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EditorPyoderma gangrenosum (PG) is a rare autoinflammatory ulcerative skin disease. 1 Fewer than 50% of the patients achieve wound healing after 6 months of immunosuppressive therapy and relapses occur in 30% to 60% of the cases. 2,3 Progression of existing lesions or development of new lesions after surgery or minor trauma is reported in up to 30% of PG patients (pathergy phenomenon). 3,4 Therefore, the role of surgical interventions such as split thickness skin grafting (STSG) and negative pressure wound therapy (NPWT) is controversially discussed, as these procedures might pose a trigger and further aggravate the condition, especially if performed without immunosuppression. 5 A broad search of the PubMed, Medline, EBSCO Biomedical Reference Collection and Cochrane databases was performed and a total of 61 relevant articles describing 94 patients could be retrieved and complemented with our personal multicentre experience of 21 patients (see Table 1). A total of 115 patients with PG (69% females, median age 53) were identified. Ulcers were mainly situated on the lower extremities (n = 90; 78%), followed by breasts (n = 11; 10%), abdomen (n = 7; 6%) and other localizations (12; 10%). Surgical treatment consisted of split thickness skin grafts (STSG) alone (n = 53; 46%), STSG together with NPWT (n = 35; 30%), NPWT alone (12; 10%) or other forms of skin grafting (cultured cells, suction blisters, full thickness skin grafts, pinch grafts n = 15, 13%). Systemic immunosuppression consisted mainly of systemic corticosteroids (n = 107; 93%), supplemented with cyclosporine (21; 19%), dapsone (12; 9%), TNF-alpha antibodies (11; 9%), mycophenolate mofetil (9; 8%), azathioprine (7, 6%) and others used in less than five patients. Treatment was successful in 84 cases (73%), 18 patients healed but had a recurrence (16%), eight improved (7%), treatment failed in three patients and two patients died due to sepsis. The lower relapse rates observed in this review is probably due to the short follow-up in the many single patients reported. No case of pathergy was observed, neither at the side of PG nor at the skin graft donor sites.On the basis of the literature review and personal experience, we developed a surgical treatment algorithm with proposed immunosuppressive and adjuvant measures shown in Fig. 1. The basic immunosuppression consists of CS. As a second step, we prefer dapsone as anti-inflammatory steroid sparing agent over cyclosporine, as it does not affect renal function or blood pressure and for its well-known additional antimicrobial properties. 6 Indeed, mortality rates from 11% to 17% have been reported for PG and were mostly related to sepsis 3,7 and septical complications were the cause of death in the two deceased patients from the literature review. 3,8 As a third step, if necessary, the anti-TNF-alpha antibody infliximab is used as the sole biologic with a positive randomized, double-blinded, placebocontrolled trial for PG. We further suggest the use of pentoxyphylline as adjuvant treatment for its known rheolo...

The modified "reading man flap" is a good option for the closure of larger rectangular facial skin defects especially in elderly patients, and the use of at least 40 ml of tumescent solution is suggested to achieve optimal pain control.

STSGs are a valid option for closing large auricular skin defects. Even large cutaneous tumors of the external ear do not necessarily infiltrate the cartilage. Thus, cartilage-sparing tumor resection with subsequent defect closure using a STSG is an excellent and quick method associated with high patient satisfaction.

We report a case of a giant BCC, measuring 25 × 13 × 5 cm, involving the abdominal wall. The article describes the curative surgical procedure, which resulted in an excellent aesthetic result.

Incidence of cutaneous melanoma is increasing in South Tyrol, especially for in situ and thin lesions, but also for thick lesions; no reduction in median tumour thickness is observed. Rural areas and elevated altitudes may contribute to this effect.

Reconstructions of large surgical defects of the central part of the nose pose a challenge for the surgeon due to its cosmetically prominent location. Treatment options include second intention healing, full-thickness skin grafts and various local flaps. In the present case the "Peng flap" was used for the reconstruction of a 3.1 × 7 cm sized deep defect of the convex curve of the central nasal area in a 66-year-old woman. The Peng flap was performed as single-stage procedure without complications. Good cosmetic outcome was provided by the use of adjacent skin from the lax perinasal area, the placement of the scar lines between facial cosmetic units, and the excellent tissue match for the sebaceous nasal skin. Considering the few complications of a single-stage procedure associated with an excellent aesthetic outcome, the Peng flap should be considered not only as an effective choice for reconstruction of the cosmetically complex midline nasal tip but also the convex curve of the central nose.