Abstract:Background:
Scalp reconstruction in cases of melanoma excision can be challenging due to specific functional and aesthetic outcome requirements. Reconstructive techniques reported in the literature were reviewed to establish whether a surgical algorithm for the management of melanoma of the scalp may be deduced.
Methods:
A literature search was conducted to evaluate reconstructive strategies after melanoma wide local excision of the scalp according to P… Show more
“…The treatment by DRT is recommended in the following cases: 1) elderly or extreme elderly patients which may present additional risk factor related to comorbidity [9,17,18] 2) in case of wide local excision (>4cm) [19][20][21] 3) in case of bone exposure resulting from the removal of the periosteum [8,9,22]; in this case it is recommended to drill the outer table to vascularize the DRT from the bone marrow [23] 4) in case of previous surgery with graft or flap failure or in case of recurrence of the neoplasm [9,24,25] 5) in case of previous radiation therapy (pre or postoperative irradiation at the surgical site) [26][27][28] 6) in patients with very aggressive cancer in which close postoperative clinical surveillance is deemed necessary. [17,21,24,27,29,30] There is also agreement among the authors that the use of the DRT is more economically advantageous than the cover with flaps [31] especially if the operated surface is greater than 120 square cm [23]. Some authors have proposed the use of the DRT with the one step technique without subsequent thin skin grafting, thus favoring healing by secondary intention [32].…”
Background:The incidence of scalp neoplasms is continuously increasing as a consequence of the progressive aging of the population. The need to perform a correct excision of scalp neoplasms often requires the removal of the entire skin, galeal and periosteum lining. The consequent complete uncovering of the thecal bone does not allow any type of local grafting and, in the past, has always involved the need to carry out the recovering using local or free flaps. The preparation of the local flaps generally involves large detachments of the scalp, which can cause severe complications of the haemorrhagic type, especially in elderly patients with anticoagulant or antiplatelet treatments. The realization of free flaps, on the other hand, involves a greater anesthetic effort and the creation of a further sacrifice in the donor site.
Methods:The introduction of Dermal Regeneration Templates made it possible to undertake repairing techniques for full-thickness lesions of the scalp with the simple aid of local anesthesia without the need to suspend antiplatelet treatments. The interventions based on the use of Dermal Regeneration Templates are not complex, however they require particular and simple measures which, if not applied, lead to not entirely satisfactory results. This work describes a method of using Dermal Regeneration Templates in the repair of full-thickness lesions of the scalp that follows a rigorous protocol as result of constant internal review.In particular, we identified three details leading to better results:• continuous Ford interlocking suture with "double pass" in the DRT;• tie-over compression fixed by sutures anchored approximately 5-8 mm externally to the margins of the main suture (8 points);• antibacterial ointment sealing.
Conclusions:In our opinion, a correct protocol concerning surgical techniques and dressing management allows the shortening of Dermal Regeneration Templates placing times from 6 to 4 weeks; better results in terms of percentage of area with good flourishness, less fluid collection under the Dermal Regeneration Templates and consequently the formation of a more homogeneous and better quality neoderm.
“…The treatment by DRT is recommended in the following cases: 1) elderly or extreme elderly patients which may present additional risk factor related to comorbidity [9,17,18] 2) in case of wide local excision (>4cm) [19][20][21] 3) in case of bone exposure resulting from the removal of the periosteum [8,9,22]; in this case it is recommended to drill the outer table to vascularize the DRT from the bone marrow [23] 4) in case of previous surgery with graft or flap failure or in case of recurrence of the neoplasm [9,24,25] 5) in case of previous radiation therapy (pre or postoperative irradiation at the surgical site) [26][27][28] 6) in patients with very aggressive cancer in which close postoperative clinical surveillance is deemed necessary. [17,21,24,27,29,30] There is also agreement among the authors that the use of the DRT is more economically advantageous than the cover with flaps [31] especially if the operated surface is greater than 120 square cm [23]. Some authors have proposed the use of the DRT with the one step technique without subsequent thin skin grafting, thus favoring healing by secondary intention [32].…”
Background:The incidence of scalp neoplasms is continuously increasing as a consequence of the progressive aging of the population. The need to perform a correct excision of scalp neoplasms often requires the removal of the entire skin, galeal and periosteum lining. The consequent complete uncovering of the thecal bone does not allow any type of local grafting and, in the past, has always involved the need to carry out the recovering using local or free flaps. The preparation of the local flaps generally involves large detachments of the scalp, which can cause severe complications of the haemorrhagic type, especially in elderly patients with anticoagulant or antiplatelet treatments. The realization of free flaps, on the other hand, involves a greater anesthetic effort and the creation of a further sacrifice in the donor site.
Methods:The introduction of Dermal Regeneration Templates made it possible to undertake repairing techniques for full-thickness lesions of the scalp with the simple aid of local anesthesia without the need to suspend antiplatelet treatments. The interventions based on the use of Dermal Regeneration Templates are not complex, however they require particular and simple measures which, if not applied, lead to not entirely satisfactory results. This work describes a method of using Dermal Regeneration Templates in the repair of full-thickness lesions of the scalp that follows a rigorous protocol as result of constant internal review.In particular, we identified three details leading to better results:• continuous Ford interlocking suture with "double pass" in the DRT;• tie-over compression fixed by sutures anchored approximately 5-8 mm externally to the margins of the main suture (8 points);• antibacterial ointment sealing.
Conclusions:In our opinion, a correct protocol concerning surgical techniques and dressing management allows the shortening of Dermal Regeneration Templates placing times from 6 to 4 weeks; better results in terms of percentage of area with good flourishness, less fluid collection under the Dermal Regeneration Templates and consequently the formation of a more homogeneous and better quality neoderm.
“…Wide local excision is the treatment of choice but the difficulty in case of scalp tumors is the defect closure which requires tissue flaps. 7 Even after transfer, it is not cosmetically aesthetic due to the lack of hair over the transplanted portion. 7 In case of bony and cerebral invasion, these tumors can present with emergencies like intracerebral or extracerebral bleed.…”
Section: Discussionmentioning
confidence: 99%
“…7 Even after transfer, it is not cosmetically aesthetic due to the lack of hair over the transplanted portion. 7 In case of bony and cerebral invasion, these tumors can present with emergencies like intracerebral or extracerebral bleed. Limited invasion of the brain parenchyma can be treated with excision but large lesions are often unresectable and are associated with morbidity.…”
Scalp soft tissue sarcomas (STS) are very rare accounting for less than 0.1% of all malignancies. We report a rare clinical image of advanced stage soft tissue sarcoma of the scalp. A 65 year woman had presented to the surgical department with complaints of a rapidly growing swelling over the scalp for three months. On examination there was huge 20 x 20 cm swelling over the scalp in the left temporoparietal region with variegated consistency. Computed tomography of head revealed a large soft tissue mass with necrosis invading the bone and underlying brain parenchyma. Histopathological finding from core needle biopsy revealed pleomorphic sarcoma. STS are highly malignant tumors which should be diagnosed and treated using multimodality approach. Recurrences are common even after complete resection and prognosis is poor.
“…Human melanoma is a fatal type of skin cancer and causes most skin cancer deaths. Only 20-30% of melanoma patients with visceral metastasis live beyond 5 years, and early detection with excision surgery is the sole reliable treatment of melanoma (Dind et al, 2021;Melo et al, 2021;Baldelli et al, 2020). Inflammation is important for maintaining homeostasis and monitoring stress signals that arise with tissue malfunction (Medzhitov, 2008).…”
The present study aimed to assess the effect of NO• on melanoma A375 cell growth and apoptotic cell death. Trypan blue exclusion assay was employed to detect the cytotoxicity induced by controlled steady-state concentrations (given in µM • min) of NO•. The characteristics of the cellular cell cycle and apoptosis in NO•-treated A375 cells were also analyzed by Annexin V/PI and DNA fragmentation assays. Western blotting was applied to detect the expression of apoptosis-related proteins (p53, Bax, Fas, DR5, caspase-3 and -9, and PARP). When exposed to preformed 100% NO• for 8 h reactor system, a cumulative dose of 3360 μM • min reduced the viability by 22% 24 h after treatment and promoted apoptosis, 2.9- and 12.2-folds 24 and 48 h after treatment higher than the argon control, respectively. Cell cycle analysis 48 h after treatment revealed S-phase arrest in cells treated with 3360 μM • min NO•. It was also observed that the expression of p53, DR5, caspase 9 and PARP increased significantly upon NO• treatment. In addition, the present study assessed the inhibitory effects of endogenous NO• on the proliferation of human melanoma cells by employing specific (AMG, 1400W and/or SMTC) and nonspecific (NMA) NO• synthase (NOS) inhibitors resulting in melanoma cell growth inhibition; the highest cytotoxic effect was seen when inducible NOS inhibition by 1 mM 1400W treatment. Collectively, the present data suggest that NO• is involved in a key mechanism limiting melanoma proliferation and apoptosis, which may play in improving the efficacy of melanoma treatment.
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