Background:
Dog ear, a characteristic bunching up of excess tissue formed during wound closure, is a common unsightly problem in cutaneous surgery. It may present as a cosmetic concern or a source of physical discomfort. Several management techniques have been reported, but it is unclear which approach is the most effective or whether outcomes vary with surgical situations. This report assesses the best practices for dog ear management.
Methods:
A systematic literature search was performed. All relevant articles written in English and involving human subjects were included.
Results:
There were 2028 potentially relevant articles, but only 36 articles met the inclusion criteria. These articles were published in multispecialty journals. They included 23 techniques or case report articles, 6 retrospective and prospective studies, but no clinical trial or randomized control trial. Ten major techniques were identified in the literature. No single technique was proved to be superior in the literature. There was no recommended algorithm in the literature.
Conclusions:
Despite there being no single recommended technique to manage dog ear deformities, there is ample evidence to suggest surgeons avoid a pre-planned elliptical design, use a proper skin-conserving design for excision, and carry out a meticulous suture closure as the first steps to prevent dog ears. We discuss the indications for each of the ten techniques and propose an algorithm for dog ear management. Until further research is performed, multispecialty cutaneous surgeons should familiarize themselves with the discussed techniques to provide patients with the best functional and aesthetic results.
A 33-year-old female developed an isolated stricture of the mid portion of her ileal pouch nine years after proctocolectomy and J-ileal pouch-anal anastomosis for ulcerative colitis. Repeated episodes of pouchitis and partial small-bowel obstruction led to pouchoscopy and pouchography, which demonstrated pouch inflammation and a long, tight, midpouch stricture. Her diagnosis was changed to Crohn's disease and she was treated with azathioprine, budesonide, and infliximab. Repeat pouchoscopy demonstrated mucosal healing but a persistent fibrotic stricture. Pouch reconstruction was performed with a midpouch strictureplasty alleviating her obstructive symptoms. One year after surgery, the patient has no clinical evidence of obstruction and repeat pouchography demonstrates a wider pouch lumen across the strictureplasty site. Strictureplasty is an alternative to pouch excision in the management of patients with Crohn's disease who have an isolated pouch stricture.
Introduction
and importance: Large cutaneous defects may result from excision of skin malignancies. Typically, skin grafting is used to manage such defects, but the final result may be compromised by inadequate take and poor cosmesis. Accordingly, transposition flaps may be indicated.
Case Presentation and clinical discussion: A 93-year-old female presented with a painful, necrotic 12 cm × 12 cm Squamous Cell Cancer of left upper back. She underwent wide excision followed by a rhomboid transposition fasciocutaneous flap. The flap was easily designed, quickly executed, and did not require any special instruments. The overall result was a good cosmetic outcome with no complications.
Conclusion
Our case outlines successful use of rhomboid flap instead of a more complicated option to reconstruct a very large cutaneous defect. The flap healed with excellent contour, texture, thickness, and color match.
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