Angiokeratoma circumscriptum in a young male.

A 20-year-old male presented with multiple eruptions on his right leg since birth; these bled and were painful on trivial trauma. Examination revealed dark brown, hyperkeratotic, indurated, verrucous linear plaques with irregular borders. Histopathological evidence of hyperkeratosis, acanthosis, and extensive vascular proliferation in papillary dermis confirmed clinical suspicion of angiokeratoma circumscriptum (AKC). Excision and skin grafting yielded a cosmetically favorable outcome. Angiokeratomas, first described by Mibeli in 1889, are a group of vascular ectasias involving the papillary dermis. Angiokeratomas are more common in males; however, AKC-the rarest of its five variants-exhibits a female preponderance (F:M:3:1). AKC is an extremely rare nevoid disorder, only 100 of its cases having been reported in the world literature until 2006. Herein, we have reported a typical case of AKC in a young male that was previously misdiagnosed, and the patient wrongly counseled about the likelihood of its spontaneous regression.

Facial plexiform neurofibromatosis: A surgical challenge.

Plexiform neurofibromatosis is a relatively common but potentially devastating manifestation of neurofibromatosis type 1 (NF1). It produces very hideous deformity if the face is involved. Surgical management remains the mainstay of therapy, but in the head and neck region it is limited by the infiltrating nature of these tumors, inherent operative morbidity and high rate of regrowth. We present two cases of facial neurofibromatosis managed in our hospital. The first patient presented with overhanging mass of skin folds on the right side of her face, completely obliterating her right eye. The other patient was a young male having a huge, unsightly swelling over the right cheek, resulting in pulled down right eyelids and right pinna. Physical examination revealed the presence of café au lait macules, freckling in the axillary region and multiple neurofibromas over the trunk. Reconstructive surgical procedure in the form of subtotal excision of tumor mass followed by re draping of the facial skin was performed in both cases. There was evidence of regrowth of the tumor on review after 6 months.

Tissue expansion: A simple technique for complex traumatic soft tissue defects.

Post-traumatic soft tissue loss results in significant functional and esthetic morbidity. Reconstruction is often limited by shortage of soft tissues. Esthetic and functional restorations are possible by generation of well-matched autogenous sensate tissue by tissue expansion. Fifteen (nine females and six males) cases of large and complex soft tissue defects after trauma, age ranging from 7 to 43 years of age, were managed by tissue expansion over a period of 22 months. Indications were post-burn scars of the face (five), post-burn alopecia (three), avulsion injury scalp (one), massive abdominal wall defect (one), post-crush injury ankylosis of the right elbow (one), and post-burn contracture of the neck (three). Tissue expansion was well tolerated by all patients. Major complications seen were accidental implant deflation (6.6%) and partial implant exposure (6.6%). Minor complications were seen in 20% of the cases. Tissue expansion is slow and staged but a simple and safe reconstructive technique for managing large post-traumatic soft tissue loss with excellent results.