Angiosarcomas are rare neoplasms of the head and neck region accounting for less than 1% of malignancies. The median survival after diagnosis varies from eleven to twenty months. The authors present a case of angiosarcoma that was difficult to diagnose at initial presentation. After initial diagnosis and treatment, the patient developed regional metastasis (parotid gland/neck) at three months, femoral head metastasis at two and one-half years, and liver metastasis at five years. These occurrences were treated aggressively. The patient is now almost seven years postpresentation and apparently disease-free and working full time.
The optimal technique of minimally invasive coronary artery revascularization using the in situ internal thoracic artery (ITA), without extracorporeal circulation, is yet to be defined. To obtain adequate exposure for both ITA harvest and left anterior descending coronary artery anastomosis, an anterior chest wall defect is created which can be difficult to reconstruct. Based on the vascular anatomy of the acromiothoracic axis and three described osteocutaneous composite tissue flaps, we present a novel dissection that not only improves exposure, but also preserves chest wall integrity.
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