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1.
Rev. bras. cir. plást ; 34(4): 561-566, oct.-dec. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047928

RESUMO

Introdução: O couro cabeludo é uma área de difícil reconstrução devido à sua pouca elasticidade e por sobrepor-se a uma estrutura rígida e convexa. Existem diferentes técnicas cirúrgicas para reparação dos defeitos, que podem ser produto de diversas etiologias, como: traumas, deformidades e consequência de doenças, principalmente oncológicas, como é o caso do paciente apresentada neste trabalho. O angiossarcoma cutâneo é um tumor vascular maligno raro e extremamente agressivo, que afeta principalmente idosos. É caracterizado clinicamente pelo aparecimento de placas eritêmato-violáceas e de rápida evolução. O tratamento depende da extensão da doença. A maioria dos casos são tratados com ampla ressecção cirúrgica e reconstrução. O objetivo é relatar um caso de reconstrução de grande defeito do couro cabeludo depois de uma dissecção oncológica, realizado no Hospital Central do Exército (HCE) - RJ. Métodos: O caso foi tratado com enxerto autólogo e uso de matriz dérmica, em 2 tempos cirúrgicos, até a total cobertura da área lesionada. Resultados: Obteve-se resultado satisfatório após as cirurgias de enxertia de pele na área ressecada. Conclusão: O enxerto autólogo, juntamente a matriz dérmica mostrou-se uma opção viável na reconstrução do couro cabeludo.


Introduction: It is difficult to reconstruct the scalp due to its poor elasticity and presence of layers over a rigid convex structure. Different surgical techniques are used to repair defects that may develop due to several etiologies, such as trauma, deformities, and disease sequelae, especially cancer, as noted in the present case. Cutaneous angiosarcoma, a rare and extremely aggressive malignant vascular tumor that mainly develops in elderly individuals, is clinically characterized by the onset of rapidly evolving erythematous purple plaques. The treatment depends on disease extent. Most patients are treated with wide surgical resection and reconstruction. The objective is to report a case of reconstruction of a major scalp defect after an oncologic dissection performed at the Hospital Central do Exército in Rio de Janeiro. Methods: An autologous graft and dermal matrices were applied during two surgical periods till the damaged area was fully covered. Results: Satisfactory results were obtained after performing skin grafting surgery in the resected area. Conclusion: The autologous graft and dermal matrix proved to be a viable option for scalp reconstruction.


Assuntos
Humanos , Masculino , Idoso , História do Século XXI , Reabilitação , Couro Cabeludo , Neoplasias Cutâneas , Procedimentos Cirúrgicos Reconstrutivos , Hemangiossarcoma , Neoplasias de Tecido Vascular , Reabilitação/métodos , Reabilitação/psicologia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Hemangiossarcoma/cirurgia , Hemangiossarcoma/terapia , Neoplasias de Tecido Vascular/cirurgia , Neoplasias de Tecido Vascular/terapia
2.
Acta Clin Croat ; 58(Suppl 1): 48-52, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741559

RESUMO

During neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery.


Assuntos
Anestesia por Condução/métodos , Hemodinâmica , Procedimentos Neurocirúrgicos , Anestesia Geral , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Couro Cabeludo/cirurgia , Coluna Vertebral/cirurgia
3.
J Craniofac Surg ; 30(8): 2493-2496, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609940

RESUMO

BACKGROUND: When a child is born with Aplasia cutis congenita (ACC), it is important for the surgeon to decide promptly whether to perform early surgical intervention, or proceed with conservative care. Several patients of ACC have been reported in which various treatments have attempted. However, the criteria of treatment remain controversial. In this study, the authors present an algorithm and the literature review to assist with objective decisions during ACC management. METHODS: A total of 4 cases of infants born with ACC were referred to our department between January 2017 and April 2019. Conservative care was to be considered a first choice of management. RESULTS: The ACC lesions were presented in the scalp vertex area in all 4 infants with the intact dura mater. There was no large vein exposure or sagittal sinus exposure in all infants. All 4 infants were managed with conservative care, which immediately resulted in complete healing of the defects without any complications. CONCLUSIONS: Rapid decision-making is required whether or not the patient requires emergency surgical coverage. Even extensive defects may be healed by conservative care alone, if the dura mater is intact and accompanying large vein or sagittal sinus exposure is not identified.


Assuntos
Displasia Ectodérmica/cirurgia , Algoritmos , Dura-Máter/cirurgia , Humanos , Lactente , Recém-Nascido , Couro Cabeludo/cirurgia , Cicatrização
4.
J Craniofac Surg ; 30(8): 2362-2367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609941

RESUMO

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is a common type of malignant skin disorder. An uncommon feature is local bony invasion, as can rarely be seen in lesions on the scalp. The optimal treatment strategy in these rare cases is still under debate. OBJECTIVE: The aim of this case report is to present a 1-stage three-dimensional planned surgical resection and reconstruction of a cSCC with bony invasion into the scalp and to discuss the alternative options and potential pitfalls. MATERIALS AND METHODS: A patient diagnosed with rT4N0M0 cSCC of the scalp underwent a cranial resection and reconstruction in 1 stage. With the use of computer-assisted design and computer-assisted manufacturing a patient-specific implant (PSI) of poly (ether ether ketone) was manufactured. After the PSI was inserted, it was covered with a latissimus dorsi muscle and a split-thickness skin graft. RESULTS: Intraoperatively the resection template generated an accurate resection and accurate and fast placement of the PSI. The reconstruction had a clinical satisfactory esthetic result, but was hampered by the development of a small wound dehiscence was observed over the postoperative course. CONCLUSION: Three-dimensional planned resection and reconstruction for composite defects of the skull after resection of a cSCC of the scalp with bony invasion may lead to an accurate and predictable resection and accurate and fast placement of the PSI. However, patient specific characteristics should be considered to assess potential risks and benefits before opting for this one-stage treatment strategy.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Estética Dentária , Humanos , Imageamento Tridimensional , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/diagnóstico por imagem , Couro Cabeludo/cirurgia , Pele , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Crânio/diagnóstico por imagem , Crânio/cirurgia
5.
An Bras Dermatol ; 94(4): 452-454, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644620

RESUMO

Proliferating trichilemmal cyst is an uncommon neoplasm arising from the follicular isthmus, whose histopathological hallmark is the presence of trichilemmal keratinization. We describe a case of proliferating trichilemmal cyst in a 57-year-old woman with a broad clinical, radiological, macroscopic and microscopic correlation.


Assuntos
Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Couro Cabeludo/diagnóstico por imagem , Couro Cabeludo/patologia , Biópsia por Agulha Fina , Diagnóstico Diferencial , Cisto Epidérmico/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Couro Cabeludo/cirurgia , Ultrassonografia
6.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527220

RESUMO

The case report discusses split thickness skin grafting in a patient with active psoriasis. This also reports a case of a rare variant of squamous cell carcinoma.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Psoríase , Couro Cabeludo/patologia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Idoso , Humanos , Masculino , Coxa da Perna/cirurgia
7.
J Craniofac Surg ; 30(7): 2073-2075, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503111

RESUMO

The Tagliacozzi cross arm flap has been historically described for repair of large nasal defects. The authors report what we believe is the youngest case in modern literature of nasal reconstruction with a Tagliacozzi flap, in a 6-year-old girl. Due to her poor face and scalp skin quality, the more modern reconstructive options of a forehead flap or free tissue transfer were not deemed suitable. Two delay procedures and a complex splint were required to position the medial arm fasciocutaneous flap over the nasal construct. The arm was immobilized for 3 weeks to allow for vascularization of the recipient bed. The child successfully tolerated the splint. She has improved breathing and nasal contour.


Assuntos
Nariz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Criança , Feminino , Testa/cirurgia , Humanos , Neovascularização Patológica , Respiração , Couro Cabeludo/cirurgia , Contenções , Retalhos Cirúrgicos/cirurgia
8.
J Craniofac Surg ; 30(7): 2268-2270, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503118

RESUMO

In this study, the authors present the challenges of replantation and management of 2 patients who have total scalp, partial forehead and ear avulsion. A 39-year-old male farmer was admitted to the emergency room with the total scalp, forehead, partial right eyebrow and upper eyelid amputation after his hair was catched by an agricultural machine. Anastomoses of 2 arteries and 2 veins in the occipital region were done first. Anastomosis of the right and left superficial temporal arteries and veins were performed end to end by turning the operating table without moving the head, followed by 1 vein anastomoses in the frontal region. Although anastomotic blood flow was observed by Doppler ultrasonography, there were changes suggesting necrosis in the frontal and both temporoparietal regions and later in the occipital region. Necrotic tissues began to be debrided tangentially from the 10th day. During serial debridement, it was observed that the necrotic tissue includes skin and connective tissue. At the end of the post-operative second month, surgical treatment was completed and 12 months after the surgery, the patient lives with the wig because of hair loss, but the patient is cosmetically satisfied. An 18-year-old female gatherer was admitted to the emergency room with the total scalp, both eyebrows, right upper eyelid and partial right ear avulsion, after her hair was catched by an agricultural machine. Totally, anastomoses of 4 arteries and 3 veins were performed. On the 10th post-operative day, necrotic skin findings appeared and serial debridement were performed and it was revealed that aponeurosis was fully intact. The defect areas of skin and connective tissue were repaired with STSG. Intact partial temporal scalp tissue was present. Scalp replantation should always be considered as the first choice, according to the similar tissue principle of tissue repair in plastic surgery if there is no contraindication. Additionally, performing multiple arterial and vein anastomoses, evaluating the patient position in the post-operative period for anastomosis and hemodynamic follow-up, avoiding aggressive debridement and early reconstruction may give the patient the chance of skin grafting which is the basis of the reconstructive ladder.


Assuntos
Orelha/cirurgia , Testa/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/cirurgia , Adolescente , Adulto , Alopecia , Anastomose Cirúrgica , Desbridamento , Orelha/irrigação sanguínea , Feminino , Testa/irrigação sanguínea , Cabelo , Humanos , Masculino , Microcirurgia , Necrose/cirurgia , Couro Cabeludo/irrigação sanguínea
9.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413048

RESUMO

A 74-year-old man had a resultant large oval scalp defect of 12×6 cm (72 cm2) following an excision of a stage IIIA melanoma. We decided to cover the defect with the pinwheel flap, with the aim to provide a good cosmetic result, preservation of hair follicles and minimal donor-site morbidity. This local flap has been traditionally used for much smaller defects. Four L-shaped flaps were designed at equal distances on the vertical and horizontal axes of the defect. The L-shaped flap had a length of 1.5 times the half diameter of the defect (4.5 cm). The incision was made through galea aponeurosis and subsequently undermined at least 3 cm to assist flap advancement. Z-plasties increased the rotation of the flap when it was required. This yielded an excellent reconstructive result at 1-year follow-up, demonstrating the usefulness of the pinwheel flap in large defects on the scalp region.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Melanoma/cirurgia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Idoso , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Melanoma/patologia , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas/patologia
10.
J Craniofac Surg ; 30(8): 2429-2431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403511

RESUMO

Scalp arteriovenous malformations (AVMs) are rare entities that may present as large, tortuous vascular lesions with resultant craniofacial deformity. Radiologic findings include feeding arteries and veins associated with dilated tortuous vessels. Intracranial extension is rare. A 5-year-old African American male presented with an occipital mass presumed to be a dermoid cyst on referral. Further workup revealed the presence of a scalp AVM that demonstrated extension into the left sigmoid sinus. Radiologic and intraoperative images are presented. Literature search revealed only 4 patients with scalp AVM extending intracranially into the sagittal sinus, 2 of which were managed with coagulation and division of the feeding vessels and the other 2 underwent preoperative embolization. Our patient is the 1st to be reported to have sigmoid sinus extension. Scalp AVMs with intracranial extension are rare, and require further preoperative workup. Following ultrasound evaluation, computed tomography angiography, magnetic resonance angiography, magnetic resonance imaging, or cerebral angiography can be considered. Treatment entails resection, but preoperative embolization is increasingly used, mirroring patients without intracranial extension. Further studies are needed to evaluate the efficacy and risk profile of these treatments.


Assuntos
Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/cirurgia , Couro Cabeludo/irrigação sanguínea , Couro Cabeludo/cirurgia , Angiografia Cerebral , Pré-Escolar , Cavidades Cranianas , Embolização Terapêutica/métodos , Humanos , Angiografia por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
12.
Anticancer Res ; 39(8): 4253-4258, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366514

RESUMO

Different entities can be the cause of scalp neoplasia. In a phenotype with multiple cystic scalp lesions, the diagnosis must be made with particular caution because the appearance of apparently benign tumors does not necessarily correspond to the biological behaviour of the lesions. This case report describes diagnosis and therapy of a patient with multiple cystic tumors confined to the scalp. Diagnosis of benign lesions all over the scalp allowed an aesthetically pleasing surgical treatment result. Long-term follow-up control was offered to the patient because the histological diagnosis identified further small tumors of the same type as the large lesions, so further neoplasms are likely to develop.


Assuntos
Cisto Epidérmico/cirurgia , Neoplasias/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/fisiopatologia , Feminino , Humanos , Neoplasias/diagnóstico , Neoplasias/diagnóstico por imagem , Neoplasias/fisiopatologia , Couro Cabeludo/diagnóstico por imagem , Couro Cabeludo/fisiopatologia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/fisiopatologia
13.
Am J Case Rep ; 20: 1141-1143, 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31375657

RESUMO

BACKGROUND Epidermoid cysts are the most common benign skin lesions that can occur anywhere on the body, and frequently occur on the face, scalp, neck, and trunk. Typically, patients are asymptomatic, and the lesions present as firm skin-colored nodules filled with keratinous or sebaceous materials that are formed by cystic expansion of the epidermal epithelium. Malignant transformation is rare in epidermoid cysts. CASE REPORT This is a case report of a 77-year-old male Caucasian patient who presented with an epidermoid cyst on the left parietal area. Due to high suspicion, the cyst was surgically excised and sent to pathology which resulted in discovery of malignant squamous cell carcinoma with unclear margins. Aimed at obtaining clear margins, a wide excision was performed, which revealed clean margins and absence of residual cancerous cells. The patient recovered well without major complications. CONCLUSIONS Although the prevalence of epidermoid cysts is high, malignant transformation of epidermoid cysts into squamous cell carcinoma is rare. Due to its scarcity, the exact pathophysiology of malignant transformation is still poorly understood. The differential diagnosis should include the possibility of malignancy for highly suspicious lesions, and proper management guidelines should be established. Surgical resection should be the treatment of choice, and once removed, all surgically excised cysts should undergo pathologic evaluation. As clinicians, it is crucial to stay vigilant and have a low threshold for excision and thorough histological examination of specimens to allow early diagnosis and interventions which can significantly improve patient outcomes. Through the suggested guidelines, we hope to aid in better management and intervention in case of malignant transformation of epidermoid cysts.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Transformação Celular Neoplásica , Cisto Epidérmico/diagnóstico , Couro Cabeludo/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Cisto Epidérmico/cirurgia , Humanos , Masculino , Margens de Excisão , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia
16.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(6): 474-481, jul.-ago. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-185275

RESUMO

Antecedentes y objetivos: La extirpación quirúrgica de tumores cutáneos de cuero cabelludo crea defectos difíciles de reparar por la poca distensibilidad de la zona. El objetivo principal de este trabajo es conseguir un algoritmo estructurado que permita la elección de la mejor técnica reconstructiva para el cierre de los defectos quirúrgicos de cuero cabelludo. Materiales y métodos: Estudio retrospectivo de 119 pacientes que requirieron la extirpación quirúrgica de tumores de cuero cabelludo con posterior reconstrucción quirúrgica para el cierre del defecto. Se excluyeron los pacientes con defectos que pudieron ser cerrados mediante sutura directa simple, así como en los que desde el principio se decidió emplear injertos cutáneos o se dejaron cerrar por segunda intención. Los defectos se clasificaron en 5 grupos según la distancia mínima de aproximación de los bordes y se evaluaron en cada grupo las diferentes opciones de reconstrucción quirúrgica. Se tuvieron en cuenta como objetivos finales el cierre completo del defecto, las complicaciones intra- y postoperatorias, así como el resultado estético final. Resultados: Se incluyeron 119 pacientes (102 varones y 17 mujeres); edad media 71 años (rango, 32-93 años). El seguimiento medio fue de 42 meses (rango, 6-120 meses). De los 119 pacientes, 68 tenían defectos de mediano tamaño con una distancia de aproximación entre 1 y 4 cm. En 43 de ellos se inició la reconstrucción mediante incisiones de descarga que permitieron el cierre del defecto en 22 casos. Los defectos con distancias de 1 a 2 cm necesitaron una sola incisión de descarga. Los comprendidos entre 2 y 3 cm, 2 incisiones y de 3 a 4 cm, 3 incisiones. En los 21 casos que no cerraron a través de las incisiones de descarga, se ampliaron estas incisiones a sus correspondientes colgajos para conseguir el cierre. Ninguno de los defectos mayores de 4 cm cerró solo con las incisiones de descarga. Conclusiones: La regla "1-2-3" permite elegir la mejor técnica reconstructiva para defectos de mediano tamaño realizando inicialmente 1, 2 o 3 incisiones de descarga según sea la distancia de aproximación de los bordes del defecto entre 1-2 cm, entre 2-3 cm o entre 3-4 cm respectivamente, con la opción de ampliar a los colgajos correspondientes si fuera necesario


Background and objective: Excision of cutaneous scalp tumors results in surgical defects that are difficult to repair because of poor distensibility in this area of the body. The main aim of this study was to develop a structured algorithm to help choose the best technique for reconstructing scalp defects. Material and methods: Retrospective study of patients who required surgical reconstruction following excision of a cutaneous scalp tumor. We excluded patients with defects that could be closed by simple direct suture and defects for which it was initially decided to use a skin graft or healing by secondary intention. The defects were classified into 5 groups according to the minimum distance between edges. The different reconstruction techniques used were evaluated in each group. The outcomes analyzed were complete defect closure, intraoperative and postoperative complications, and final aesthetic result. Results: We included 119 patients (102 men and 17 women) with a mean age of 71 years (range, 32-93 years). Mean follow-up was 42 months (range, 6-120 months). Sixty-eight patients had a moderate-sized defect with a distance between edges of 1 to 4cm. Reconstructions started with relaxation incisions in 43 defects and resulted in the successful closure of 22 of them. Defects with a distance of 1 to 2cm required a single relaxation incision. Two incisions were required for defects with a distance of 2 to 3 cm, while 3 incisions were required for those with a distance of 3 to 4cm. In the 21 cases in which relaxation incisions were insufficient to close the defect, the incisions were extended to mobilize the flap to achieve closure. Relaxation incisions alone were insufficient for closing defects with a distance greater than 4 cm. Conclusions: The 1-2-3 rule can help in choosing the best reconstruction technique for moderate-sized defects based on the principle that 1, 2, or 3 initial relaxation incisions are needed depending on the minimum distance between edges (1-2 cm, 2-3 cm, or 3-4 cm). In all cases, incision extension to mobilize the corresponding flaps remains an option


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Couro Cabeludo/cirurgia , Carcinoma de Células Escamosas/cirurgia , Estética , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia , Carcinoma Basocelular/cirurgia
17.
An. bras. dermatol ; 94(4): 452-454, July-Aug. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1038305

RESUMO

Abstract: Proliferating trichilemmal cyst is an uncommon neoplasm arising from the follicular isthmus, whose histopathological hallmark is the presence of trichilemmal keratinization. We describe a case of proliferating trichilemmal cyst in a 57-year-old woman with a broad clinical, radiological, macroscopic and microscopic correlation.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Couro Cabeludo/patologia , Couro Cabeludo/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/diagnóstico por imagem , Couro Cabeludo/cirurgia , Ultrassonografia , Biópsia por Agulha Fina , Diagnóstico Diferencial , Cisto Epidérmico/cirurgia
18.
J Craniofac Surg ; 30(7): 2181-2183, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31283641

RESUMO

PURPOSE: To report long-term surgical outcomes of Cutler-Beard reconstructive surgery in patients with large full-thickness upper eyelid defects following malignant tumor excision. METHODS: The medical records of 5 consecutive patients with full-thickness upper eyelid defects following tumor resection who underwent Cutler-Beard surgery were reviewed retrospectively between April 2005 and November 2018. Surgical procedure comprises 2 stages: first, complete tumor resection followed by bridged full-thickness lower eyelid advancement flap; second, separation of the closed eyelid with eyelid margin repair 7 to 9 weeks later. Postoperative anatomical, functional and cosmetic outcomes, and complications were evaluated during follow-up at 22 to 77 months. RESULTS: Patients were in the age group of 49 to 75 years, including 3 (60%) females and 2 (40%) males. Three of the 5 patients (60%) exhibited sebaceous cell carcinoma and 2 (40%) showed squamous cell carcinoma. Three patients (60%) underwent Cutler-Beard surgery after recurrence of primary carcinoma following previous operation. Three patients underwent revision surgery with entropion, 2 underwent correction for wound dehiscence and 1 was treated with symblepharon lysis. No serious or permanent ocular complications were observed during the operation or follow-up with the patients. The procedure resulted in good aesthetic quality and acceptable sequelae at the donor site. CONCLUSIONS: Cutler-Beard procedure for the reconstruction of large and full-thickness upper eyelid defects is an effective procedure with satisfactory long-term results, although a few patients may require minor revision surgery.


Assuntos
Doenças Palpebrais/cirurgia , Adenocarcinoma Sebáceo/cirurgia , Idoso , Blefaroplastia/métodos , Carcinoma de Células Escamosas/cirurgia , Estudos de Viabilidade , Feminino , Cabelo , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Couro Cabeludo/cirurgia , Neoplasias das Glândulas Sebáceas/cirurgia , Retalhos Cirúrgicos/cirurgia , Doadores de Tecidos
19.
J Craniofac Surg ; 30(5): e404-e406, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299793

RESUMO

Vascular anomalies are a group of lesions originating from blood vessels and lymphatics with varying histology and clinical behavior. They form the most common congenital anomalies in infants and children. The reconstructive method for the facial region defects varies depending on the size and position of the defect, as well as the patient's age, health status and aesthetic concerns. In this case, the authors present a male patient who underwent a wide resection of his mustache area because of vascular malformation and reconstructed with hair-bearing temporal artery island flap.A 42-year-old male patient presented with swelling and ongoing color change in the cheek and lip area on the left side of the face. His examination revealed a vascular malformation extending from the preauricular region to the left side of the nose, to the upper lip and to the medial canthal region. Superficial temporal artery island flap was designed to reconstruct the upper lip area while full thickness skin graft planned for the defect on nose and cheek.STA island flap has been applied in many areas such as forehead, eyebrow, eyelid, cheek, and nose reconstruction due to its advantages such as providing good color and texture harmony, reliable and constant pedicle, simple and fast dissection, wide rotation arc and low donor area morbidity. Superficial temporal artery island flap should be considered as a favorable reconstruction option in upper and middle face region for moderate and small sized defects.


Assuntos
Face/cirurgia , Couro Cabeludo/cirurgia , Retalhos Cirúrgicos , Artérias Temporais/cirurgia , Adulto , Dissecação , Estética Dentária , Testa/cirurgia , Cabelo , Humanos , Masculino , Retalhos Cirúrgicos/cirurgia
20.
J Craniofac Surg ; 30(8): 2416-2420, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31274819

RESUMO

Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo/cirurgia , Cicatriz/cirurgia , Humanos , Transplante de Pele/métodos , Pele Artificial , Cicatrização
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