Facial epithesis on a budget. Still an option?

Cancer is regarded as the abnormal cellular multiplication; it is not controlled by the organism; and its cells present a differentiated DNA. Initially, the disease does not show clinical signs, but it can be diagnosed by laboratorial examinations. When tumors are present in the maxillofacial area, they can entail the loss of these area organs, which become responsible for the carrier's social environment exclusion. This paper aimed at showing, through a literature review, the cancers that more commonly happen in the face and the possibilities of regenerating in the patient mutilated through surgical reconstruction and prostheses.

Background: Basal cell carcinoma (BCC) stands as the prevailing form of malignancy, and its prevalence is on the rise. While BCC carries a minimal risk of mortality, it can induce notable morbidity, chiefly due to localized damage. The incidence of BCC increases significantly after the age of 40 years, especially in women who are caused by exposure to ultraviolet (UV) rays. There are a variety of surgical and non-surgical treatments for BCC. In general, surgical methods are used more frequently because of their higher cure rates. We are reporting a case of pigmented basal cell carcinoma in an old Asian man who was treated with surgical excision with wound reconstruction using flap surgery. Case Report: A 70-year-old man sought consultation at the Dermatology and Venereology outpatient clinic of Dr. Soetomo Regional Public Hospital. His main complaint was a wound on his forehead from two years ago. Initially, it appeared as a small lump with skin color. Over time, the lump got bigger and then turned into a wound that got wider. He also felt pain and itchy on the wound. For the past year, the wound had become easily bleeding. Dermatological examination revealed an ulcer with a clean base, not sharply marginated, asymmetry, and a size of 1,8 x 1,6 cm, with a rolled-up margin and an elevated edge. There was a translucent hyperpigmented nodule on the edges and a sign of bleeding in the center of the ulcer. A dermoscopy examination showed a blue-gray ovoid nest, shiny white structureless area, arborizing vessels, and ulceration. Histopathological results from both biopsies showed the proliferation of anaplastic basal cells was a monotonous rounded nucleus, coarse chromatin, several prominent nuclei, and narrow cytoplasm to moderately that partially contained melanin. The patient was diagnosed with Pigmented BCC. The treatment plan was to use surgical excision with advancement flap reconstruction. Postoperative lesions showed improvement and healed after three weeks post-surgery. Conclusion: The management of BCC is determined based on the anatomical location and histological features. Widely used therapeutic approaches such as standard excision surgery or other invasive methods are significant therapeutic options.

Lip cancer corresponds to 25-35% of all oral cancers. Squamous cell carcinoma is the most common histological type in this location (95%). Various wound reconstruction options are described for the exeresis of this type of tumor in the lower lip – the choice depending on the surgeon’s experience and the proportion of the final defect regarding the dimensions of the lip. The present article describes the case of a male patient with a wound in the lower lip that was histologically diagnosed as an invasive squamous cell carcinoma. Mohs surgery was implemented and a transposition flap (Abbe flap) was used in the reconstruction of the upper lip. The complete opening of the mouth, without functional impairment of the speech or chewing function, and a favorable aesthetic result, were observed in the follow-up, thus demonstrating the usefulness of this type of reconstruction.

Hidradenitis suppurativa is a chronic inflammatory dermatologic condition occurring most commonly in areas with large numbers of apocrine sweat glands. Surgical excision and wound reconstruction are indicated for severe or refractory disease. This study aims to explore institutional reconstructive outcomes following hidradenitis suppurativa excision and compare these to the nationally recognized Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database to determine best-practice guidelines. A retrospective chart review of all patients with surgically treated hidradenitis suppurativa from January of 2004 to January of 2016 was performed. Data on patient characteristics, reconstructive methods, and outcomes were collected. Outcomes for each reconstructive method were analyzed and associations between reconstruction and complications were determined. These results were compared to TOPS data. A total of 382 operative sites for 101 individual patients were reviewed. Overall complication rates were 80, 68.3, and 59.6 percent for simple, intermediate, and complex closure, respectively; 68.3 percent for adjacent soft-tissue rearrangement; and 100 percent for split-thickness skin grafts and perforator flaps. Statistical significance was identified between superficial wound dehiscence and adjacent tissue rearrangement compared to intermediate and complex closure (p = 0.0132). TOPS data revealed similar wound breakdown rates for primary closure methods but much lower rates with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. Primary closure techniques for hidradenitis suppurativa wound reconstruction possess high complication rates, whereas improved outcomes are observed with negative-pressure wound therapy, split-thickness skin grafts, and muscle flaps. The correlation in outcomes between our experience and that reported in the TOPS database provides a level of validation to this national database.

Infection of the subcutis and skin of cats with rapidly growing mycobacteria: a review of microbiological and clinical findings

Surgical Experience With Genital and Perineal Extramammary Paget's Disease

Background: Burns are uncommon in small animal surgery routine and represents a real therapeutic challenge. Skin can be affect in different degrees of deepness as superfcial, partial thickness, full thickness and full thickness affecting underlying tissues. Each degree has individual features. Progression through degrees can occur in the frst 24 h or if treatment is inadequate. This paper aims to describe therapeutic approach and surgical technique to treat a huge dorsal iatrogenic thermal burn injury. Case: A 4-year-old female German Shepard was referred to veterinary hospital after 11 days of elective ovariosalpingohisterectomy. The patient presented a severe skin injury with crusts, eschars, purulent discharge and myiasis on dorsal cervical, thoracic and lumbar region. Beside severity of the wound, animal present good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. Histopathologic analysis of a wound tissue sample revealed the presence of coagulation necrosis and inflammatory response. The absence of traumatic events, histopathologic result and wound features increased suspicious of an iatrogenic burn injury from a poorly regulated thermal mattress used during surgical intervention. “Rule of Nines” was estimated as 25% of total body surface area. Systemic antibiotics and topical treatment with 0.05% chlorhexidine digluconate and 2.5% silver sulfadiazine ointment followed by wet-wet bandage was performed after initial surgical debridement. Muscle and vertebral bone explosion were evident. Topical treatment with Silver Sulfadiazine and chlorhexidine persisted twice daily until granulation tissue formation. Pain killers and sedation were often necessary during bandage changes. At 65th day proceeded to en bloc excision of scar tissue and surgical reconstruction with skin advancement and recruitment technique. Tie-over dressing was applied to cover the fnal wound. After 14 days animal received hospital discharge, and was assessed bi-weekly for 60 days. Discussion: Besides great extension of the burn injury, patient’s age, absence of systemic involvement and fluid therapy or critical care the prognosis was good. Modifed “rule of nine” are used to estimate wound size in dogs. The wound was classifed as forth degree or full thickness injury due to exposed muscular layer and bone. Early debridement, standard topical and systemic treatment protocol applied granted good recovery of wound bed. Due to be uncommon in small animal routine, main diagnosis and therapeutic recommendations for veterinary patients are based on human data. Systemic antimicrobial drugs are usually not recommended due to low concentration in burned tissues, however, prophylactic use was necessary due to highly infected tissues and possible bacterial absorption from devitalized tissues. Delayed primary closure technique was necessary due to highly infection site and extension, which turns surgical approach hard to perform. After formation of a granulation tissue bed for wound reconstruction, surgical treatment was performed. Surgical reconstruction is indicated in large full thickness defects and for better cosmetic appearance. The correct use and regulation of thermal mattress can avoid burns that can be life threatening. This case report rises the important concept that even low contact temperatures when persistent for long time can cause burn injuries. Keywords: thermal, mattress, injury, dogs, plastic.

Introduction: Facial asymmetry has been one of the important themes in jaw deformities.The course of treatment for jaw deformities is usually decided in response to cephalometrical analysis, but it is difficult to suspect the movement of soft tissue after surgery. In this paper, asymmetry, caused by the buccal lipoma discovered postoperatively, is discussed.Case: A seventeen-year-old female visited Hamamatsu University Hospital in 1991 with maxillary retrusion, mandibular protrusion, and facial asymmetry diagnosed cephalometrically. After preoperative orthodontic treatment, Le Fort I osteotomy and ramus sagital split osteotomy were carried out in September 1993. After surgery the cephalometrical asymmetry was improved, but her cheek remained swollen. The excess tissues of the cheek, especially the right buccal fat pad, was thought to be the cause because there were no other abnormal findings such as induration. Then the buccal fat pad was partially removed when the miniplates were removed. However, the facial asymmetry of soft tissue was not improved. After taking a CT and an MRI, the right buccal lipoma with capsule was found. In March 1996, the lipoma was resected, and as a result, her facial asymmetry was corrected.Discussion: Facial asymmetry is caused by hard tissue and/or soft tissue. In consideration of the incidence of asymmetry among the jaw deformities and the incidence of lipoma in the maxillofacial area, such as this case, soft tissue tumors such as lipoma are thought to be possible causes of facial asymmetry. When evaluating facial asymmetry, especially in cases of facial asymmetry of soft tissue remaining postoperatively, an image diagnosis such as a CT or an MRI should be utilized.Conclusion: Since soft tissue tumors such as lipoma are possible causes of facial asymmetry, facial asymmetry should be examined carefully.

Most conflict injuries affect the limbs. Appropriate immediate treatment of these injuries and initiation of damage control principles saves lives and optimizes recovery, rehabilitation, and long-term function. Immediate formal surgical stabilization and reconstruction of wartime limb injuries is often limited by patient medical status and restrictions of resources, so rudimentary techniques like splinting, traction, and external fixation play a significant role in the initial stabilisation and management of these cases. Experience with these provisional techniques must be acquired by surgeons planning to work in conflict environments.

Two new mixed-chelate dinuclear copper(II) complexes, [Cu2(tmen)2(TAP)]X2 where tmen = N,N,N′,N′-tetramethylethylenediamine, TAP = tetraacetylpropane, and X = or , were prepared and characterized by physicochemical and spectral (IR, UV–vis) data. The X-ray diffraction study of [{Cu(tmen)(CH3CN)}{Cu(tmen)(ClO4)}(TAP)](ClO4) demonstrated that coordination geometry around the copper centers is square pyramidal where axial position of one copper is occupied by a ClO4 − and the second copper with acetonitrile. However, in solution, the resulting complexes display affinity for axial ligation so that the apical ligands are driven out by solvent molecules. The solvatochromism of the complexes was investigated in various organic solvents and was compared with that of the corresponding mononuclear complex [Cu(tmen)(CH3-acac)]ClO4. A multi-parametric equation has been utilized to explain the solvent effect on the d–d transition of the complexes using SPSS/PC software. To explore the mechanism of the interaction between the solvent molecules and the complexes, different solvent parameters such as DN, AN, α, E T(30), π ∗, and β using stepwise multiple linear regression method were employed. In pyridine, the original color of the solution changed over time due to removal of tmen chelates and substitution by pyridine in two successive steps.

A thorough documentation of a patient’s medical history
\nis widely recognised as providing good indicators of potential intraoperative and postoperative complications. As preoperative assessment can be time consuming, computerbased Information Collection Systems (ICS) can help free up precious and limited resources, leaving clinicians with more time to fulfil their primary mission of administrating medical care. In addition, medical histories collected by ICSs have proved to be more accurate than traditional pen-and-paper questionnaires or face-to-face interviews.
\nA challenge remains however in designing questionnaires
\nwhich are general enough to suit a majority of patients,
\nwhile at the same time, being able to capture critical individual information. In this paper, we propose a solution
\nto this dilemma with a context-sensitive adaptive information collection system. The proposed method permits to iteratively capture finer-grained information with each successive step, should this information be relevant according to a questionnaire ontology. We argue that the method is robust, scalable and highly configurable. It results in questionnaires which are coherent and well structured and are able to capture enhanced patients’ medical histories.

Most of the Italian school buildings were not designed according to seismic criteria and, therefore, they are vulnerable from a seismic point of view. A clear proof of this was the catastrophic collapse of the school at San Giuliano during the October 2002 earthquake: thirty people died, of which twenty seven were young students and one their teacher. After this seismic event, the process for identifying the most seismically vulnerable school buildings was started in Italy, with the final aim of improving their strength. Furthermore, several school buildings, mainly located in the historical town centre were damaged during the recent seismic event of L’Aquila (April 6, 2009), as reported by Salvatore et al. (Rapporto dei danni provocati dall’evento sismico del 6 aprile sugli edifici scolastici del centro storico de L’Aquila, http://www.reluis.it). The proposed research work was driven by the idea of defining a methodology that implements an analysis in successive steps with an increasing level of detail. Only the buildings with seismic risk higher than a given threshold go through to the following phase, so that the number of buildings analysed decreases at each phase. The implemented procedure follows some well known works published in literature (Grant et al. 2007; Crowley et al. 2008). The definition of a prioritisation scheme of intervention is strictly due to the high number of school buildings (almost 50000) that cannot be deeply analysed considering the limited resources available. The school building location, the exposure data and seismic input information are implemented in a WebGIS platform through interactive maps and tabs. By means of the developed WebGIS tools, the seismic risk analyses of the school buildings are performed and the obtained results, in terms of maps and tables, are herein presented.

Background: Breast cancer patients who receive radiotherapy for postoperative tumor control are exposed to the possibility of adverse effects including osteoradionecrosis and ulceration. The purpose of this study is to explore reconstruction of ulcers according to their characteristics, and also to investigate the incidence of skin ulcers in patients who had undergone radiotherapy after modified radical mastectomy (MRM).Methods: Data of patients who underwent radiation therapy after MRM from 1979 to 2003 were collected. Demographics and radiation details were analyzed along with their reconstruction outcomes and pathologic characteristics. Effects of surgical debridement and reconstruction strategies for success were also assessed.Results: A total of 113 patients had radiotherapy after MRM in our institution, out of which nine patients (7.96%) developed ulcerations in the chest wall. Eleven patients underwent reconstructive surgery, including the nine patients who developed chest wall ulcerations and an additional two patients from other hospitals. Seven patients had thoracoepigastric flaps while three had latissimus dorsi musculocutaneous flaps and one had a perforator flap. The average initial wound size was 5.77 cm<sup>2</sup>, and this average was enlarged by 23.6 times after debridement. There was no reconstructive failure in any of the patients. Fibrosis, necrosis with ulceration, and dystrophic calcification were common pathological findings. Dystrophic calcification was found in seven of 11 cases. Additionally, ossification with bone formation was noted in three of seven cases with dystrophic calcification.Conclusion: A thorough preparation of the wound bed and reconstruction with flaps appropriate for the defect can successfully treat chronic radiation-induced ulceration.

Sternal wound infection after heart transplantation: incidence and results with aggressive surgical treatment

End-stage heart failure is a growing problem associated with high mortality, using conventional medical care.1 Although heart transplantation remains the gold standard therapy for end-stage heart failure, it is a limited resource that is not applicable to a large portion of heart failure patients, particularly the elderly. An alternative strategy for patients who do not meet standard heart transplantation criteria is destination therapy with left ventricular assist device (LVAD) implantation.2 The implantation of nonpulsatile, continuous-flow LVADs has become a relatively routine procedure in large surgical centers that is associated with a relatively low complication rate.3 However, cannulation for LVAD implantation is occasionally challenging. In particular, patients who have undergone a LV restoration and patch volume reduction plasty (ie, “Dor procedure”)4 pose a particular challenge. We describe a favorable 1-year outcome for a severely symptomatic patient with chronic ischemic heart failure and a large LV aneurysm treated by a Dor procedure and simultaneous LVAD implantation. ### Patient Presentation A 52-year-old patient with ischemic heart failure was referred to our institution for further therapy and possible evaluation for heart transplantation. His medical history was pertinent for heart failure and multiple stenting of the left anterior descending artery. The …