Large Scalp Defect Reconstruction With Tissue Expansion, Orticochea Flap, and Acellular Dermal Matrix for Soft Tissue Augmentation: A Case Report.

Reconstruction of a large scalp defect following oncologic surgical resection is a challenging task. The defect size, location, and elasticity of the soft tissue overlying the calvarium are important factors to be considered when exploring available reconstructive options. When primary closure is not feasible with a large defect, a skin flap or graft is utilized. Skin flap is advantageous as it produces a similar color and texture as the surrounding areas, thus being the favorable method. Wounds involving exposed bone, tendon, and cartilage cannot support grafts due to poor vascularity and thus require a skin flap. One of the multi-flap closure modalities, the Orticochea flap, is an excellent choice for scalp reconstruction on large defects greater than 50 cm2. We present an interesting case of a patient with a large scalp defect following Mohs surgery of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) that was successfully reconstructed with tissue expansion utilizing Orticochea flap, with the addition of an acellular dermal matrix as an adjunct in such hostile scalp reconstruction.

Brought to you courtesy of the red, white, and blue-pigments of nontuberculous mycobacteria.

Pigments are chromophores naturally synthesized by animals, plants, and microorganisms, as well as produced synthetically for a wide variety of industries such as food, pharmaceuticals, and textiles. Bacteria produce various pigments including melanin, pyocyanin, bacteriochlorophyll, violacein, prodigiosin, and carotenoids that exert diverse biological activities as antioxidants and demonstrate anti-inflammatory, anti-cancer, and antimicrobial properties. Nontuberculous mycobacteria (NTM) include over 200 environmental and acid-fast species; some of which can cause opportunistic disease in humans. Early in the study of mycobacteriology, the vast majority of mycobacteria were not known to synthesize pigments, particularly NTM isolates of clinical significance such as the Mycobacterium avium complex (MAC) species. This paper reviews the overall understanding of microbial pigments, their applications, as well as highlights what is currently known about pigments produced by NTM, the circumstances that trigger their production, and their potential roles in NTM survival and virulence.

A paucity of knowledge regarding nontuberculous mycobacterial lipids compared to the tubercle bacillus.

All mycobacteria, including nontuberculous mycobacteria (NTM), synthesize an array of lipids including phosphatidylinositol mannosides (PIM), lipomannan (LM), and lipoarabinomannan (LAM). While absent from Mycobacterium tuberculosis (M. tb), glycopeptidolipids (GPL) are critical to the biology of NTM. M. tb and some NTM also synthesize trehalose-containing glycolipids and phenolic glycolipids (PGL), key membrane constituents with essential roles in metabolism. While lipids facilitate immune evasion, they also induce host immunity against tuberculosis. However, much less is known about the significance of NTM-derived PIM, LM, LAM, GPL, trehalose-containing glycolipids, and PGL as virulence factors, warranting further investigation. While culling the scientific literature on NTM lipids, it's evident that such studies were relatively few in number with the overwhelming majority of prior work dedicated to understanding lipids from the saprophyte Mycobacterium smegmatis. The identification and functional analysis of immune reactive NTM-derived lipids remain challenging, but such work is likely to yield a greater understanding of the pathogenesis of NTM lung disease. In this review, we juxtapose the vast literature of what is currently known regarding M. tb lipids to the lesser number of studies for comparable NTM lipids. But because GPL is the most widely recognized NTM lipid, we highlight its role in disease pathogenesis.

Terminological reaction.

When the terminology services at our institution encountered the installation of a new multi-site laboratory information system (LIS), we pursued obtaining a regular dictionary feed to keep the central terminology up-to-date. What we didn't predict was the value added to the LIS implementation effort by a cooperative vocabulary strategy. In this report, we describe how preexisting terminology services were leveraged to facilitate the integration of 2 previously independent laboratories into a new cross-campus LIS.