Melanoma is a malignant tumor that originates from the melanocytes, primarily involving the skin. Its incidence is rising worldwide in the white population, especially in those areas where fair-skinned peoples receive excessive sun exposure. 1 The incidence of cutaneous melanoma has increased at rapid rate during the last 50 years, much higher than any other cancer in the world, with an estimated 91 270 new cases in 2018 only in the United States. 2 Such alarming epidemiological data show that melanoma is a major public health problem and it requires further attention.The principal clinical and histological melanomas' subtypes are as follows: superficial spreading melanoma, lentigo maligna melanoma, nodular melanoma, and acral lentiginous melanoma (ALM). 1 Despite being the least common of the four major subtypes, it has been reported that 7% of all cutaneous melanomas are located at acral
Implant-based breast reconstruction is part of breast cancer treatment, and increasingly optimized reconstructive procedures exploit highly biocompatible materials to ensure enhanced aesthetic-functional results. Acellular dermal matrices (ADMs) are collagen-based materials that made prepectoral implant placement possible, thanks to their bioactive antifibrosis action. Recently, the first three-dimensional ADM, BRAXON®Fast, has been produced. Its 3D design represents the technological evolution of BRAXON® ADM, a flat collagen matrix, and allows for a time-saving complete wrapping of the synthetic prosthesis, thus creating a total biological interface on the implant with patient's tissues. Here, we report our experience on the first 23 eligible patients who received BRAXON®Fast-assisted prepectoral reconstruction. On a total of 27 breasts, the overall complication rate was 11.1%, including one minor seroma (3.7%), one case of necrosis (3.7%), and one implant removal due to infection. As new-generation devices, 3D ADMs showed an effective performance, allowing to reduce the overall exposure time for implant preparation and providing an optimal safety profile.
Nowadays silicone is a widespread material for medical devices. In particular, it is commonly used for implants manufacturing, for that patients undergoing breast augmentation or breast reconstruction after mastectomy. However, the use of silicone implants is not free from risks. Ruptures of silicone breast implants are uncommon, in general post-traumatic or iatrogenic, and usually related to implant’s wall weakness of unknown origin but probably due to biochemical reactions that cause wall rupture. As a consequence of a rupture, silicone gel from damaged implants may have a continuity migration to the chest wall, axillae, and upper extremities, resulting in granulomatous inflammation or siliconoma, or a lymphatic migration to axillary lymph nodes. In this regard, silicone thoracic migration is extremely rare, and nowadays a leakage is unlikely to happen with more modern cohesive silicone gel implants. Nevertheless, procedures such as thoracic surgery and thoracotomies may be responsible for accidental breast implant rupture, capsular discontinuity, and eventually intrathoracic silicone migration, especially when dealing with older generations of breast implants. We report a rare case of a 75-year-old woman presenting with pleural silicone effusion, 18 years after a right breast reconstruction for breast cancer, followed by right upper lobe resection for a lung carcinoma. A combination of muscular flap and DTI pre-pectoral breast reconstruction with biological membrane (ADM) has been used for treatment. Literature was reviewed for cases of breast implants free silicone localization in the chest cavity, focusing on previous surgeries, anamnestic relevances, and surgical management.Level of Evidence: Level V, risk/prognostic study.
Late hematoma associated with breast implants used in esthetic and reconstructive breast surgery represents a rare entity. These hematomas do not have a clear etiology, but triggering events like trauma, anticoagulant use, capsule contracture, or chronic inflammation are reported in literature. We describe an 82-year-old patient who developed a unilateral intra-capsular hematoma 19 years after mastectomy and breast reconstruction with McGhan 445 g implant. Differential diagnosis with anaplastic large cell lymphoma (ALCL) was considered and potential causes of hematoma were evaluated. Constant pressure forces on chest wall were defined as pathophysiological cause. A systematic literature review concerning late hematoma cases was carried out, focusing on late hematoma etiology and various surgical treatments.Level of evidence: Level V, diagnostic study.
Introduction and aim. Gas gangrene is usually related to a trauma and can involve different districts of the body. It is a life-threatening condition, and its consequences lead to functional and aesthetical deficit. Atraumatic gas gangrene is a rare event, sometimes related to a Clostridium septicum (C. septicum) bacteremia. Aim of this article is to discuss existing literature about relation between colon adenocarcinoma and Clostridia infections, integrating with a case-report. Patients and methods. A 54-year-old obese female patient developed an atraumatic gas gangrene of the posterior trunk, started from a C. septicum bacteremia. Gas gangrene involved skin, soft tissues and muscles of the back. A multidisciplinary clinical and surgical management involved anesthesiologists, general and plastic surgeons. During hospitalization, an occult colon adenocarcinoma was diagnosed and recognized as the bacteremia trigger, and it was successfully addressed. The gangrene was properly treated with seriate surgical debridement and final soft tissue coverage. After a long hospital stay, the patient was discharged in stable clinical conditions. Results and conclusions. C. septicum gas gangrene remains one of the most fearful infections. An early diagnosis and a prompt antibiotic and surgical treatment, with life supportive care, are mandatory to avoid the necrotizing fasciitis spreading and the death of the patient. However, due to the rarity and variability of this condition, there is no standardized protocol for its treatment. Since a strong relation between C. septicum infection and colon malignancy is reported in literature, in cases of C. septicum bacteremia it should be mandatory to investigate gastrointestinal tract to exclude colon malignancy.
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