Background: Management of facial skin cancer and its complications is important research topics needing continuous update to improve the outcome. Objective:The study is to share our findings with surgeons and healthcare providers.The authors provide their efforts by pooling data from multiple institutions; as reporting surgical outcomes is significantly lacking and much needed in the Middle East and North Africa region in order to meaningfully improve quality of care. This study proposes an algorithm for management that could aid a surgical decision-making for reconstruction of defects after excision of facial skin cancer. Methods:Retrograde simple descriptive analysis study is conducted for multicenter data about management of facial skin cancer and its cosmetic outcome. The analysis involves 159 male patients and 95 females.Results: Nonmelanoma skin cancer was reported in 250 (98.4%) of 254 cases.Reconstructive procedures were complicated in 16 cases (~6.3% of the study). Skin cancer recurrence in head and neck has happened in five cases (~1.9% of the study).Flaps used survived without major complications; however, V-Y advancement flaps showed the best aesthetic outcome. Conclusion:This study reports data in order to meaningfully improve the quality of care. Disease incidence, reconstructive complications, recurrences, and aesthetic outcome of facial skin cancer are included in the study. Based on the data pooling, the study proposes a simple treatment algorithm that could aid in surgical decisionmaking. V-Y advancement flaps showed the best aesthetic outcome. K E Y W O R D Saesthetic, algorithm, face, multicenters, skin cancer | INTRODUC TI ONSkin cancer is classified into melanoma and nonmelanoma types. 1,2 Incidence of each type varies according to a genetic, predisposing, 3 ethnic, or geographic factor. 4 In management of facial, scalp, and neck skin cancer, surgery always has a basic contribution. 5 Surgeons and dermatologists have many choices for the closure of the defects after excision, according to each lesion; site and size, patient age skin elasticity, in addition to individual experience and understanding of facial proportion. 6,7
Purpose: Objective and subjective evaluation of the results of flexor digitorum superficialis tendon transfer for the restoration of finger extension in irreparable radial nerve lesions. Methods: Restoration of finger extension, thumb extension, was done in 10 patients (seven with radial nerve and three with posterior interossius nerve injury; age range: 5-60 years). We used tendon transfer technique using the flexor digitorum superficialis (FDS) 3 [to extensor pollicis longus (EPL)] and FDS 4 [to extensor digitorum communis (EDC)] as donors for the reconstruction of fingers and thumb extension (all patients) and pronator teres (PT) for wrist extension. Results: Eight patients (out of 10) yielded 'Excellent to good' results: These patients showed marked improvement to the motor power scoring M4-M5 on the MRC grading system while 2 patients (out of 10) yielded 'Fair' results: Moderate improvement to the motor power scoring M3 on the MRC grading system. Conclusions: The FDS transfer provides thumb extension independent from the fingers and wrist extension, because the FDS control for each finger is independent from the other fingers.
Background: Wound coverage of exposed lower third tibia and ankle region remains a difficult task. Muscle flaps are preferred for infected wounds especially where there are exposed bone, joint and/or tendons.Patients and Methods: This study includes 60 patients with soft tissue defects at the distal third of leg. The study duration was from April 2014 to April 2016. Cases in this study were classified into two groups. Flap selection was random. Group (A) include 30 patients reconstructed by distally based peroneus brevis muscle flap. Group (B) include 30 patients reconstructed by distally based medial hemisoleus muscle. Routine investigations included full laboratory investigations and plain X-rays. Patients were operated under regional or general anesthesia. Flap was assessed daily and first dressing was done on day five of surgery. Patients were discharged once flap and split skin grafting were healthy on assessment after first dressing and subsequent dressings. Patients were followed up twice weekly for the first month and then once a month for six months.Results: Group (A): Mean age 41 year, 29 cases male and one case female. Site of the soft tissue defect: 14 case at the lateral malleolus, 2 cases at the medial malleolus, 9 cases for exposed tendoachillies, 4 cases at the anterior part of the ankle joint and one case at the peritibial part of the distal third leg. Size of the defect width rang from 3cm to 10cm and length rang from 3cm to 12cm. Splitting of the muscle was done for 7 patients to increase its width and 23 case non splitting. Complications: Only flap necrosis in one case need other procedure for reconstruction and complete successful in 29 case. Group (B): Mean age 41 year, 28 case male and 2 cases female. Site of the defect: 16 case at the medial malleolus and 14 cases at the peritibial part of distal third leg. Size of the defect width rang from 3cm to 7cm and length from 3cm to 10cm. Complication: Flap failure occurred in 11 case and complete successful in 19 cases. Conclusion:Local muscle flaps is areliable method for reconstruction of soft tissue defects at the distal third of the leg.
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