Skin Retraction Research Articles

Infliximab after Boston Keratoprosthesis in Stevens–Johnson Syndrome: An Update

ABSTRACTPurpose: To report our experience using intravenous infliximab for the treatment of tissue melt after Boston keratoprosthesis (B-KPro) types I and II in patients with autoimmune disease.Methods: Case series.Results: We identified four patients who were treated with intravenous infliximab in the context of tissue melt after B-KPro. Stevens–Johnson syndrome-associated corneal blindness was the primary surgical indication for B-KPro implantation in all patients. Two patients received a B-KPro type I and two patients received a B-KPro type II. The patients received intravenous infliximab for skin retraction around B-KPro type II, melting of the carrier graft or leak. Treatment resulted in a dramatic decrease in inflammation and, in some cases, arrest of the melting process. Cost and patient adherence were limiting factors to pursuing infliximab therapy. In addition, one patient developed infusion reactions.Conclusions: Intravenous infliximab may be considered as globe- and sight-saving therapy for tissue melt after B-KPro.

Tumour-adapted Reduction Mammoplasty – a New (Old) Breast Conserving Strategy: Review

Today over 70 % of patients treated for primary breast carcinoma in certified breast centres are managed with breast conserving surgery. The classical semicircular incision directly above the tumour, though in many cases easily carried out and associated with good cosmetic results, does have limitations. Unsatisfactory aesthetic results often occur when tumour location is unfavourable or when there is unfavourable tumour size relative to breast size. Distortion of the nipple, changes to breast shape and retraction of skin overlying surgical defects can occur. Tumour-adapted reduction mammoplasty/mastopexy or the "modified B technique" offer excellent chances of combining the oncological demands of breast surgery with satisfactory symmetrical cosmetic results. This article reviews a traditional, old operative technique that has been re-embraced in various new forms.

Surgical correction of cleft earlobes Hassen

Background Earlobes are considered as an important element in the cosmetic feature of the entire ear and face. Several techniques have been suggested to repair the torn earlobe. These corrections have been done to restore the natural appearance and shape of the ear for cosmetic, professional, or social reasons. Aim The aim of the present study was to present and discuss the technique used in the Unit of Plastic Surgery at Al-Azhar University Hospital, New Damietta, Egypt, for the repair of earlobe clefts. Settings and design A prospective study was carried out on the procedures used to repair split earlobes in our hospital. Materials and methods We present a personal and geometrical modification of the double-lobed flap carried out on 24 patients with split earlobes. Results The anatomical curvature of the earlobe was restored apart from reducing the skin retraction without causing scars or adding skin grafts. Conclusion We proved that our technique has many advantages and improved cosmetic results.

A New Rat Model for Translational Research in Bone Regeneration.

The European Union (EU) directive 2010/63/EU on the protection of animals used for scientific purpose focused on reducing the number of animals and refinement of breeding. Animal studies are necessary to protect human health. Lots of animal models exist to study bone regeneration, but a reliable, well reproducible, and relatively inexpensive model with the possibility for multiple testing in the same animal is still missing. Rats may serve as good models for this due to the small animal size and good cost/benefit ratio. The present study aimed to develop a novel rat caudal vertebrae critical size defect model for bone regeneration and implant osseointegration studies The study was performed using Wistar rats with weight from 380 to 450 g. An incision was made on the dorsal side of the tail. After skin and muscles retractions, the vertebrae were exposed. Critical size defects for bone tissue engineering or implant placements for titanium body experiments were possible in each of the first four caudal vertebrae. Micro-computed tomography (CT) and histology were used to detect bone growth. There was no bone formation in the defects after 1 or 2 months of healing. When a calcium phosphate biomaterial was used (Bio-Oss®; Geistlich Pharma AG, Wolhusen, Switzerland), a good stability of the material in the defect was noted and bone growth was visible after 1 or 2 months. Results based on implant placement showed good primary stability after 3 months of healing. MicroCT showed integrated implant position through the vertebra. These results suggest that the rat caudal vertebrae may serve as a good new model for studying bone regeneration and implant osseointegration with the possibility of multiple testing within the same experimental animal and the potential to decrease number of experimental animals.

TBC of the Thoracic Wall with Fistulisation through the Breast.

A 53-year-old North African woman presented with a longstanding history of ulcerations of the right breast. Physical examination showed (Fig. 1 subfigure) an ulcer of 1.5 cm in the outer inferior quadrant, another smaller areolar ulcer and a discharging sinus tract in the inframammary sulcus. Apart from female genital mutilation, her past medical history was negative. Laboratory work up was essentially normal, culture of the ulcers were taken. Mammography showed infra-areolar skin retraction, associated with irregular, high density distortion of the breast tissue. Ultrasound (Fig. 1) revealed communicating sinus tracts coming from an intercostal mass with central necrosis. Mobile internal echoes were suggestive for abscess formation and a truecut biopsy was taken. An important granulomatous inflammatory pattern and fibrosis were found. Axillary lymphadenopathy was present.

Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery - A case series.

BackgroundOxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP.Patients and methods18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred.ResultsBelow the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications.ConclusionDuring 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients.

L’utilisation de l’acide désoxycholique (ATX-101) en médecine esthétique : un traitement prometteur

ATX-101 is a synthetic derivative from deoxycholic acid, which leads to destruction of adipocytes and to a skin retraction. The US Food and Drug Administration (FDA) has authorized ATX-101 injections for reduction of moderate to severe submental fat. The purpose of this note is to review the data of literature regarding the deoxycholic acid (ATX-101) where a significant difference for the submental fat between the treated group and the placebo group according to clinical and morphological criteria was observed (Refine Study 1 and 2). Side effects of this molecule seems to be limited.

ILEOSTOMIES AND COLOSTOMIES

Background: An intestinal stoma is an opening of intestine on the anteriorabdominal wall made surgically. The commonly performed procedures include colostomy andileostomy. The purpose of the present study was to identify indications for commonly performedintestinal stomas and to study complications related to it. Objective: To identify indications forcommonly performed intestinal stomas and to study complications related to it. Study Design:Observational study. Setting: Department of General Surgery, Unit- B, Lady reading Hospital,Peshawar. Period: 1st Jan 2013, to 31st Dec 2013. Subjects and Method: A total of 106 patientswho underwent surgery and ended up in intestinal stomas, ileostomy or colostomy, were includedin the study. Indications, immediate and late complications of stomas were recorded. Results: Abreak up of 106 patients of different intestinal stomas. Majority (61.32%) of patients were males.There were 49 ileostomies and 57 cases of colostomy making a total of 106 patients. Mainindications of Ileostomy were enteric perforation (55.10%), and intestinal tuberculosis (20.40%).Main indications of colostomy were penetrating injuries (50.88%), and intestinal obstruction. Ina total of 106 stomas local complications appeared in 23 (21.69%). Skin excoriation, ulceration,lap and wound infection were the most common respectively. Seventy eight stomas including 36ileostomies and 42 colostomies were closed on an average of 3 months after primary operation.There were 7 cases of wound infection, 2 anastamotic leak-ages and one mortality (1.3%) in thestoma reversal group. Conclusion: Common indications for intestinal stomas were abdominalpenetrating trauma, enteric perforation, intestinal obstruction and intestinal tuberculosis. Maincomplications included local skin problems, wound infection and retraction.

Victorian Vampires Validated--The Similarities Between a Legendary Creature and a Dermatologic Pathology.

In 1885, the Western world was introduced to Romanian folklore with EmilyGerard’s bookTransylvanianSuperstitions. Shedescribes agroup of peoplewho, for hundreds of years, blended Christian traditionswith folk tales, which led them to believe in a demonic creature who would drinkhumanblood.Accordingtotheir superstitions, theonlywaytocombat thismonster was by driving a stake through its corpse or by removing its head and stuffing itsmouthwith garlic. Although countless artistic endeavors haveportrayed vampires in the years sinceGerard’swork published, the most iconic of them is Count Dracula, who first appeared inBramStoker’sdefiningnovel in 1897. InDracula,apersonwho appears pale and cold, is avoidant of bright lights, and has prominent teethwouldcarry thepathognomonic features toqualify for avampire. Althoughthisevil creature ismerelyacharactercreatedbyhumanminds, one cannot help but recognize the striking resemblance certain physical features bear to people with porphyria cutanea tarda (PCT). For example, a vampire “sleeps when others wake, that he may be awakewhilst theysleep!”Similarly,patientswithPCTmayprefer tocome out at night, because their skin blisters in the sun. Although there are numerous typesofporphyrias, PCT is themost commonof theporphyrias with cutaneous manifestations. Moreover, the skin around the patient’smouthmight retract, as if tightening from sun damage. This skin retraction may consequently reveal the teeth and cause them to appear more prominent. Furthermore, because these patients avoid the sun, they may develop a pale skin complexion, also causing them to fit the physical description of a vampire. It is ironic,however,thatvampireswerethoughttopreyonhumansand survive by drinking their blood, because repeated phlebotomy is amodernantidote forPCT.Nevertheless, onecannothelpbutwonder if these legendswerebornfromattemptsofpeople inthepasttocopewiththedisfigurement they encounteredonmeetingmedieval patientswith PCT.

English

4 ORIGINAL PROF-3079 ABSTRACT… Background: An intestinal stoma is an opening of intestine on the anterior abdominal wall made surgically. The commonly performed procedures include colostomy and ileostomy. The purpose of the present study was to identify indications for commonly performed intestinal stomas and to study complications related to it. Objective: To identify indications for commonly performed intestinal stomas and to study complications related to it. Study Design: Observational study. Setting: Department of General Surgery, Unit- B, Lady reading Hospital, Peshawar. Period: 1 st Jan 2013, to 31 st Dec 2013. Subjects and Method: A total of 106 patients who underwent surgery and ended up in intestinal stomas, ileostomy or colostomy, were included in the study. Indications, immediate and late complications of stomas were recorded. Results: A break up of 106 patients of different intestinal stomas. Majority (61.32%) of patients were males. There were 49 ileostomies and 57 cases of colostomy making a total of 106 patients. Main indications of Ileostomy were enteric perforation (55.10%), and intestinal tuberculosis (20.40%). Main indications of colostomy were penetrating injuries (50.88%), and intestinal obstruction. In a total of 106 stomas local complications appeared in 23 (21.69%). Skin excoriation, ulceration, lap and wound infection were the most common respectively. Seventy eight stomas including 36 ileostomies and 42 colostomies were closed on an average of 3 months after primary operation. There were 7 cases of wound infection, 2 anastamotic leak-ages and one mortality (1.3%) in the stoma reversal group. Conclusion: Common indications for intestinal stomas were abdominal penetrating trauma, enteric perforation, intestinal obstruction and intestinal tuberculosis. Main complications included local skin problems, wound infection and retraction.

Single-Centre Experience with Percutaneous Cryoablation of Breast Cancer in 23 Consecutive Non-surgical Patients.

To present our single-centre prospective experience on the use of cryoablation (CA) applied to treat primary breast cancer (BC) in a cohort of patients unsuitable for surgical treatment. Twenty-three consecutive post-menopausal female patients (median age 85 years; range 56-96) underwent percutaneous CA of unifocal, biopsy-proven BC, under ultrasound/computed tomography (US/CT) guidance. Clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) follow-ups were systematically scheduled at 3, 12, 18 and 24 months. Local tumour control was assessed by comparing baseline and follow-up DCE-MRI. Twenty-three BC (median size 14 mm) were treated under local anaesthesia (78.3 %) or local anaesthesia and conscious sedation (21.7 %). Median number of cryo-probes applied per session was 2.0. A "dual-freezing" protocol was applied for the first ten patients and a more aggressive "triple-freezing" protocol for the remaining 13. Median follow-up was 14.6 months. Five patients recurred during follow-up and two were successfully re-treated with CA. Five patients presented immediate CA-related complications: four hematomas evolved uneventfully at 3-month follow-up and one skin burn resulted in skin inflammation and skin retraction at 3 and 12 months, respectively. Percutaneous CA is safe and well tolerated for non-resected elderly BC patients. Procedures can be proposed under local anaesthesia only. Given the insulation properties of the breast gland, aggressive CA protocols are required. Prospective studies are needed to better understand the potential role of CA in the local treatment of early BC.

Easy and cheap way to prepare skin extenders.

Skin extender is a very useful method to repair wounds when oedema and skin retraction make a direct suture impossible. We have developed a new, simple and cheap way to prepare skin extenders based only on elastic vessel loops and metal clips stapler commonly used for skin suture and available in any operating room. This simple method can be performed both in the operating room and at the patient bedside, even under local anaesthesia, causes no bleeding and appears to be inexpensive and rapidly usable and should be made readily available in any hospital.

Three-dimensional Superficial Liposculpture of the Hips, Flank, and Thighs.

Background:In the last 3 decades, liposuction has become a mainstay of the plastic surgeon’s armamentarium, and the technique has evolved considerably. We retrospectively review all of the liposuction procedures that we performed over the past 20 years.Methods:The principles of superficial 3-dimensional liposuction with respect to preoperative, intraoperative, and postoperative management of patients scheduled to undergo liposuction of the hips, flanks, and thighs were described.Results:A total of 4000 patient charts were reviewed. The results indicated that 50 patients experienced a postsurgical seroma that was resolved after syringe aspirations. One patient developed a major mycobacterial infection that was resolved after antibiotic therapy. Twenty patients complained of minor asymmetries that were corrected 6 months later under local anesthesia; 18 patients suffered from minor skin irregularities, which improved after lipofilling. In 6 cases, transient hyperpigmentation (6–12 months) of the skin before the use of suction drainages in the removal of large adiposities in patients with light skin was experienced, and in 2 cases, transient paresthesia (8 and 10 months) was experienced. No skin necrosis, deep vein thrombosis, or death occurred.Conclusions:If performed correctly, 3-dimensional superficial liposuction of the trunk, hips, and thighs can yield very satisfying outcomes because of the excellent contour and the enhanced skin retraction provided by the thin cutaneous adipose flap. Three-dimensional liposuction is a reliable method with proven results. A careful application of the technique combined with accurate surgical planning, a thorough preoperative explanation of real expectations, and postoperative care is crucial.

Fasciotomy Wound Management and Closure

While although full-compartment fasciotomy is unquestionably the best treatment for acute compartment syndrome, it is not a benign procedure. It leaves a large open wound that should be left open for at least 2 to 3 days. The outward pressure from swollen muscle and skin retraction serves to increase the dimensions of these wounds, which makes delayed primary closure challenging and often not possible in the most common fasciotomy site—the leg. This study discusses recent advances in the management of fasciotomy wounds that can reduce the morbidity of this procedure. Negative pressure wound therapy and dermatotraction are 2 important innovations, which improve overall outcomes.

La chirurgie de la pointe large

The multiple techniques, the accurate examination and the checking of the various anatomic components (skin, cartilage resistance) could explain the difficulty for the surgeon to choose a main line, achieving the purpose of perfect and permanent results. Facing this complexity, the goal of this study is to plan step by step, using a simple and original technique in order to correct a broad nose. The modification of the nasal tip includes resection techniques, currently the most used, the cartilaginous reshaping with sutures or onlay grafts and more recently the reinforcement structures approach by inlay grafts. Basically, there are 3 important stages in the performing of a new nose tip: projection and rotation control of the tip, nasal base stability and reshaping of the tip. The author reports an original technique for the control of the tip projection and reshaping the middle crus with two cartilaginous grafts disposed on the external side of the medial crus. These two grafts permit both improving naturally the support of the tip and stabilizing the columella, avoiding the classical median columellar strut. Through a ten-year experience with 203 cases, every patient result was analyzed and criticized. All the cases were reviewed after 2 years at least, and the unwanted effects were noted. Nineteen patients have had a secondary rhinoplasty (11%), 4 for a revision tip surgery (2%). There is no respiratory dysfunction and more than 90% of patients are satisfied for their aesthetic result. We think that the main problems as resection techniques with skin or mucosa retraction, unpredictable long-term effect on the tip, unknown future of the grafts, especially onlay grafts responsible sometimes for unpleasant irregularities, could be minimized with this procedure. The more the nasal tip is stabilized, the more the results are better and longer lasting. The surgery of the nose tip is focused not only with shaping procedures of the middle or lateral crus. The technique reported is very simple and safety for the nasal tip surgery through a modification and/or a reinforcement of the initial structure, maximizing the contact between skin and anatomical component and economizing the interposition of a cartilage graft as far as possible. It is a new concept including respect of the anatomy, and stability, which are the best guarantee for a durable result.

Experimental study on histomorphological changes of expanded skin after transplantation in dogs

Objective To investigate the biological changes after transplantation of expanded skin and discuss the mechanism of skin retraction for further improving the clinical efficacy.Methods Eight adult dogs were used.On the back of each animal,4 rectangular expanders were implanted beneath the skin and panniculus carnosus bilaterally.Final injection was terminated through weekly injection over an 8-week period.Dogs were divided into 4 groups (n =2 each).At 3rd week,6th week,3rd month and 6th month after inset of the flaps respectively,the skin-flap area was measured with histological examination stained with hematoxylin and eosin (HE),ultrastructural observation under transmission electron microscope,and the expression level of α-smooth muscle actin (α-SMA) mRNA and protein.Results The epidermis and dermis of expanded flap returned to normal 6 months after the flap inset.The ultrastructural study revealed the following changes.In the epidermis,the intracellular spaces in all layers of expanded epidermis were significantly reduced.The expanded dermis contained large bundles of compacted collagen fibers which lined in disordering fibroblasts.A few myofibroblasts were seen in deeper part of the dermis.Three months post-inset,the fibroblasts functioned normally.Collagens lined themselves regularly and myofibroblasts disappeared.The α-SMA mRNA expression in skin expansion was significant between high expression (1.204 ± 0.011) at 3rd week and low expression (0.910 ± 0.008) at 3rd month.The expression of protein was same between (1.533 ±0.012) at 3rd week and (0.519 ±0.007) at 3rd month.The change trend of α-SMA mRNA and protein was consistent (P ＜ 0.05).Conclusion The changes after skin expansion returned to normal after 6 months,expanded skin had certain degree of contraction after transplantation,which may be related to the appearance and persistence of myofibroblasts in dermis. Key words: Skin ; Tissue expansion ; Myofibroblast; Histology

Liposucción láser-asistida en ginecomastia: seguimiento ecográfico y estadístico de los efectos observados de retracción cutánea

We evaluate efficacy of laser-assisted liposuction in gynecomastia by means of ultrasonography and statistical study, taking into account skin retraction, pa...

Métastases mammaires de cancers d’origine extra-mammaire : état des lieux et difficultés diagnostiques

ObjectivesIntramammary metastasis (IM) of non-breast cancers are infrequent. The purpose of this review of literature was to update the knowledge and explain diagnostic errors. Patients and methodsA review of literature with PubMed was used to select 54 articles published in English between 2003 and 2012. ResultsMelanoma (138 cases, 29.8%) were more frequently responsible of 463 cases of MIM, followed by lung, gynecological, gastrointestinal and hematologic cancers. IM occur mainly in women (92.2%), around 50 years, and are metachronous (84.2%). Clinically, they are usually round, painless, without skin retraction and associated with adenopathies (33%). In imaging, they are frequently single. Diagnosis, sometimes evoked by morphological study of the tumor, is confirmed by immunohistochemistry. Systemic metastasis are common, involving a shorter survival. DiscussionThe prevalence of primitive cancers is not alone responsible for the frequency of IM, as we can observe it with melanoma. The “seed and soil” hypothesis of Paget may explain it: some tumor cells grow preferentially in selected organs. Vascularity of the breast also seems to be an important factor. Clinically, IM can be confused with benign tumors. However, a history of cancer and multiple lesions should raise the suspicion of malignancy. In imaging, signs are non-specific. The morphological characteristics do not confirm the diagnosis with certainty. Immuno-histochemistry is fundamental, as the comparison with the histology of primary tumor. Support is mainly palliative.

Modified bilobed flap for one-stage earlobe reconstruction: A case report

Many techniques have been described in the literature for the reconstruction of congenital or acquired defects of the earlobe. Most techniques for earlobe reconstruction use adjacent tissue to compose a pedicled or bilobed flap, but usually require a two-stage procedure, or need a skin graft; more rarely reconstructive methods that led to a satisfactory result and a pleasant appearance in one-stage procedure have been described. We describe a personal and geometrical modification of the double-lobed flap according to Gavello's original technique, which allows to shape the anatomical curvature of the earlobe and to reduce the skin retraction without adding any scars or skin graft. In our opinion, the revisited reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.

Skin Retraction As a Marker for Aggressive Basal Cell Carcinoma

Skin Retraction As a Marker for Aggressive Basal Cell Carcinoma