Large single cutaneous metastasis of colon adenocarcinoma mimicking a squamous cell carcinoma of the skin: A case report.

INTRODUCTION: Metastases represent one of the most outstanding characteristics of malignant neoplasms and are relatively rare in the skin, in spite of the great extension of the cutaneous organs. Development of cutaneous metastases from colon cancer is a rare event, usually occurring in widely disseminated disease and commonly leading to a poor prognosis. As to location, cutaneous metastases often favor areas close to the primary malignancy, such as lung cancer and skin metastases on the trunk. However, remote sites as the scalp may be also involved. CASE PRESENTATION: We present the case of a 92-year-old female patient with a massive single nodular skin lesion on her left supraclavicular area, that came back positive for cutaneous metastasis of colon adenocarcinoma. DISCUSSION: Cutaneous metastasis of colorectal cancer a rare event (2.3%-6%) that usually occur two years after the detection or resection of the primary tumor. It seldom occurs before the identification of the primary tumor and involvement of secondary organs, such as the liver. There are few cases reported with only cutaneous metastases. CONCLUSION: In conclusion, dermatological evaluation of patients who are undergoing screening or who have already been diagnosed with cancer is extremely important.

Postural Changes After Abdominoplasty in Morbid Obese Patients.

BACKGROUND: In the multidisciplinary treatment of obesity, the role of a plastic surgeon is to remove the excess of skin after weight loss to obtain cosmetic, functional, and psychological benefits. Obesity modifies body geometry, increases the mass of different segments, and imposes functional limitations in life activities that may predispose the obese to injury. The authors evaluated the postural conditions of obese patients, before and 12 months after surgery. METHODS: The study included 15 obese patients of both genders affected by class II obesity. Postural function was evaluated preoperatively and 12 months postoperatively. Patients underwent conventional abdominoplasty surgical procedure. In all patients, plantar pressure distribution and balance (stabilometric test) were evaluated before and 3 months after surgery. RESULTS: The static pedobarographic revealed a significant reduction in forefoot peak pressure; total plantar force; rearfoot plantar force percentage; midfoot plantar force percentage; and forefoot, midfoot, and rearfoot plantar contact areas percentage 3 months after surgery; the dynamic's one showed a reduction in the first metatarsal peak pressure and plantar contact. The stabilometric values showed a reduction in the range of center of foot pressure (CP) displacement along y axis, the average displacement of the CP speed from the mean (RMS y velocity), and CP mean peak in the condition of vision. CONCLUSIONS: Our study demonstrates the beneficial effect of dermolipectomies and the consequential weight loss on postural stability of obese men. Such findings may support the hypothesis that dermolipectomy may improve postural stability with and without vision. The data demonstrate that the benefits are related to the magnitude of the resected tissue.

Deep burn of hand and forearm treated by abdominal wall flap. A case report.

AIM: Post-traumatic hand and forearm defects always represent a challenge for reconstructive surgeons, especially when multiple structures are involved, because of a high rate of amputation. MATERIAL OF STUDY: A 21 years old woman arrived to the E.R. with a complex crush-burn trauma of the upper limb caused by an accident with an industrial ironing machine, resulting in a ulnar bone fracture, ulnar artery laceration and a wide burn of the dorsum of the right forearm. RESULT: We achieved toTAL limb salvage with coverage of the "nobles" structures of the forearm. DISCUSSION AND CONCLUSIONS: Different reconstructive methods have been used over time to treat these defects focusing the attention on both functional and cosmetic aspects. The abdominal pedicle flap was one of the achiest reconstructive methods for hand and forearm defects. In an era in which microsurgery takes the lion's share, some basic procedure may be helpful, especially in certain cases. In this study the authors reported a case of a young woman with a complex trauma of the right arm resulting from an occupational accident.

The role of plastic surgeon in complex cephalic malformations. Our experience.

AIM: Our aim is focused on the field of action of plastic surgery in the cephalic malformation and on description of the surgical indications and techniques for their correction. MATERIAL OF STUDY: We looked at 27 patients from 2006 to 2012 with cephalic district deformities. All patients underwent surgical and rehabilitative treatments. RESULTS: After a median follow-up from one to five years, in most cases we reached both morphological and functional reconstruction, alone or in a surgical team together with other surgical disciplines. DISCUSSION: The correction of craniofacial malformations makes use of a surgical discipline particularly demanding, which must associate a basic surgical training with a learning techniques specific to the area and a knowledge of craniofacial malformation. CONCLUSIONS: The surgical treatment of craniofacial malformations can be seen only through a joint neurosurgical and plastic-maxillo-facial surgery, guided by knowledge of the malformation, under the close supervision of anesthetists and pediatricians. This surgery is not limited to remodel the morphology but has its bases on the recovery of the functions, maintained by rehabilitation treatment.

Commissural localization of squamocellular carcinoma of the lip Our experience.

AIM: Lip cancer is the most common malignant tumour of the oral cavity and the oral commissure is the origin of the tumour in 6% to 8.5% of cases. Reconstruction of oral commissure defects aims at securing oral competence and providing an acceptable appearance. Satisfactory reconstruction of defects affecting the lip commissure is always challenging. MATERIAL OF STUDY: The authors present a selected group of 22 patients, who, between November 2005 and 31st October 2012, underwent reconstruction for primary or secondary defects involving the oral commissure. RESULTS: The results were generally satisfactory, both functionally and cosmetically. The patients had been followed up for 5 years. CONCLUSIONS: All patients had excellent oral competence during rest, speaking and eating. Good sphinteric function was obtained in early postoperative days. No drooling or air leakage. The aesthetic results were good in all patients.

The use of local flaps in the one-step nose reconstruction after cancer resection.

PURPOSE: Purpose of this study is to assess different surgical techniques, comparing them in order to remove nasal skin cancer by restoring the anatomy and the function of the respiratory system without neglecting the aesthetic result. METHODS: A total of 107 patients were enrolled in the study between January 2006 and December 2012. We compared the results obtained using 23 front-glabellar flaps, 30 bilobed flaps, 27 nose-cheek flaps, 15 sliding flaps, 12 frontal island flaps. RESULTS: We obtained the oncological radicality with good aesthetic results. There were no infections and no sensory (numbness and tenderness) and motor abnormalities of the facial nerve. None of the used techniques has lead to scarring ectropion or to alteration of the nasal filter. CONCLUSIONS: The best nasal reconstruction mostly depends on skin cancer location and on the amount of tissue to be removed to definitely eradicate the neoplastic lesion; during the planning of a nasal reconstruction we also must assess adjacent tissue characteristics, the presence of fixed structures and the donor skin area (color, thickness, pils, etc) . Using these parameters we have chosen for the ala the nose-cheek flap, for the dorsum the front-glabellar flap, the bilobed flap and the sliding flap (lateral region) and for the tip both the frontal island flap and the bilobed flap.

Negative pressure dressing in split-thickness skin grafts: experience with an alternative method.

BACKGROUND: The use of negative pressure in the dressing of splitthickness skin grafts has been shown to promote healing by a variety of mechanisms, including a decrease in interstitial edema, an increase in perfusion, and a decrease in bacterial colonization. METHODS: An observational study was performed on 52 patients at the Department of Plastic Surgery, University of Perugia in Perugia, Italy, undergoing split-thickness skin grafting for acute wounds after trauma and for chronic wounds, such as pressure ulcers and diabetic wounds. The dressing used consisted of a single foam sheet, a conventional disposable closed-system suction drain, and an adhesive dressing. RESULTS: In all patients, there was a 95% take of the graft, with 5% of partial loss. There were no significant complications encountered. CONCLUSIONS: Negative pressure wound therapy is an innovative and commercially successful concept for the management of difficultto- treat wounds of nearly every etiology, and the authors' technique is an alternative to commercially available negative pressure dressings..

Cephalic traumas with lacrimal apparatus involvement. Our experience.

PURPOSE: The involvement of the lacrimal ducts in the extreme cephalic trauma is an infrequent condition. A correct diagnosis and appropriate management of injuries of the lacrimal system are essential to prevent the onset of post-traumatic epiphora. METHODS: In the last 5 years, 37 patients were treated for lacrimal apparatus injury as a result of cephalic trauma: in 16 there was an isolated lacrimal injury and in 21 were documented fractures combined with lacrimal damage. RESULTS: In 16 patients who had only deep lesions, was performed a reconstruction after location lesion localization, and only in 4 cases, because of the gravity of the lesion, it was decided to perform a reconstruction in a second time. In the remaining 21 patients the facial fractures were treated before lacrimal injuries, whose reconstruction was carried out on a second time. CONCLUSIONS: The reconstruction of the cephalic district has to be based on the restoration of morpho-functional component and on the identification and treatment of lacrimal injuries. The reduction of fractures in our view should start from the lateral area (centripetal reconstruction) allowing to have a guide for alignment of the fracture lines. The objectives to be achieved in a facial trauma are therefore three: the maintenance of vital functions, the recovery of the function and the restoration of morphological and functional prior to the event.