Liquen escleroso en los párpados / Lichen Sclerosus on the Eyelids

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Reconstrucción de defectos auriculares mediante el «colgajo en isla en puerta giratoria». Serie de casos / Reconstructing Ear Defects Using the Revolving Door Island Flap: A Case Series

INTRODUCCIÓN Y OBJETIVOS: Los defectos de la zona anterior del pabellón auricular (PA) son un desafío reconstructivo debido a la compleja topografía y el difícil acceso. Describimos nuestra experiencia con el uso del colgajo en isla en puerta giratoria (CIPG) para la reconstrucción de defectos auriculares y se presentan los resultados quirúrgicos. MATERIAL Y MÉTODOS: Estudio descriptivo retrospectivo de pacientes tratados mediante reconstrucción de oreja, de diversas localizaciones de la zona anterior, mediante el CIPG, tras la resección de tumores malignos. RESULTADOS: Entre 2011 y 2019 se operó a 17 pacientes: 7 carcinomas epidermoides y 10 basocelulares. El estudio histológico convencional mostró bordes quirúrgicos libres en todas las piezas de resección. El tiempo medio de seguimiento fue de 40 meses. Hubo una recidiva local en un carcinoma epidermoide, con buena respuesta a radioterapia, de forma que todos los pacientes estaban libres de enfermedad al completar el seguimiento. Solo 3 pacientes presentaron complicaciones menores (depresión de la superficie del colgajo en un caso y retracción del oído hacia la mastoides en 2 casos). Mediante escalas de valoración subjetiva, se determinó el resultado postoperatorio estético y funcional, tanto por parte del dermatólogo como del paciente. En todos los pacientes se conservó el contorno normal del PA reconstruido y ningún paciente requirió cirugía correctiva adicional. CONCLUSIONES: La reconstrucción auricular mediante CIPG permitió la reparación satisfactoria tras la resección completa de los tumores, preservando la estructura y funcionalidad. Está descrito que el CIPG es una muy buena opción reconstructiva de la concha auricular; es una técnica sencilla que permite reparar grandes defectos con mínimos riesgos de necrosis. En la serie presentada, el resultado cosmético fue excelente, con muy bajo índice de recurrencias. Los resultados son óptimos en la reparación de lesiones conchales pero también de otras zonas, como el antihélix y las fosas triangular y escafoidea

BACKGROUND AND OBJECTIVES: Defects of the anterior region of the pinna pose a reconstruction challenge owing to the complex topography and difficult access. We report our experience using the revolving door island flap (RDIF) to reconstruct pinna defects and present the surgical results. MATERIAL AND METHODS: Retrospective descriptive study of patients undergoing ear reconstruction using RDIF at different sites of the anterior region after resection of malignant tumors. RESULTS: Seventeen patients underwent surgery between 2011 and 2019 for squamous cell carcinoma (n = 7) and basal cell carcinoma (n = 10). Conventional histology showed disease-free surgical margins in all the resected tissue specimens. The mean follow-up period was 40 months. One local recurrence of squamous cell carcinoma was observed, which responded well to radiation therapy; all patients were free of disease at the end of follow-up. Only 3 patients presented minor complications (depression of the flap surface in 1 case and retraction of the ear toward the mastoid process in 2 cases). Subjective rating scales were used to evaluate cosmetic and functional outcomes as assessed by both the dermatologist and the patient. The normal contour of the pinna was conserved in all patients and no patients required additional corrective surgery. CONCLUSIONS: Reconstruction of the pinna using RDIF allowed for satisfactory repair following complete resection of the tumors, while conserving structure and functionality. RDIF has been reported to be a very good option for reconstruction of the pinna. It is a simple technique that makes it possible to repair large defects with minimal risk of necrosis. In our series, the cosmetic results were excellent and recurrence rates were very low. RDIF provided optimal results in repairing lesions in the concha and in other regions, such as the antihelix, triangular fossa, and scapha

Reconstructing Ear Defects Using the Revolving Door Island Flap: A Case Series. / Reconstrucción de defectos auriculares mediante el «colgajo en isla en puerta giratoria¼. Serie de casos.

BACKGROUND AND OBJECTIVES: Defects of the anterior region of the pinna pose a reconstruction challenge owing to the complex topography and difficult access. We report our experience using the revolving door island flap (RDIF) to reconstruct pinna defects and present the surgical results. MATERIAL AND METHODS: Retrospective descriptive study of patients undergoing ear reconstruction using RDIF at different sites of the anterior region after resection of malignant tumors. RESULTS: Seventeen patients underwent surgery between 2011 and 2019 for squamous cell carcinoma (n=7) and basal cell carcinoma (n=10). Conventional histology showed disease-free surgical margins in all the resected tissue specimens. The mean follow-up period was 40 months. One local recurrence of squamous cell carcinoma was observed, which responded well to radiation therapy; all patients were free of disease at the end of follow-up. Only 3 patients presented minor complications (depression of the flap surface in 1 case and retraction of the ear toward the mastoid process in 2 cases). Subjective rating scales were used to evaluate cosmetic and functional outcomes as assessed by both the dermatologist and the patient. The normal contour of the pinna was conserved in all patients and no patients required additional corrective surgery. CONCLUSIONS: Reconstruction of the pinna using RDIF allowed for satisfactory repair following complete resection of the tumors, while conserving structure and functionality. RDIF has been reported to be a very good option for reconstruction of the pinna. It is a simple technique that makes it possible to repair large defects with minimal risk of necrosis. In our series, the cosmetic results were excellent and recurrence rates were very low. RDIF provided optimal results in repairing lesions in the concha and in other regions, such as the antihelix, triangular fossa, and scapha.

Pápula solitaria nasal de larga evolución / Long-Standing Solitary Nasal Papule

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Sarcoma de Kaposi subcutáneo primario, una rara variante clínica / Primary Kaposi Sarcoma of the Subcutaneous Tissue: A Rare Clinical Variant

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Histiocitosis de células de Langerhans cutánea de presentación en el adulto / Cutaneous Langerhans Cell Histiocytosis Presenting in Adulthood

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Pápulas faciales en alopecia frontal fibrosante con buena respuesta a isotretinoína / Facial Papules in Frontal Fibrosing Alopecia: Good Response to Isotretinoin

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Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review. / Cirugía funcional en tumores malignos subungueales. Serie de casos y revisión de la literatura.

BACKGROUND AND OBJECTIVES: Amputation is the conventional treatment for malignant subungual tumors (MSUTs), namely, subungual squamous cell carcinoma (SUSCC) and subungual melanoma (SUM). Functional surgery consisting of wide local excision (WLE) of the nail unit can preserve function without modifying prognosis in such cases. We present a series of MSUTs treated with WLE of the nail unit, describe the technique, and review its indications. MATERIAL AND METHODS: Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017. The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5mm followed by repair with a full-thickness graft. RESULTS: Eleven MSUTs were treated in the study period: 7 SUMs (4 in situ; mean thickness, 1.17mm; range, 0-4mm) and 4 SUSCCs (mean thickness, 3.4mm; range, 1.6-6mm). WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM. Mean follow-up was 39 months (range, 12-96 months) and no local or regional recurrences were detected. One of the 2 patients who underwent amputation developed metastasis to the brain and died. In our review of the literature, we identified 5 series of patients with SUSCC treated with WLE of the nail unit (105 patients) and 14 series of patients with SUM (243 patients). Based on an analysis of these cases and ours, it would appear that WLE of the nail unit is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation. CONCLUSIONS: WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM (Breslow depth <1mm). It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection. Amputation, by contrast, is the treatment of choice for SUSCCs with bone involvement, very thick SUMs (>4mm), and recurrent tumors.

Cirugía funcional en tumores malignos subungueales. Serie de casos y revisión de la literatura / Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review

ANTECEDENTES Y OBJETIVOS: El tratamiento clásico de los tumores malignos subungueales (TMSU), carcinoma epidermoide (CESU) y melanoma (MSU), es la amputación. La cirugía funcional del aparato ungueal (CFAU) puede preservar la función sin modificar el pronóstico. Presentamos nuestra serie de TMSU manejados con CFAU, describimos la técnica y revisamos sus indicaciones. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo de TMSU tratados con CFAU entre 2008 y 2017, con exéresis supraperióstica en bloque del aparato ungueal, margen a 5 mm, y cierre con injerto de piel total. RESULTADOS: Se trataron 11 TMSU, de los cuales 7 fueron MSU (4 in situ, espesor medio: 1,17mm; rango: 0-4mm) y 4 CESU (espesor medio: 3,4 mm; rango: 1,6-6 mm). Se realizó CFAU en 9 casos y 2 amputaciones en sendos MSU invasivos. El seguimiento medio fue 39 meses, con un rango de 12-96 meses. No hubo recidivas locales ni regionales. Solo un caso -una de las 2 amputaciones- tuvo metástasis (cerebrales) y muerte. La revisión de la literatura de CFAU en TMSU mostró 5 series (103 pacientes en total) con CESU y 14 series (243 pacientes en total) con MSU. El análisis de nuestros casos y de los casos publicados muestra muy escasas recurrencias locales (< 7%), y mejores resultados funcionales y estéticos frente a la amputación. CONCLUSIONES: La CFAU es de elección en CESU sin afectación ósea y MSU no invasivo o delgado (Breslow <1mm). Es factible en MSU de grosores intermedios siempre con detallado estudio histológico de márgenes que asegure una resección completa. Por el contrario, en CESU con afectación ósea, MSU muy grueso (>4mm) o recurrencias, la amputación debe ser habitualmente de elección

BACKGROUND AND OBJECTIVES: Amputation is the conventional treatment for malignant subungual tumors (MSUTs), namely, subungual squamous cell carcinoma (SUSCC) and subungual melanoma (SUM). Functional surgery consisting of wide local excision (WLE) of the nail unit can preserve function without modifying prognosis in such cases. We present a series of MSUTs treated with WLE of the nail unit, describe the technique, and review its indications. MATERIAL AND METHODS: Retrospective observational study of MSUTs treated with WLE of the nail unit between 2008 and 2017. The technique consisted of en bloc supraperiosteal excision of the nail unit with a margin of 5mm followed by repair with a full-thickness graft. RESULTS: Eleven MSUTs were treated in the study period: 7 SUMs (4 in situ; mean thickness, 1.17 mm; range, 0-4mm) and 4 SUSCCs (mean thickness, 3.4mm; range, 1.6-6 mm). WLE of the nail unit was performed in 9 patients and amputation in 2 patients with invasive SUM. Mean follow-up was 39 months (range, 12-96 months) and no local or regional recurrences were detected. One of the 2 patients who underwent amputation developed metastasis to the brain and died. In our review of the literature, we identified 5 series of patients with SUSCC treated with WLE of the nail unit (105 patients) and 14 series of patients with SUM (243 patients). Based on an analysis of these cases and ours, it would appear that WLE of the nail unit is associated with a very low rate of local recurrence (<7%) and offers better functional and cosmetic outcomes than amputation. CONCLUSIONS: WLE of the nail unit is the treatment of choice for SUSCC without bone involvement and for thin noninvasive SUM (Breslow depth <1mm). It is also feasible in intermediate-thickness SUMs when detailed histologic examination of the margins confirms complete resection. Amputation, by contrast, is the treatment of choice for SUSCCs with bone involvement, very thick SUMs (> 4 mm), and recurrent tumors

Metástasis cutáneas de adenocarcinoma de próstata / Cutaneous Metastases From Adenocarcinoma of the Prostate

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