Ear melanoma: influence of perichondrium involvement in evaluating surgical strategy.

Adequate treatment of melanomas of the external ear offers unique surgical challenges because of the complex anatomical features of the auricle and the need for proper oncologic aggressiveness, as well as for valid aesthetic results. In this study, we evaluated nine different cases of melanoma of the auricle treated in our Institute between 1994 and 2008. Every enrolled patient underwent surgical excision, nonetheless reconstruction was performed with different surgical techniques. In accordance with histological reports, we could observe the absence of neoplastic cells in perichondral bone and in cartilagenous tissue, providing further assurance concerning the importance of preserving the outer ear in expectation of reconstruction. As a matter of fact, it has been proven that it is possible to reconstruct the auricle while guaranteeing oncologic safety in melanomas with a Breslow thickness >1 mm. Therefore, an excision preserving the cartilagenous tissue, thus allowing an efficient full-thickness cutaneous grafting may guarantee good functional and aesthetic results. In conclusion, the suggested therapeutic management may be considered in <1 mm melanomas without taking further unnecessary oncologic risks.

Multidisciplinary care in severe pediatric electrical oral burn.

Oral burns in pediatric patient are commonly due to electrical injuries, representing an important reconstructive issue even for functional than esthetic reason. Different classification, surgical management and even oral device were described to allow the best long-term result. In most case a multidisciplinary approach is necessary to achieve a satisfactory outcome. A severe case of pediatric oral burn with germinative teeth damage is presented, describing a multispecialist team approach that guarantee a satisfactory outcome by reconstructive surgery, careful progressive evaluation of dental and soft tissue healing and speech recovery. The use of acellular dermal substitute template within traditional reconstructive surgery had provided a good functional and esthetic result joint to valid preservation of germinative dental element as shown at long-term X-ray evaluation. Intensive rehabilitation speech program has also avoided phonetic impairment in an important speech develop period. It was so evident that the necessity of a multispecialist care in such difficult injury to achieve the best long-term result.

Management of complex pediatric burn scars in a humanitarian collaboration.

Burn scars still represent a challenge to the reconstructive surgeon. Their management requires a specific expertise and set up involving the possibility of long term rehabilitation and follow up. Cases encountered in humanitarian missions present additional issues. Often the local environment is not suitable for an appropriate treatment plan, requiring the case to be transferred to a foreign country for surgical care as part of an integrated international and multidisciplinary management. We present the case of a three year-old patient injured in a bomb explosion during the Arab Spring and suffering from severe scar contracture limiting thoracic and upper limb movement. After initial consultation at distance, transfer to our country was organized and an intensive surgical and rehabilitative program was carried out over three months. After five months, the patient returned to his home country where a supportive network had been set up for continued rehabilitation, ensuring follow up for over a year and ultimate success.

Les cicatrices de brûlures représentent toujours un défi pour le chirurgien de reconstruction. Leur gestion nécessite une expertise spécifique et la possibilité de réhabilitation à long terme, y compris le suivi. Les cas rencontrés dans les missions humanitaires présentent des problèmes supplémentaires. Souvent l'environnement local n'est pas adapté pour un plan de traitement approprié, et donc il faut transféré le patient dans un pays étranger pour des soins chirurgicaux dans le cadre d'une gestion internationale et multidisciplinaire intégrée. Nous présentons le cas d'un patient de trois ans blessé à cause de l'explosion d'une bombe pendant le printemps arabe. Ce patient souffrait de contractures graves qui limitaient le mouvement du membre thoracique et supérieure. Après une consultation initiale à distance, il a été transferé à notre pays où il a subi un programme de chirurgie et de réadaptation intensive qui a duré trois mois. Après cinq mois, le patient est retourné à son pays d'origine où un réseau de soutien a été mis en place pour continuer la réhabilitation, assurer un suivi de plus d'un an et le succès final.