AbstractIt is unusual to find a giant invasive basal cell carcinoma in the occipital region of the head. We are presenting a case of basal cell carcinoma invading and eroding occipital bone, managed with an unusual scalp reconstruction method. A 69-year-old female presented with a 16x19 cm diameter tumour in the occipital region. Preoperative biopsy revealed a basal cell carcinoma. A complete surgical excision of the tumour was performed in one-step surgery and tissue defect was reconstructed by a pedicle latissimus dorsi musculocutaneous flap. Our case shows that this distant pedicle flap is safe and reliable, and should be revised as the option for the occipital region reconstruction.
Successful single-vessel arteriovenous replantation of a completely amputated human ear is described. This result was followed by an experimental study using a rabbit model, to confirm that an amputated ear could survive replantation with only a single arteriovenous anastomosis. Fifteen animals were placed in one of two experimental groups: Group 1-arteriovenous replantation, no treatment (n = 6); and Group 2-arteriovenous replantation with medicinal leeching (n = 9). All ears demonstrated initial reperfusion of the replantation immediately following microanastomosis. Laser Doppler flow readings in the non-leeched replanted ears fell to zero by 8 hr and, by 12 hr, the non-leeched ears demonstrated signs of necrosis. All the leeched, replanted ears demonstrated perfusion and complete viability at the time of sacrifice. The case report, combined with the results from the experimental study, confirm that single-vessel arteriovenous replantation of an amputated ear is feasible.
Successful management of shotgun-blast injuries to the face with loss of composite tissue is discussed. While emphasis in the literature has generally been on weapons ballistics and their destructive effect on tissues, the most massive tissue destruction can be anticipated from close-range gun-barrel effects due to rapidly expanding gases. The authors stress uncommonly aggressive tissue transfer as the method of choice in reconstructing facial shotgun wounds. The surgeon must evaluate patient psychological readiness for step-by-step reconstruction. Fistulas are avoided by transplanting several small flaps, rather than one large flap. The dorsalis pedis flap is recommended as an excellent choice for contaminated intraoral reconstruction. A staged approach providing osteocutaneous composite tissue for repair of shotgun-blast facial wounds is presented. At subsequent stages, soft tissue defects are repaired and restoration of mandibular continuity is provided with the use of the scapular flap and other alternatives. Microsurgical management of facial gunshot wounds can provide satisfactory reconstruction and almost normal function.
Three male patients, each receiving microvascular tissue transfer of the second toe to the thumb of their dominant hand, underwent a formal program of sensory reeducation immediately following the transfer. A high degree of functional sensation is reported.
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