Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand?

Abstract

Summary: Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.

The Overwhelming Postsplenectomy Sepsis: Role of Plastic Surgeon

“…Dressings and autolytic or enzymatic debridement are essential for adequate wound healing. 11 Hyperbaric therapy, [12][13][14][15] as well as negative pressure wound therapy, [16][17][18] can be considered a supportive treatment. (See figure, Supplemental Digital Content 1, which shows an algorithm for the complementary role of surgical debridement and close observation, http://links.lww.com/PRSGO/C658.…”

“…After the acute phase, patients often recover with permanent sequelae and cosmetic implications, becoming of primary importance during the post healing period. The plastic surgeon allows for functional and aesthetic restoration of the injured parts using different surgical procedures such as DS, 18 skin grafts, autologous fat graft, [19][20][21] local flaps, 22 or free flaps. 23,24 In case 1, we used split-thickness skin grafts for coverage of skin defects of hands and feet.…”

Reconstruction of Complex Anterior Chest Wall Defects: The Lasagna Technique

“…In general, autologous bone-free flap is restricted by donor bone availability and surgical trauma. 17 , 18 Autologous tissues, such as bone grafts, have been proposed for sternal reconstruction with a significant rate of success, 19 , 20 but for smaller defects. For these reasons, we opted for titanium bars.…”

Secondary Autologous Fat Grafting for the Treatment of Chin Necrosis as a Consequence of Prone Position in COVID-19 Patients

“… 23 Compared with secondary-intention healing, skin flaps show several advantages, including faster healing, better cosmetic result, and fewer medications needed. 24 , 25 Nevertheless, patients affected by COVID-19 presented poor clinical condition and, therefore, conservative management of the wounds is generally suggested. Minimal and serial debridement with secondary-intention healing allows for saving vital tissue while waiting for a precise necrotic demarcation.…”