Primary chemotherapy allowed for TM in patients with large tumours. Intraoperative margin assessment decreased reoperation rate. Contralateral matching procedures resulted in histological detection of occult disease. TM is an oncologically appropriate and cosmetically favourable technique.
Trichilemmal carcinoma (TC) is described as a very rare cancer of the skin adnexa. Ninety per cent of the lesions present on the scalp. Prognostic factors in TC are limited to lymph node status and surgical margins, with no statistical significance observed for age or gender of the patient, size of tumour or locoregional recurrence. We present a 46-year-old black patient who developed TC during treatment for breast cancer. Postoperative histology of the scalp lesion excision confirmed no involved margins. At the three monthly appointment, the patient was reviewed and multiple, new scalp lesions were noted. A CT scan of the head, neck found multiple lesions on the scalp, limited to the soft tissue, not involving the outer table of the skull. There was bilateral invasion of the parotid glands. To the best of our knowledge, no syndromes or associations between breast cancer and adnexal skin tumours exist.
Case reports detailing the effects of targeted intraoperative radiation therapy (IORT) on patients with cardiac pacemakers (PMs) are rare. This growing population subgroup requiring IORT and lack of standardized guidelines necessitate more practical published research. An 81-year-old patient with clinical stage II, T1 N0 grade III, triple-negative invasive ductal carcinoma and an implanted single-lead chamber PM (VVIR mode, model: Biotronik, type Effecta SR) received targeted intraoperative radiotherapy at the time of wide local excision and sentinel lymph node biopsy. It presents the shortest distance between the outer diameter of the PM and IORT applicator in literature. Target IORT was performed utilizing an Intrabeam device (50 kV, Carl Zeiss Surgical, Oberkochen, Germany). This case elucidates the successful use of targeted IORT for breast-conserving surgery in a patient with a single ipsilateral chamber VVIR mode PM. No device failure or malfunction was reported for the PM before, during, or after the procedure. These findings support the use of targeted IORT for patients diagnosed with early-stage breast carcinomas who have a PM implanted. However, further research is needed to understand the safety of other methods and devices for IORT patients with cardiac implantable electronic devices.
Background:
Unsightly scars after facial surgery might be a worry for patients and surgeons alike. To prevent unfavorable scars after facial operations, it is inevitable for the surgeon to adhere to different principles and to follow an algorithm: patient assessment, incision planning, surgical technique, suture material, and postoperative scar management. A defined knowledge about the pathophysiology of wound healing is required. The aim of this report is to serve as a teaching purpose and to verify the well-known empirical practices in scar prevention with the corresponding explanatory research. Based on these findings, the suggestion of an appropriate algorithm for the best scar management will be elaborated.
Methods:
This article elucidates the basics of unsightly scar prevention and the concomitant scientific proofs in detail by reviewing the literature and newest research published in PubMed.
Results:
The preoperative, intraoperative, and postoperative guidelines for the achievement of acceptable facial scars will be distinguished regarding the valid state of knowledge. Special attention is drawn to the “flat incision technique” as the first surgical step. Based on the newest research, an algorithm of the important preoperative, intraoperative, and postoperative features to achieve scar improvement is presented.
Conclusions:
To prevent unsightly facial scars, a well-defined algorithm must be followed. In summary, three well-established, empirically proven measures are documented now by the equivalent physiological scientific proof: (1) the flat incision technique, (2) the wound closure with maximal tension reduction, and (3) the postoperative scar management with further tension reduction and more moisturizing of the scar.
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