Case report on the approach to surgical management for a large chest wall chondrosarcoma.

INTRODUCTION AND IMPORTANCE: Primary chest wall tumours are uncommon. Challenges arise in management due to delays in diagnosis and timing of treatment. The mainstay of treatment remains complete resection as adjuvant therapy has a limited role. Choice of repair and materials for chest wall reconstruction vary depending on the size and location of the defect. There are no published reports on management of chondrosarcomas arising from the rib in the Caribbean. CASE PRESENTATION: A 61-year-old female was referred from a rural clinic with a 10-month history of a progressively enlarging, painless right anterior chest wall lump. Computed Tomography (CT) shows features of a conventional chondrosarcoma arising from the ribs and including surrounding soft tissue, muscle and pleura. Surgical specimen confirms a grade 2 chondrosarcoma. CLINICAL DISCUSSION: This case illustrates the importance of a multidisciplinary team discussion. Differentiating a chondrosarcoma from a benign cartilaginous tumour requires consideration of clinical features, radiological characteristics and histological features. Chest wall reconstruction aims to preserve functional and structural integrity with adequate soft tissue coverage. The patient had good cosmesis as well as pulmonary function postoperatively and no recurrence at the 3 year follow up. CONCLUSION: This case highlights that the MDT is essential to a good outcome for the surgical management of a chest wall chondrosarcoma. Wide en-bloc resection followed by reconstruction using polypropylene mesh and a latissimus dorsi flap as a one-stage procedure can be successful.

Case series: The modified skoog approach for definitive management of severe hidradenitis suppurativa of the axilla.

Hidradenitis Suppurativa (HS) is a chronic, recurrent, suppurative, cutaneous disease, manifested by abscesses, fistulating sinus tracts and scarring (Brown, Rosen, & Orengo, 1998). After failed conservative management, surgical excision is the only definitive option (Edlich et al. 1986). There are several approaches to the excision and wound closure of axillary HS, mostly involving radical excision with associated risks of poor wound healing despite advanced wound closure techniques. We present a case series using the Modified Skoog approach for the management of axillary HS as a skin sparing technique that offers adequate wound healing, a short hospital stay and high patient satisfaction.

Pedicled vertical rectus abdominis myocutaneous flap for coverage of the elbow

A 30 year old, accountant, right-handed male driver sustanined a side-swipe collision to the right side while his right elbow was protruded from his car window. He sustanined a Gustillo-Anderson type III A injury to the elbow and postero-lateral, proximal forearm. The elbow joint and proximal ulna were very comminuted and exposed. He was placed in an external fixator spanning the joint and stabilized at 90 degrees with the forearm in mid pronation. His position of comfort was with the limb held supported against his abdomen. His orthopaedic plan of management included wound coverage and eventual fusion or elbow replacement.