Split Skin Graft Reconstruction Research Articles

An Exasperating and Unusual Presentation of Buschke-Lowenstein Tumor in an Adolescent Girl: Case Report with Review of Literature

AbstractGiant condylomata acuminata of Buschke-Löwenstein (GCBL) is a benign condition with a high recurrence rate and a remote possibility of developing into cancer. It is characterized by excessive proliferation of verrucous lesions on the genitalia and/or perianal region, and is frequently linked to human papillomavirus (HPV) subtypes 6 and 11. With the exception of a few case series, case reports make up the majority of the literature. Despite the literature's support for surgical excision, the current evaluation reveals a lack of clarity regarding the disease's diagnosis and best course of action. Better assessment and management of these patients are necessary to prevent any progression/recurrence of disease.Here, we present a case of a GCBL of the vulva in an 18-year-old girl, who was effectively treated with a simple vulvectomy and split skin graft reconstruction. The reported case is one of the rarest presentations of Buschke-Löwenstein tumor as it is not associated with any of the HPV subtypes and is seen in an 18-year-old girl, one of the youngest patients reported till date. This case report is followed by a brief review of the literature on GCBL, which will add to our understanding of this entity and the most effective therapy to treat the disease.

Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases.

Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.

955 Management of A Progressed SCC Case in the COVID-19 Era

Abstract We herein report the case of an elderly patient who underwent amputation of their hand for a squamous cell carcinoma (SCC) due to lack of timely treatment during the COVID-19 pandemic. The patient had a biopsy-proven SCC of the dorsum of their left hand, first diagnosed in March 2020, before the first lockdown. The lesion was 3cm, mobile, easily excisable, and the defect routinely reconstructable. Unfortunately, a number of appointments were missed and when the patient was eventually seen back in the clinic, the lesion was bigger and firmly fixed to the deeper structures. An urgent wide excision of the lesion with split skin graft reconstruction was planned. Intraoperatively, axillary lymph nodes were identified and a FNAB reported metastatic disease. After a failed attempt to fully resect the hand lesion and salvage the surrounding structures, a joint consultant decision was made that an amputation would give the patient the best chance of survival. Since the patient was lacking capacity, and following a discussion with the family, an above wrist amputation was performed in the patient’s best interests. This case sheds light on the unseen and unrecorded victims of COVID-19. Due to the pandemic, most outpatient follow-up appointments were cancelled, and operating waiting times were significantly increased. National research studies showed that all skin cancer treatments were negatively affected by the COVID-19 pandemic. During this lockdown, there is an urgent need to continue the provision of these services as the risk of untreated skin cancer is even greater.

A predictive model to identify patients at risk of local recurrence following glansectomy for penile squamous cell cancer (SCC).

427 Background: Penile preserving surgery for penile cancer is associated with a higher risk of local recurrence (LR). This study developed a predictive model for LR following glansectomy and split skin graft reconstruction . Methods: Retrospective review performed of 177 patients undergoing glansectomy over a 10 year period. The clinicopathological features, LR patterns and cancer-specific survival (CSS) were recorded. Univariate and multivariate logistic regression was used to identify prognostic indicators for LR. The hazard ratio (HR) for LR was estimated using a KM analysis and based on these data we designed a postoperative model for the prediction of LR. Results: The median follow-up period following surgery was 41.4 (1.9-155) months. In total, 9.3 % of the patients developed a LR. Univariate, but not multivariate logistic regression identified perineural invasion (PNI), carcinoma in situ and high grade disease, but not basaloid variant, T stage, lymphovascular invasion and positive resection margins on the specimen to be predictors of LR. A risk model was designed using PNI, CIS and high grade disease in the resected specimen. KM analysis and log rank test revealed no significant differences in LR-free survival between patients with 0 vs 1 or 2 vs 3 risk factors whereas the chance of having local recurrence with 2 risk factors was significantly higher (HR = 5,75; 95% CI 1,43 to 23,15) than with 1 risk factor. A risk stratification model based on a cut-off score of > 1 out of 3 risk factors discriminated well between patients with a high vs low chance of recurrence in a Kaplan-Meier analysis (HR 9.18, 95% CI 3.29 to 25.65 P < 0.001). Indeed, ROC-curve analysis showed an optimal cut-off point of > 1 risk factors with an AUC of 0.77 (P < 0.001, specificity 63%, specificity of 85%) for prediction of LR. Conclusions: Although,LR after glansectomy does not affect the CSS, patients at risk of local recurrence can be identified when > 1 of the factors PNI, CIS and high grade are found on histopathological analysis of the glans. These findings can define the frequency of follow-up and -if validated on pre-op biopsy- potentially be helpful in planning the margins of surgical resection in patients with penile SCC.

Outcome of penile cancer management in the west midlands – A review of outcomes from referrals to a tertiary centre

Outcome of penile cancer management in the west midlands – A review of outcomes from referrals to a tertiary centre

Pleomorphic Hyalinising Angiectatic Tumour: A Tumour Diagnosis of Suspicion

A 62 year old male was referred to our service complaining of a 5 year history of a painful, erythematous swelling on the proximal third of his right tibia. A previous MRI scan displayed appearances suggested to be consistent with fat necrosis, erythema nodosum or pretibial myxoedema. On examination there was an ill-defined, soft, subcutaneous mass on the right anterior leg measuring approximately 30mm x 40mm in diameter. The overlying skin was warm to palpation and mildly tender but with no epidermal changes. There were no associated neurovascular signs or lymphadenopathy. An incisional biopsy revealed histological features highly suggestive of Pleomorphic Hyalinizing Angiectatic Tumour (P.H.A.T). Wide local excision of 3cm margin (90 x 85mm) was subsequently performed with split skin graft reconstruction. The patient remains recurrence-free at 1 year post surgery. Pleomorphic Hyalinizing Angiectatic Tumour is an unusual, highly vascular soft tissue tumour, usually occurring in the subcutis of the lower extremity. Differential diagnoses include neurilemoma and malignant fibrous histiocytoma and, as illustrated by this case report, erythema nodosum or even pretibial myxoedoema. Clinical suspicion of PHAT should initiate MRI scan and incision biopsy. Current literature suggests that, due to a 20-33% rate of local recurrence, P.H.A.T should be treated by wide local excision by a 3cm margin and is to include deep fascia, down to periosteum. It should be reviewed regularly as reports of multiple recurrences 25 years after excision suggest that life-long review may be prudent. J Med Cases. 2012;3(6):334-336 doi: https://doi.org/10.4021/jmc573w

Pleomorphic Hyalinising Angiectatic Tumour: A Tumour Diagnosis of Suspicion

A 62 year old male was referred to our service complaining of a 5 year history of a painful, erythematous swelling on the proximal third of his right tibia. A previous MRI scan displayed appearances suggested to be consistent with fat necrosis, erythema nodosum or pretibial myxoedema. On examination there was an ill-defined, soft, subcutaneous mass on the right anterior leg measuring approximately 30mm x 40mm in diameter. The overlying skin was warm to palpation and mildly tender but with no epidermal changes. There were no associated neurovascular signs or lymphadenopathy. An incisional biopsy revealed histological features highly suggestive of Pleomorphic Hyalinizing Angiectatic Tumour (P.H.A.T). Wide local excision of 3cm margin (90 x 85mm) was subsequently performed with split skin graft reconstruction. The patient remains recurrence-free at 1 year post surgery. Pleomorphic Hyalinizing Angiectatic Tumour is an unusual, highly vascular soft tissue tumour, usually occurring in the subcutis of the lower extremity. Differential diagnoses include neurilemoma and malignant fibrous histiocytoma and, as illustrated by this case report, erythema nodosum or even pretibial myxoedoema. Clinical suspicion of PHAT should initiate MRI scan and incision biopsy. Current literature suggests that, due to a 20-33% rate of local recurrence, P.H.A.T should be treated by wide local excision by a 3cm margin and is to include deep fascia, down to periosteum. It should be reviewed regularly as reports of multiple recurrences 25 years after excision suggest that life-long review may be prudent. J Med Cases. 2012;3(6):334-336 doi: https://doi.org/10.4021/jmc573w

Direct closure of the radial forearm flap donor defect

A method of direct closure of the donor defect of the radial forearm flap is described. This avoids the complication of delayed wound healing which remains a problem after split skin graft reconstruction.

Lip and laryngeal flaps for reconstruction of the floor of the mouth following glossectomy.

Following glossectomy, the reconstruction of the floor of the mouth is a major problem facing the head and neck surgeon. We have devised split-lip and laryngeal mucosal flaps for this. In selected patients, they have a significant advantage over distant skin flaps. The initial postoperative deformity, from the lip being drawn into the mouth, is corrected by a secondary operation with split-skin graft reconstruction of the vestibule. These lip and laryngeal flaps do not require a delay procedure prior to the cancer surgery, and the operating time is considerably reduced. The cosmetic and functional results have been satisfactory.