractive and Repulsive Tomonaga-Luttinger Liquids in Spin Ladders.

We present a direct NMR method to determine whether the interactions in a Tomonaga-Luttinger liquid (TLL) state of a spin-1/2 Heisenberg antiferromagnetic ladder are attractive or repulsive. For the strong-leg spin ladder compound (C_{7}H_{10}N)_{2}CuBr_{4} we find that the isothermal magnetic field dependence of the NMR relaxation rate T_{1}^{-1}(H) displays a concave curve between the two critical fields bounding the TLL regime. This is in sharp contrast to the convex curve previously reported for a strong-rung ladder, (C_{5}H_{12}N)_{2}CuBr_{4}. We show that the concavity and the convexity of T_{1}^{-1}(H), which is a fingerprint of spin fluctuations, directly reflect the attractive and repulsive fermionic interactions in the TLL, respectively. The interaction sign is alternatively determined from an indirect method combining bulk magnetization and specific heat data.

Management of Large Sternal Wound Infections With the Superior Epigastric Artery Perforator Flap.

The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the superior epigastric artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails.

One-Third Magnetization Plateau with a Preceding Novel Phase in Volborthite.

We have synthesized high-quality single crystals of volborthite, a seemingly distorted kagome antiferromagnet, and carried out high-field magnetization measurements up to 74 T and ^{51}V NMR measurements up to 30 T. An extremely wide 1/3 magnetization plateau appears above 28 T and continues over 74 T at 1.4 K, which has not been observed in previous studies using polycrystalline samples. NMR spectra reveal an incommensurate order (most likely a spin-density wave order) below 22 T and a simple spin structure in the plateau phase. Moreover, a novel intermediate phase is found between 23 and 26 T, where the magnetization varies linearly with magnetic field and the NMR spectra indicate an inhomogeneous distribution of the internal magnetic field. This sequence of phases in volborthite bears a striking similarity to those of frustrated spin chains with a ferromagnetic nearest-neighbor coupling J_{1} competing with an antiferromagnetic next-nearest-neighbor coupling J_{2}.

Reentrant superconductivity driven by quantum tricritical fluctuations in URhGe: evidence from

Our measurements of the ^{59}Co NMR spin-spin relaxation in URh_{0.9}Co_{0.1}Ge reveal a divergence of electronic spin fluctuations in the vicinity of the field-induced quantum critical point at H_{R}≈13 T, around which reentrant superconductivity (RSC) occurs in the ferromagnetic heavy fermion compound URhGe. We map out the strength of spin fluctuations in the (H_{b},H_{c}) plane of magnetic field components and show that critical fluctuations develop in the same limited region near the field H_{R} as that where RSC is observed. This strongly suggests these quantum fluctuations as the pairing glue responsible for the RSC. The fluctuations observed are characteristic of a tricritical point, followed by a phase bifurcation toward quantum critical end points.

Longitudinal and transverse Zeeman ladders in the Ising-like chain antiferromagnet BaCo(2)V(2)O(8).

We explore the spin dynamics emerging from the Néel phase of the chain compound antiferromagnet BaCo(2)V(2)O(8). Our inelastic neutron scattering study reveals unconventional discrete spin excitations, so-called Zeeman ladders, understood in terms of spinon confinement, due to the interchain attractive linear potential. These excitations consist of two interlaced series of modes, respectively, with transverse and longitudinal polarization. The latter, which correspond to a longitudinal fluctuation of the ordered moment, have no classical counterpart and are related to the zero-point fluctuations that weaken the ordered moment in weakly coupled quantum chains. Our analysis reveals that BaCo(2)V(2)O(8), with moderate Ising anisotropy and sizable interchain interactions, remarkably fulfills the conditions necessary for the observation of discrete long-lived longitudinal excitations.

Field-induced quantum soliton lattice in a frustrated two-leg spin-1/2 ladder.

Based on high-field (31)P nuclear magnetic resonance experiments and accompanying numerical calculations, it is argued that in the frustrated S=1/2 ladder compound BiCu(2)PO(6) a field-induced soliton lattice develops above a critical field of µ(0)H(c1)=20.96(7) T. Solitons result from the fractionalization of the S=1, bosonlike triplet excitations, which in other quantum antiferromagnets are commonly known to experience Bose-Einstein condensation or to crystallize in a superstructure. Unlike in spin-Peierls systems, these field-induced quantum domain walls do not arise from a state with broken translational symmetry and are triggered exclusively by magnetic frustration. Our model predicts yet another second-order phase transition at H(c2)>H(c1), driven by soliton-soliton interactions, most likely corresponding to the one observed in recent magnetocaloric and other bulk measurements.

Incomplete devil's staircase in the magnetization curve of SrCu2(BO3)2.

We report on NMR and torque measurements on the frustrated quasi-two-dimensional spin-dimer system SrCu(2)(BO(3))(2) in magnetic fields up to 34 T that reveal a sequence of magnetization plateaus at 1/8, 2/15, 1/6, and 1/4 of the saturation and two incommensurate phases below and above the 1/6 plateau. The magnetic structures determined by NMR involve a stripe order of triplets in all plateaus, suggesting that the incommensurate phases originate from proliferation of domain walls. We propose that the magnetization process of SrCu(2)(BO(3))(2) is best described as an incomplete devil's staircase.

Microscopic properties of the pinwheel kagome compound Rb(2)Cu(3)SnF(12).

Using (63,65)Cu nuclear magnetic resonance in magnetic fields up to 30 T, we study the microscopic properties of the 12-site valence-bond-solid ground state in the "pinwheel" kagome compound Rb(2)Cu(3)SnF(12). We find that the ground state is characterized by a strong transverse staggered spin polarization whose temperature and field dependence points to a mixing of the singlet and triplet states. This is further corroborated by the field dependence of the gap Δ(H), which has a level anticrossing with a large minimum gap value of ≈ Δ(0)/2, with no evidence of a phase transition down to 1.5 K. By the exact diagonalization of small clusters, we show that the observed anticrossing is mainly due to staggered tilts of the g tensors defined by the crystal structure and reveal symmetry properties of the low-energy excitation spectrum compatible with the absence of level crossing.

Attractive Tomonaga-Luttinger liquid in a quantum spin ladder.

We present NMR measurements of a strong-leg spin-1/2 Heisenberg antiferromagnetic ladder compound (C7H10N)2CuBr4 under magnetic fields up to 15 T in the temperature range from 1.2 K down to 50 mK. From the splitting of NMR lines, we determine the phase boundary and the order parameter of the low-temperature (three-dimensional) long-range-ordered phase. In the Tomonaga-Luttinger regime above the ordered phase, NMR relaxation reflects characteristic power-law decay of spin correlation functions as 1/T1∝T(1/2K-1), which allows us to determine the interaction parameter K as a function of field. We find that field-dependent K varies within the 1

Quantum-critical spin dynamics in quasi-one-dimensional antiferromagnets.

By means of nuclear spin-lattice relaxation rate T(1)(-1), we follow the spin dynamics as a function of the applied magnetic field in two gapped quasi-one-dimensional quantum antiferromagnets: the anisotropic spin-chain system NiCl(2)-4SC(NH(2))(2) and the spin-ladder system (C(5)H(12)N)(2)CuBr(4). In both systems, spin excitations are confirmed to evolve from magnons in the gapped state to spinons in the gapless Tomonaga-Luttinger-liquid state. In between, T(1)(-1) exhibits a pronounced, continuous variation, which is shown to scale in accordance with quantum criticality. We extract the critical exponent for T(1)(-1), compare it to the theory, and show that this behavior is identical in both studied systems, thus demonstrating the universality of quantum-critical behavior.

Field evolution of coexisting superconducting and magnetic orders in CeCoIn5.

We present nuclear magnetic resonance (NMR) measurements on the three distinct In sites of CeCoIn5 with a magnetic field applied in the [100] direction. We identify the microscopic nature of the long range magnetic order (LRO) stabilized at low temperatures in fields above 10.2 T while still in the superconducting (SC) state. We infer that the ordered moment is oriented along the c axis and map its field evolution. The study of the field dependence of the NMR shift for the different In sites indicates that the LRO likely coexists with a modulated SC phase, possibly that predicted by Fulde, Ferrell, Larkin, and Ovchinnikov. Furthermore, we discern a field region dominated by strong spin fluctuations where static LRO is absent and propose a revised phase diagram.