Skin Necrosis Research Articles

Impact of the Prepectoral Breast Reconstruction Assessment Score on Expander-Based Reconstruction Success

Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m2. ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation.

Continuous debridement combined with short-term posaconazole therapy for cutaneous mucormycosis caused by Rhizopus oryzae infection secondary to acute myeloid leukemia: a case report

Cutaneous mucormycosis is a rare fungal infection marked by skin abscesses, swelling, necrosis, dry ulcers, and eschars. Though less fatal compared to other mucormycosis forms, delayed diagnosis and treatment in immunocompromised patients can cause the infection to spread to vital organs, becoming life-threatening. We report a case of lower extremity cutaneous mucormycosis secondary to acute myeloid leukemia, successfully managed with sustained surgical debridement and short-term oral posaconazole. This case highlights the effectiveness of surgical debridement and the potential for short-course antifungal therapy in managing cutaneous mucormycosis.

The Extended Corset with Bra Strap: Refinements in the Corset Trunkplasty Technique.

The corset trunkplasty was introduced by Moya et al. in 2009 (Moya and Sharma inJPRAS 62:56-64, 2009). It is a modified abdominoplasty technique that combines vertical and high lateral incisions to achieve an hourglass shape in post-massive weight loss patients. Like the traditional fleur-de-lis abdominoplasty (Dellon in Aesth Plast Surg 9:27-32, 1985) it results in a midline scar, as well as additional transverse breast fold scars, however the lack of tissue undermining reduces the risk of skin necrosis and wound-healing problems. Since its original description, it has been promoted as a practical, cost- and time-efficient procedure in the massive weight loss patient population (Loh et al. in J Plast Reconstr Aesthet Surg 74:2303-2310, 2021). The senior author (PM), has performed 43 extended corset trunkplasties since 2018. Drawbacks of the original technique include migration of the midline scar over time, stretch and enlargement of the umbilicus giving an unnatural appearance, high, unsightly lateral scars, upper back skin redundancy relative to the anterior skin tightening, and persistence of tissue excess in the flanks and lower back. Over time, the senior author has refined his technique to overcome these post-operative complications and thus improve overall aesthetic appearance and patient satisfaction.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparative Efficacy of Classic Versus Horizontal Incision Techniques in Skin-Reducing Mastectomy: A Single Center Retrospective Analysis.

Background: The reconstruction of large breasts carries a heightened risk profile. While skin-reducing mastectomy (SRM) techniques facilitate the correction of breast ptosis, they are frequently associated with a high incidence of vascular complications. This study compares two SRM techniques-the horizontal incision and the classic inverted T incision-by examining their clinical and surgical outcomes. Methods: We retrospectively analyzed data from 24 patients (30 breasts) who underwent SRM with immediate prosthetic reconstruction between 2019 and 2023 at the European Institute of Oncology in Milan, Italy. Our comparison focused on breast aesthetic outcome, reconstruction quality, complication rates (early and late), and patient satisfaction, utilizing the BREAST-Q questionnaire to gauge the latter. Results: Among the 24 patients included in the study, 16 (20 breasts) were treated with the inverted T technique, and 8 (10 breasts) with the horizontal incision approach. A higher overall complication rate was observed with the inverted T technique compared to the horizontal method, with early complications outnumbering late ones. The most common issues were recurrent seroma and skin necrosis leading to implant exposure. Notably, there were no cases of implant infection. Although the horizontal incision technique achieved slightly higher patient satisfaction scores, the difference was not statistically significant. Discussion: The inverted T and horizontal incision techniques each have unique benefits and drawbacks. Our findings indicate enhanced patient satisfaction and reduced complication rates with the horizontal incision technique. The selection of the technique should be customized based on the patient's individual risk factors, tissue quality, and preferences.

Pathological and Fungal Isolation study of dog skin disease in Iraq Governorates

Dogs are susceptible to several types of infectious diseases can be worrisome for their owner because some of them are fatal if not treated soon enough. Fungal infection can be contracted through different parts of body furthermore many of them are zoonotic infection among human and dogs the signs of any disease typical depend on location of infection either local or system infection. Local infection usually involves skin surface that look like wound the objective of this study was to briefly about the most common pathogenic fungal infection in dogs by describing information about the causative agent, clinical signs and grossly appearance with histopathological change skin examination current study were done on 200 dogs collected in Iraq governorates (Baghdad, Erbil, Anbar, Sulaymaniyah) during a period 6 months (January – June) 2023. 200 examined dogs with different age, breed and sex ( k9, ornamental and stray dogs ) were observed fungal isolation and pathological examination with clinical signs by using diagnostic tools for skin biopsies (biopsy punch) from suspected infected skin dogs. Results showed pathogenic fungi after collected on fungal culture for detection pathogenic fungal (Dermatophyte Test Agar) D.T.M Agar Base. Fungal isolation constitutes the following pathogenic fungi (100 infected samples from 200 suspected samples). 60% Aspergillus niger, 30% Trichophyton Verrucosum, 10% Alternaria spp. Clinical signs and grossly lesion showed complete skin ulcer, allopecia, odema, abscessation while microscopic appearance revealed skin ulcer, hyperkeratosis, folliculitis, necrosis, apoptosis, pyogranuloma and granulation tissue with septate hyphae in skin dermis and epidermis which infected with Aspergillus niger.

Neck Lift to Treat Platysma Bands and Defining Cervical Angle: A Systematic Review and Pooled Analysis.

Many surgical techniques have been proposed to address the submental-cervical angle in neck lift. Despite the several advances, obstacles persist when dealing with platysma bands and redefinition of the obtuse cervical angle. The aim of this study was to quantify platysma bands recurrence, any neurovascular damage, and other complications following neck lift procedures involving platysma muscle. After the approval and registration on the International Prospective Register of Systematic Reviews (PROSPERO), the systematic review was performed in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A series of specific keywords and predefined MeSH terms were utilized in different search engines (Medline, PubMed, Google Scholar, and the Cochrane library databases). Primary outcome was the recurrence of platysma bands; secondary outcomes included any postoperative complications, including any nerve damage. Pooled analysis was performed using a random effects model. Twelve articles, encompassing 2,106 patients, were relevant to this issue and included data on neck lift surgery with any platysma transection outcomes. Twenty-six patients had a recurrence of platysma bands during the follow-up, with a pooled rate of 1.4%. The pooled overall nerve damage rate was 0.9%. At the reported follow-up, the pooled hematoma percentage was 1.8%, and the pooled sialoma rate was 0.3%. Even less common complications were long-lasting edema, dehiscence of the submental suspension, and skin necrosis. Cervicomental angle redefinition remains a controversial and complicated procedure, which can be approached with different maneuvers. However, more long-term outcome reports as well as standardized complication outcomes are warranted in order to compare different and new techniques. LEVEL OF EVIDENCE: III.

Giant uterine fibroid with phlegmona of the anterior abdominal wall

This report presents a rare case of giant uterine fibroids in a 52-year-old patient, which was complicated by phlegmon of the anterior abdominal wall. Physical examination revealed skin necrosis above the navel, measuring 12×10 cm, with purulent content. On palpation, a space-occupying formation reaching the xiphoid process was noted, indicating an abdominal distension. The patient underwent surgery as planned; a suppurated section of the anterior abdominal wall, extending to the aponeurosis, was placed on the operating table. An inferomedial laparotomy with excision of a necrotic, suppurating area of the anterior abdominal wall was performed. Furthermore, a mass in the abdominal cavity was removed using a blunt and sharp method, and extirpation of the uterus and appendages was conducted. Histological examination revealed a giant uterine leiomyoma with stromal hyalinosis and omentitis. The patient was discharged on postoperative day 10 in satisfactory condition. No complications were observed during the postoperative period. Advanced uterine fibroids are common, and ignoring the need to undergo regular medical examinations and insufficient medical examination coverage can lead to such complications, which can significantly affect the quality of life of patients.

Pre-procedural Topical Antisepsis in the Neonate: A Systematic Review Evaluating Risk Factors for Skin Injury.

Pre-procedural antisepsis is a critical component of hospital-acquired infection prevention in the neonatal intensive care unit (NICU). However, broadly utilized topical antiseptic agents pose an elevated risk of disruption to neonatal skin integrity, and evidence-based guidelines are lacking. This systematic review of the literature sought to assess and characterize the predisposing risk factors for and types of neonatal skin injury from topical antiseptic agents. A systematic search of Medline Ovid, Embase, Web of Science, CINAHL, and Cochrane Library was conducted, including academic literature providing data on neonatal skin injuries related to topical antisepsis in the NICU. A total of 19 articles (99 patients) met the inclusion criteria. Of the available data, most reported skin injuries were described in extremely preterm (98.1%) and very low birth weight (98.4%) infants. The majority of reported adverse cutaneous events were attributed to chlorhexidine preparations (74.8%), followed by octenidine (18.2%), povidone-iodine (6.1%), and isopropyl alcohol (2.0%). Erythema (40.1%), skin breakdown (23.4%), and chemical burns (17.5%) were the skin reactions reported most frequently, followed by skin irritation (8.3%), and skin necrosis (2.8%). Our findings indicate that both extremely preterm and very low birth weight infants are particularly susceptible to skin toxicities from pre-procedural antiseptic preparations. These data underscore the need for future research to support the development of guidelines which minimize iatrogenic cutaneous injuries in the neonatal population, specifically for the care of infants under 2 months of age, for whom current recommendations are lacking due to a paucity of data.

Computed tomographic features of Morel-Lavallée lesions in 3 cats.

To describe the CT features of Morel-Lavallée lesions (MLLs) and their association with trauma in cats. This study aimed to investigate whether MLL fluid in cats accumulates between the dermis and deep fascia near superficial trauma, exhibits a vertical attenuation gradient, and shows no or only mild contrast enhancement on CT images. 3 young cats: a 1-year-old neutered male domestic shorthair cat, a 2-year-old neutered male domestic shorthair cat, and a 3-year-old neutered female British Shorthair cat. The clinical presentation of the 3 cats in the study involved recurrent swelling and fluid accumulation affecting at least 1 pelvic limb following trauma. In all cases, there was a fluid-filled space deep to the skin and superficial subcutaneous layer but superficial to the deep fascial plane overlying the muscular component of the pelvic limbs. The MLL fluid had a vertical attenuation gradient and no or only mild contrast enhancement. Morel-Lavallée lesions are often initially overlooked, likely due to distraction by concomitant significant bone injuries, and can be mistaken for hematomas, seromas, subcutaneous edema, contusions, or cellulitis, leading to less aggressive treatment. If left untreated, MLLs present a significant risk of extensive skin necrosis compared to other types of subcutaneous swelling.

Incisional Management in the Multiply Operated Total Knee Arthroplasty

Total knee arthroplasty in the setting of multiple previous skin incisions can be a complex clinical scenario for the arthroplasty surgeon. Inappropriate incision choice can lead to devastating complications such as skin necrosis and its sequelae, including periprosthetic joint infection and the need for flap reconstruction. It is therefore critical for knee surgeons to understand the blood supply to the anterior aspect of the knee to prevent adverse outcomes. This article challenges some of the long-held dogma regarding incisional management for total knee arthroplasty and utilizes case examples to demonstrate that skin necrosis between parallel incisions can be avoided by utilizing an existing lateral incision with full-thickness subfascial skin flaps.

Factor associated with postoperative complications of inguinal lymph node dissection for penile cancer Test

Background: Inguinal lymph node dissection (ILND) is the standard of care for palpable, biopsy-proven lymph node metastases or high-risk groups for nonpalpable lymph nodes in the treatment of penile cancer. ILND is associated with a significant incidence of complications and adverse events, specifically wound complications. Few studies have identified risk factors related to postoperative ILND complications. Objective: The objective of this study was to assess the prevalence of 30-day postoperative complications and to identify risk factors associated with postoperative complications of ILND for penile cancer. Materials and Methods: This was a retrospective review of medical records for all patients who had ILND for penile cancer between January 2012 and December 2022. According to the modified Clavien–Dindo classification, the 30-day postoperative complications were collected. Using an ordinal univariate logistic regression model and multivariate analysis, potential risk variables for complications were determined. Results: A total of 60 patients were performed ILND. Sixty percent of the patients had a postoperative complication including wound infection 50%, wound dehiscence 36.7%, skin necrosis 26.6%, lymphocele 33.3%, leg edema 46.7%, and scrotal edema 16.7%. Higher grade of modified Clavien–Dindo classification was associated with body mass index (BMI) (odds ratio [OR] = 1.15; P = 0.03), diabetes mellitus (OR = 3.13; P = 0.04), American Society of Anesthesiologist classification ≥3 (OR = 1.14; P = 0.03), radical ILND (OR = 1.57; P = 0.01), and bilateral ILND (OR = 1.60; P = 0.02). In multivariate analysis, a higher grade of modified Clavien–Dindo classification was correlated with BMI (OR = 1.48; P = 0.01) and bilateral ILND (OR = 4.56; P = 0.01). Conclusion: ILND is associated with high rates of complication. The severity of the modified Clavien–Dindo classification was associated with BMI and bilateral ILND.

Skin Necrosis Due to Misuse of a COVID-19 Antigen Home Test Kit: A Case Report

Background: Many people are still infected with coronavirus disease 2019 (COVID-19), and the use of home test kits for diagnosis is becoming common. The misuse of the kits may cause unexpected patient harm. Purpose: The purpose of this case study was to report a rare case of facial skin necrosis caused by contact with a reagent in a COVID-19 Ag home test kit due to misuse of the kit. Case Study: A 50-year-old male patient with pain, redness, and swelling throughout the nose, right ocular area, and forehead visited the emergency room of the hospital. The symptoms were caused by using a COVID-19 Ag home test kit in the wrong way. Initially, partial skin color change and ulcerative skin lesions with pus-like discharge were observed throughout the wound. Finally, partial skin necrosis progressed and was treated using appropriate dressing treatment, antibiotics, and steroids. Conclusion: The use of COVID-19 Ag home test kits that can be easily used will gradually increase. As in this case, it should be kept in mind that problems due to incorrect use of COVID-19 Ag home test kits can occur, and initial treatment is important to prevent systemic infection or scar formation.

A shock with skin necrosis is not always necrotising soft tissue infection.

A shock with skin necrosis is not always necrotising soft tissue infection.

Simple and Safe Soft-Tissue Coverage Technique Using the Bipedicled Flap in the Lower Leg.

Skin and soft-tissue defects in the lower legs present significant challenges for surgeons, especially when tendons, bones, or implants are exposed. In such cases, simple dressings or skin grafts are insufficient, necessitating flap surgery. The bipedicled flap is a simpler and more reliable method with a high success rate compared to other flaps, showing minimal flap failures. This study aimed to examine the advantages and limitations of using a bipedicled flap for soft-tissue reconstruction in the lower legs. This retrospective study reviewed medical records from January 2013 to May 2020, involving 10 bipedicled flaps performed on the lower legs. The study included 5 male and 5 female patients, with an average age of 54.5 years. The defects were due to various causes, including trauma, tumor surgery, postoperative complications such as dehiscence and skin necrosis, and chronic osteomyelitis. The size of the defects ranged from 4 × 3 cm to 16 × 13 cm. The outcomes assessed included flap viability, postoperative complications, and patient satisfaction. Patient satisfaction was assessed on a 15-point scale, evaluating appearance, function, and sensation with up to 5 points each, and categorizing scores as poor (1-3), below average (4-6), average (7-9), good (10-12), and excellent (13-15). All flaps were successfully performed, and there were no cases showing any special complications. Patient satisfaction following the operation was excellent in 3 patients, good in 6 patients, and average in 1 patient, with an overall average score of 11.5 (good) out of 15 among the 10 patients evaluated. The bipedicled flap is a simple and secure method for treating soft-tissue defects in the lower legs. Therefore, this technique can be considered as one of the viable options for treating such defects.

Xylazine Induced Skin Necrosis.

Xylazine Induced Skin Necrosis.

Oseltamivir-Induced Steven Johnson Syndrome, Case Report

First described in 1922, Steven Johnson Syndrome (SJS) is an acute mucocutaneous disease with conjunctivitis, stomatitis, purple macules and skin necrosis in which an acute inflammatory process followed by the action of immune complexes has been identified. In the middle hypersensitivity, it should involve less than 10% of the total body surface. Its annual incidence in the world is unknown, it is estimated 1-2 cases per million in a year of which 20% will be pediatric patients; this can be triggered by drugs, infectious agents and biological agents. It manifests as lesions in the skin and mucous membranes of which it can involve ocular conjunctiva, oral, nasal, vaginal, urethral and perianal mucosa

HEALING AND REGENERATIVE EFFECT OF PRF ON COMPLICATIONS OF RHINOPLASTY

Introduction: With the increasing number of rhinoplasties performed, an increase in complications related to the procedure is also expected. Although skin and/or mucosal necrosis are rare complications, they are feared due to its strong negative aesthetic and psychological impact on patients. Therefore, the search for solutions has been incessant, and the platelet-rich plasma (PRP) and/or platelet-rich fibrin (PRF) have shown themselves to be a promising answer. Objective: This article presents three clinical cases of mucosal/cutaneous necrosis after rhinoplasty, in which PRF membrane...

Performance of Human and Porcine Derived Acellular Dermal Matrices in Prepectoral Breast Reconstruction: A Long-term Clinicaland Histologic Evaluation.

Human acellular dermal matrices (ADMs) remain the most used matrices in prosthetic breast reconstruction. However, the availability and cost of ADMs limit their use in prepectoral reconstruction-which requires large amounts of ADM-and alternative matrices are therefore being explored. The aim of this study was to demonstrate the safety and efficacy of human-porcine ADM constructs via clinical outcomes and histologic evidence of graft integration. Consecutive patients undergoing tissue-expander/implant reconstructions with human-porcine ADM constructs were included. Biopsies of both ADMs were obtained at expander/implant exchange and evaluated for cellularization, vascularization, and inflammation. Postoperative complications were retrieved from patient records. Fifty-nine patients met the inclusion criteria. Mean [standard deviation] follow-up was 6.7 [0.56] years; minimum follow-up was 5 years. Any complication rate was 8.6%, including skin necrosis (6.9%), seroma (1.7%), expander/implant exposure (1.7%), and return to the operating room (2.6%). A total of 138 ADM biopsy specimens were obtained from 38 patients at expander/implant exchange. Histologic analyses revealed lower fibroblast infiltration and vascularization and higher inflammatory response in porcine vs human ADM specimens, consistent with published results in nonhuman primates. Despite these differences, there were no cases of graft rejection, capsular contracture, or expander/implant loss. Porcine ADM performs clinically in a similar manner to human ADM, albeit with minor differences in cellular ingrowth and vascularization, suggesting that it may be an alternative to human ADM in prepectoral breast reconstruction.

Terlipressin-induced skin necrosis in cirrhotic patients-A case report and comprehensive literature review.

The occurrence of terlipressin-induced skin necrosis in cirrhotic patients is a rare but serious adverse event that warrants further investigation. Clinicians should be aware of this potential complication in cirrhotic patients receiving terlipressin therapy and closely monitor for any signs of skin necrosis. Early recognition and prompt intervention are crucial in preventing further complications and improving patient outcomes. Further research is needed to better understand the risk factors associated with terlipressin-induced skin necrosis and to develop effective preventive strategies. Overall, healthcare providers should exercise caution when prescribing terlipressin to cirrhotic patients, weighing the potential benefits against the risks of this rare but significant adverse event. Terlipressin is commonly used to manage conditions related to portal hypertension, such as hepatorenal syndrome and esophageal variceal bleeding. Despite its therapeutic benefits, terlipressin can rarely lead to severe ischemic complications involving the skin vasculature, known as terlipressin-induced skin necrosis. We present a 50-year-old male with cirrhosis and acute variceal bleeding who developed skin necrosis following terlipressin administration. We performed a comprehensive review of the literature by analyzing 18 case reports/case series comprising 22 cirrhotic patients with terlipressin-induced skin necrosis. Among these individuals, we found a mean age of 51 years with a male predominance (78%). Further analysis showed that the onset of skin necrosis ranged from 2 to 5 days post-terlipressin initiation, with bolus administration being predominant (85.7%). The underlying pathophysiological mechanisms of terlipressin-induced skin ischemia are still elusive but primarily attributed to the vasoconstrictive and thrombogenic effects. Management involves terlipressin discontinuation and supportive care. Physicians should be aware of this potential complication in patients receiving terlipressin and closely observe for any signs of skin rash.

Reevaluation of Recipient Vessel Selection in Breast Free Flap Reconstruction.

Current consensus has established the internal mammary vessels (IMV) over the thoracodorsal vessels (TDV) as the preferred recipients for microvascular breast reconstruction due to their superior flow rates and long-established outcomes. Yet, there are occurrences where the IMVs are not reliable and may subsequently prompt intraoperative decision-making. Several options exist, including the contralateral IMVs, thoracoacromial vessels, and TDVs. The appropriate sequence for vessel choice is not universally agreed upon. This study reevaluates the TDVs to highlight their viability as a second-line intraoperative alternative to the IMV and provide reference to the straightforward dissection required for harvest. A retrospective, single-institution, breast-level analysis examining 4754 breast free flaps from 2978 patients undergoing bilateral free flap reconstruction was conducted. Postoperative complications within 180 days were evaluated, and cohorts based on anatomic anastomosis (IMV vs. TDV) were created to compare outcomes. Subanalysis was conducted based on flap laterality as well as whether a flap was planned or converted intraoperatively. Of 4754 breast free flaps, 4269 (89.8%) used the IMV while 485 (10.2%) used the TDV. Most complication rates between the TVD and IMV were not significantly different. Rates of flap loss were 1.0% and 1.2% for the IMV and TDV anastomosis (p = 0.59). IMV and TDV anastomosed flaps experienced similar rates of fat necrosis (6.3% vs. 6.2%, p = 0.915). However, multivariable analysis of all breasts regardless of laterality showed that skin necrosis was significantly less likely in TDV breasts (OR 0.45, 95% CI 0.29-0.71, p < 0.001). Given the relative similarity in cohort outcomes, TDV anastomosis can be considered a viable alternative to the IMV when the IMV is unavailable or technically disadvantageous. The TDV artery remains a robust and reliable option in the present-day plastic surgeon's repertoire for breast reconstruction.