Objective: We present the case of a white man with a facial nodule suspicious for basal cell carcinoma. Methods: Biopsy revealed clusters of basaloid tumor cells with peripheral palisading, consistent with a superficial spreading variant of basal cell carcinoma. Results: The patient was treated with Mohs micrographic surgery, with clear margins achieved after the second stage of excision. However, since it was a superficial spreading basal cell carcinoma, this was followed by topical imiquimod treatment. Conclusion: Topical chemotherapy with imiquimod or 5-fluorouracil may be valuable alternatives or adjuncts, given the increased likelihood of recurrence after surgical excision of superficial spreading basal cell carcinoma. Mohs surgery is of limited value in the management of superficial spreading basal cell carcinoma because it characteristically shows areas of uninvolved skin between tumor nests.
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Lesser toe salvage secondary to soft tissue ulceration and underlying osteomyelitis is a challenge, and amputation is frequently the primary procedure recommended. The author presents an observational case series involving retrospective review of prospectively collected data of 4 lesser toe salvage procedures with external fixation and delayed autogenous bone grafting for the treatment of osteomyelitis in 4 consecutive patients. Each patient underwent initial resection of involved soft tissue ulceration and underlying osseous components of the lesser toe with application of external fixation and polymethylmethacrylate antibiotic-loaded bone cement spacer. Once eradication of osteomyelitis was confirmed clinically, the patient underwent delayed insertion of autogenous bone graft harvested from the ipsilateral calcaneus or osteocutaneous flap transfer from the fibular border of the ipsilateral great toe. There were 2 men and 2 women with a mean age of 56.5 years. Three patients had diabetes mellitus, and 1 had previous history of open fracture. There were 2 right feet and 2 left feet involved and 2 second, 1 third, and 1 fourth toe salvage procedures performed with a mean follow-up of 12 months. The external fixation device was maintained until complete osseous integration was verified, which occurred at a mean of 7.5 weeks. All procedures were deemed successful with complete osseous incorporation of the proximal and distal graft-host bone interfaces and no recurrent soft tissue ulcerations, osteomyelitis, toe deformity, or fracture about the bone graft sites.
12:07 pm | Posted in
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From the Journal of Wound Care…
Adequate drainage is a prerequisite for closing a vesicocutaneous fistula, but the continued exposure to urine makes this impossible. Here, VAC was successfully used as a preoperative therapy before flap transplantation
Yoko Katsuragi, K. Ueda, A. Kajikawa, T. Tateshita, H. Okochi
Journal of Wound Care, Vol. 19, Iss. 4, 08 [...]
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From Journal of Foot & Ankle Specialist
Needle penetration and local anesthetic infiltration are 2 painful steps that cause considerable stress and anxiety during digital nerve block, which is the most frequently used regional anesthesia for ingrown nail surgery. The purpose of this study was to evaluate the effectiveness of topical alkane vapocoolant spray in decreasing [...]
9:57 am | Posted in
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Anand R. Kumar,1,2,* Raymond Harshbarger,1,3 and Barry Martin1,3
1Department of Surgery (Plastic Surgery), Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland.
2Department of Plastic and Reconstructive Surgery, National Naval Medical Center (NNMC), Bethesda, Maryland.
3Department of Plastic and Reconstructive Surgery, Walter Reed Army Medical Center (WRAMC), Washington, District of Columbia.
Background: Military treatment facilities continue to treat [...]
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Introduction: Auricular reattachment or reconstruction after traumatic ear loss remains a challenge for the plastic reconstructive surgeon. Because of the diverse accident mechanisms, no standard algorithms exist and several modalities have been proposed in the literature.
Methods: A case of an innovative ear reconstruction of a partially avulsed ear is presented. The amputated cartilage was reattached after being deepithelized from the anterior skin. A transauricular-retroauricular random pattern flap was then harvested and used for anterior skin coverage. Results: The described technique provided a nice final result without the need of any further operations.
Conclusion: In general, a microsurgical replantation should be applied when the circumstances allow. In other cases, especially in partial upper-ear amputations with severe skin contusions, the described technique should be considered as a safe, single-step approach with good final results.
11:51 am | Posted in
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