PERTHESE implant-identical cohesive-gel sizers in breast augmentation: a prospective report on 200 consecutive cases and implications for treatment of breast asymmetry.

BACKGROUND: The insertion of sizers in breast augmentation surgery is a common method of predicting the final volume of prosthesis required. However, saline-filled sizers may not accurately represent the shape of the cohesive-gel-augmented breast. PERTHESE cohesive-gel breast implants are produced with matching sets of reusable (sterilizable) cohesive-gel-filled sizers that accurately predict the form of the augmented breast. OBJECTIVES: The authors assess the efficacy of PERTHESE sizers and implants in 200 consecutive patients who presented for breast augmentation. METHODS: Data were prospectively collected for all patients who underwent bilateral breast augmentation between 2003 and 2010 with the senior author (BGHL), during which time he inserted PERTHESE implants exclusively in his clinical practice. The 200 patients included in this series were analyzed according to demographic details, preoperative findings (including the presence of breast asymmetry), surgical approach, postoperative patient and surgeon satisfaction scores, and complications. RESULTS: Less than 2% of patients in this series experienced complications such as hematoma, seroma formation, or infection. Capsular contracture developed in 7% of patients, but there were no visible or painful capsules. Only 2% of patients elected to undergo surgical revision for aesthetic reasons. A high proportion (87%) of the 27 patients who had significant preoperative breast asymmetry were satisfied with the aesthetic outcome of their surgery. Likewise, a significant percentage (92%) of the 148 patients who had preoperative breast symmetry were satisfied with their outcome. CONCLUSIONS: Application of intraoperative form-stable cohesive-gel sizers can enhance the surgeon's ability to predict the final appearance of the augmented breast. The placement of these form-stable sizers and implants is a particular advantage in cases of established breast asymmetry.

Neuronal differentiation in basal cell carcinoma: possible relationship to Hedgehog pathway activation?

Although deregulated Hedgehog signalling and elevated Gli transcription factor expression are known to promote the development of basal cell carcinoma (BCC), little is known about molecular mechanisms driving the development of specific growth pattern subtypes. Using gene array analysis, we have previously observed that over-expression of GLI1 in human keratinocytes promotes increased expression of the neuronal differentiation markers ARC and ULK1. We asked whether neuronal differentiation is a characteristic of BCC and whether there is any correlation with BCC subtype. Using RT-PCR and immunohistochemistry, we confirmed that the neuronal markers ARC, beta-tubulin III, GAP-43 and Neurofilament are expressed in human BCC but not in normal epidermis. Moreover, we found that expression of these neuronal differentiation markers showed strong correlation to BCC subtype, with more aggressive infiltrative and morphoeic BCC showing low levels or lack of expression compared to nodular, superficial and micronodular subtypes. Primary human keratinocytes retrovirally expressing GLI1(-) and GLI2(-) showed elevated levels of beta-tubulin III and ARC but not Neurofilament or GAP-43, suggesting that beta-tubulin III and Arc may be early targets of aberrant Gli expression in BCC, whereas expression of Neurofilament and GAP-43 are either later, downstream targets or under control of alternative pathways. We propose that neuronal differentiation is a feature of BCC and that expression of these markers is in part due to aberrant Hedgehog signalling. Moreover, we suggest that correlation between loss of expression of neuronal markers in infiltrative and morphoeic BCC subtypes reflects dedifferentiation of more aggressive BCC subtypes.

Bilateral trigger finger in a 7-year-old after a viral infection: case report.

Triggering in young children is rare. In this report, we describe spontaneous bilateral ring finger triggering in a 7-year-old boy after a viral infection. The pathology completely resolved without intervention. We propose that the triggering resulted from a viral synovitis. Such a case highlights the importance of eliciting evidence of recent infections in children presenting to hand clinics with finger triggering. It also implies that the transient synovitis often described in children may actually occur symptomatically in tenosynovium as well as articular synovium.

Prospective study of sentinel node biopsy for high-risk cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Nodal metastasis from cutaneous squamous cell carcinoma (SCC) is poorly predicted clinically and is associated with a high mortality rate. METHODS: From 2010 to 2013, patients with high-risk cutaneous SCC were assessed with sentinel node biopsy (SNB) either at the time of primary cutaneous tumor resection or at secondary wide local excision. RESULTS: Of 57 patients, 8 (14%) had nodal metastasis. Significant predictors of metastasis are the number of high-risk factors (p = .008), perineural invasion (PNI; p = .05), and lymphovascular invasion (LVI; p = .05). During a mean of 19.4 months, 9 patients developed recurrence and 6 died of cutaneous SCC, indicating that over 1300 patients would be required for a randomized controlled trial with 80% power to detect a significant difference in disease-free survival. CONCLUSION: Lymph node metastasis occurs in 14% of patients with high-risk cutaneous SCC. Larger studies will be required to identify which "high-risk" factors should be considered as an indication for surgical assessment of the nodal basin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E884-E889, 2016.

Concurrent chemoradiotherapy compared with surgery and adjuvant radiotherapy for oral cavity squamous cell carcinoma.

BACKGROUND: The purpose of this study was to compare survival and functional outcomes in patients with advanced oral cavity squamous cell carcinoma (SCC) treated with either surgery + adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CRT). METHODS: Patients treated with curative intent by either surgery + RT or concurrent CRT were identified over a 6-year period (2001-2007). Disease and functional outcomes were analyzed on an intention-to-treat basis. RESULTS: Fifty-four patients underwent surgical excision and received postoperative RT. Fifty patients underwent concurrent CRT. Overall survival (OS) and disease-specific survival (DSS) was significantly higher in the surgically treated group (p < .001). Long-term enteral feeding tube support was more commonly required in those treated with CRT, whereas osteoradionecrosis rates were comparable between the 2 groups. CONCLUSION: Treatment by surgery + adjuvant RT for advanced oral cavity SCC resulted in better disease control than treatment with CRT. This supports traditional surgical treatment algorithms for oral cavity cancer.

Head and neck multidisciplinary team meetings: Effect on patient management.

BACKGROUND: The purpose of this study was for us to present our findings on the prospectively audited impact of head and neck multidisciplinary team meetings on patient management. METHODS: We collected clinical data, the pre-multidisciplinary team meeting treatment plan, the post-multidisciplinary team meeting treatment plans, and follow-up data from all patients discussed at a weekly multidisciplinary team meeting and we recorded the changes in management. RESULTS: One hundred seventy-two patients were discussed in 39 meetings. In 52 patients (30%), changes in management were documented of which 20 (67%) were major. Changes were statistically more likely when the referring physician was a medical or radiation oncologist, when the initial treatment plan did not include surgery, and when the histology was neither mucosal squamous cell cancer nor a skin malignancy. Compliance to the multidisciplinary team meeting treatment recommendation was 84% for all patients and 70% for patients with changes in their treatment recommendation. CONCLUSION: Head and neck multidisciplinary team meetings changed management in almost a third of the cases.

Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction.

BACKGROUND: A number of microvascular free-flap tissue transfer techniques exist for reconstruction of head and neck defects. The scapular free flap is a versatile option that can be used for a wide variety of defects in this complex region. METHODS: A series of 42 free flaps from 41 patients was retrospectively identified from the senior author's (J.R.C.) [corrected] database between 2006 and 2012. Information regarding patient demographics, indication for surgery, type of flap, reconstructive methods, complications, and prosthodontic outcome were reviewed and have been described. RESULT: A wide range of defects were reconstructed using the scapular free flap. Of the 42 reconstructions, 24 were for mandibular, 13 were for maxillary, and five were for calvarial reconstruction. The patients' ages ranged from 28 to 82 years, with a median of 70 years. Dental restoration was achieved in eight patients with maxillary reconstruction and two patients with mandibular reconstruction. There were 11 major complications, including two total flap failures. CONCLUSIONS: The authors have found the scapular free flap to be a reliable, robust, and versatile flap that provides an unparalleled range of reconstructive options, with minimal donor-site morbidity. Thus, the authors believe that the scapular free flap is a valuable reconstructive option for patients with complex head and neck defects and in patients in whom comorbid disease contraindicates the use of the fibular free flap.

Central breast excision with immediate autologous reconstruction for recurrent periductal sepsis: an application of oncoplastic surgical techniques.

OBJECTIVE: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. METHODS: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. RESULTS: Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. CONCLUSIONS: This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease.

Chest wall reconstruction using a turbocharged chimaeric anterolateral thigh flap.

Extremely large chest wall defects may result following salvage oncological surgery. Typically these defects involve a large skin defect combined with a variable resected area of underlying muscle and ribs. In situations where the skin defect is very large the use of a large latissimus dorsi flap may require skin grafting to the donor site if a myocutaneous flap is used or to the recipient defect if a muscle-only flap is used. Alternatively a transverse rectus abdominis flap is a second option but in certain cases this may not be available. We describe the use of a free anterolateral thigh flap to reconstruct a chest wall defect and demonstrate the principle of side-to-side stacking of separate skin paddles to achieve skin closure of a massive defect whilst permitting primary closure of the donor site. The principle of turbocharging components of a chimaeric flap is also described.

Mirror ear: a reconstructive technique for substantial tragal anomalies or polyotia.

Polyotia (mirror ear) is an extremely rarely reported congenital anomaly of the external ear. The aetiology of this condition is unclear, and there are few descriptions of surgical techniques used. We aimed to review our experience with this condition by performing a retrospective review of the cases treated in our unit. Eight cases of polyotia treated at a referral centre for ear reconstruction in a 12 year period (1992-2004) were reviewed. Patient demographic data and associated syndromes were recorded. Operative techniques used in the cases were studied. There was an equal number of males and females. Four patients had abnormal contralateral ears and two patients were formally diagnosed as suffering from a congenital developmental syndrome. Five main components of surgical technique were found to be particularly relevant to these cases. These relate to deconstruction of the defect, management of extra cartilage, management of skin, proximity of the facial nerve and the timing of surgery. The authors conclude that a structured surgical approach can lead to successful reconstruction of these difficult abnormalities.