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1.
Background
Phaeohyphomycosis is a fungal infection caused by heterogenous group of fungi known as phaeoid or dematiaceous fungi. It manifests in four clinical forms—cutaneous, subcutaneous, systemic and cerebral phaeohyphomycosis. The subcutaneous form is the most common presentation. Clinically these subcutaneous swellings resemble benign skin and soft tissue neoplasms like lipoma, sebaceous cyst or neurofibroma. Histopathology serves as a very useful tool in diagnosing these cysts by identifying the fungal elements.Methods
A retrospective review of all cases diagnosed as phaeohyphomycosis in the department of Pathology at a tertiary care centre in South India over 9 years (January 2009–December 2017) was done. The clinical, histopathological findings of these cases were reviewed and analysed.Results
Sixty-six cases of subcutaneous phaeohyphomycosis were reported during the 9 year period. Sixty-two per cent of these patients were diagnosed as skin and soft tissue neoplasms. In 94% cases, the extremities were affected. Multiple cysts were seen in 11% of patients. Fine needle aspiration cytology was done in 29 cases with fungal hyphae identified in all cases on cytology.Conclusion
Subcutaneous phaeohyphomycosis mimics benign skin and soft tissue neoplasms clinically. Histopathological examination along with cytology plays a major role in diagnosis of phaeohyphomycosis and thus helps in appropriate patient management.2.
3.
R.-D. Bader 《Trauma und Berufskrankheit》2018,20(1):45-54
Background
Resection of musculoskeletal soft tissue tumors can cause large resection defects.Objective
Which defects after resection of musculoskeletal soft tissue tumors can be covered?Methods
A literature search was carried out, the results were analyzed and are discussed.Results
Musculoskeletal soft tissue tumors are comparatively rare tumors in Germany. There are guidelines for oncological therapy. Even though there are no guidelines for the plastic reconstruction after musculoskeletal soft tissue tumor resection, multiple concepts have been described in the literature. A differentiation must be made between the resection defect coverage and the restoration of function. The donor site morbidity must also be taken into account when planning the covering. In addition to reconstructions with autologous tissue, a reconstruction with prostheses is also possible.Conclusion
Decisive for the successful therapy is the early involvement of the plastic or reconstructive surgeon in the treatment planning in order to achieve an optimal result for the patient.4.
Introduction
Reconstruction of anterior abdominal wall after necrotizing abdominal wall infections is a challenge.Material and methods
A 35-year-old lady presented with 20 × 18 cm sized defect of the anterior abdominal wall following fungal necrotizing fascitis. The defect was covered by an overlay prolene mesh and the soft tissue deficit was corrected by pre-expanded epigastric flap based on the superior epigastric artery.Conclusion
A concerted multi-specialty effort is needed to correct these defects.5.
Arsheed Hussain Hakeem Imtiyaz Hussain Hakeem Fozia Jeelani Wani 《European journal of plastic surgery》2016,39(3):187-192
Background
Reconstruction of the lip defects following wide excision of the squamous cell cancer is challenging for the surgeon. Our aim was to define the role of the inferiorly based nasolabial flap for lip reconstruction in such cases with moderate to large size defects.Methods
Lip defects were reconstructed with a unilateral or bilateral subcutaneous nasolabial flaps depending on the size of the defect following wide resection of their lip cancers.Results
All the defects were reconstructed in a single stage. We achieved good lip seal and at least good function in eating and speaking. There was no entropion of the lip, and all the reconstructed lips preserved their height.Conclusion
Simplicity of dissection, robust blood supply, best color match, short procedure time, and minimal donor site morbidity reinforce this flap as a useful adjunct in lip reconstruction.Level of Evidence: IV, therapeutic study.6.
Magdy Ahmed Abd-Al Moktader 《European journal of plastic surgery》2016,39(2):107-112
Background
Major scrotal skin loss represents a significant challenge for reconstructive surgeons. Although many therapeutic methods have been established for the treatment of such defects, each technique has its own advantages and disadvantages. A posteriorly based pudendal thigh fasciocutaneous flap at the perianal region has been described for reconstruction of genital organs, but an anteriorly based pudendal thigh fasciocutaneous flap has not been described for scrotal reconstruction.Aim
The aim of this study was to introduce and evaluate the use of an anteriorly based pudendal thigh flap for scrotal reconstruction.Methods
Twenty flaps in 15 patients with major scrotal defects were subjected to reconstruction using this flap. The etiology of scrotal loss was Fournier gangrene in all cases. Five patients each underwent bilateral and ten patient unilateral reconstructions, by the anteriorly based pudendal thigh flap, based on the deep external pudendal artery (DEPA).Results
All 20 flaps survived completely. Additionally, the donor site was closed directly, and the scar was hidden in the perineal crease. The donor site healed uneventfully, as one patient required a secondary procedure for healing.Conclusion
An anteriorly based pudendal thigh flap is highly reliable for coverage of major scrotal defects. This flap allows adequate coverage with excellent aesthetic appearance of the scrotum.Level of Evidence: Level II, therapeutic study.7.
Introduction
We evaluated the usefulness of xeno-Biosheets, an in-body tissue architecture-induced bovine collagenous sheet, as repair materials for abdominal wall defects in a beagle model.Materials and Methods
Biosheets were prepared by embedding cylindrical molds into subcutaneous pouches of three Holstein cows for 2–3 months and stored in 70% ethanol. The Biosheets were 0.5 mm thick, cut into 2 cm?×?2 cm, and implanted to replace defects of the same size in the abdominal wall of nine beagles. The abdominal wall and Biosheets were harvested and subjected to histological evaluation at 1, 3, and 5 months after implantation (n?=?3 each).Results
The Biosheet and bovine pericardiac patch (control) were not stressed during the suture operation and did not split, and patches were easily implanted on defective wounds. After implantation, the patch did not fall off and was not perforated, and healing was observed nacroscopically in all cases. During the first month of implantation, accumulation of inflammatory cells was observed along with decomposition around the Biosheet. Decomposition was almost complete after 3 months, and the Biosheet was replaced by autologous collagenous connective tissue without rejection. After 5 months, the abdominal wall muscle elongated from the periphery of the newly formed collagen layer and the peritoneum was formed on the peritoneal cavity surface. Regeneration of almost all layers of the abdominal wall was observed. However, almost all pericardium patches were remained even at 5 months with inflammation.Conclusion
Bovine Biosheets requiring no special post-treatment can be useful as off-the-shelf materials for abdominal wall repair.8.
Background
The tasks involved in reconstructing the urethra after failed hypospadias repair range from correction of a trivial meatal stenosis to reconstruction of the entire anterior urethra.Objectives
To describe pathological findings in the urethra after failed hypospadias repair and the respective surgical methods used for their correction.Materials and methods
The various pathological findings after unsuccessful hypospadias surgery are classified according to their location and complexity.Results
The general rules of reconstruction that should be applied in each particular situation are described.Conclusions
Successful reconstruction of the urethra in patients with failed hypospadias surgery requires experience and good knowledge of the anatomy of the normal and hypospadic urethra and penis. Mastery of plastic surgical techniques and profound knowledge of the various surgical methods of hypospadias surgery are essential.9.
D. Böckler K. Meisenbacher A. S. Peters C. Grond-Ginsbach M. S. Bischoff 《Gef?sschirurgie》2016,21(6):418-425
Background
The most important structural proteins of the vascular wall are collagen and elastin. Genetically linked connective tissue diseases lead to degeneration and aneurysm formation, spontaneous dissection or rupture of arteries. The most well-known are Marfan syndrome, vascular Ehlers-Danlos syndrome type IV, Loeys-Dietz syndrome and familial aortic aneurysms and dissections.Objective
This review article adresses the current status of endovascular treatment options for important connective tissue diseases.Material and methods
Evaluation of currently available randomized studies and register data.Results
The therapy of choice for patients who are mostly affected at a young age is primarily conservative or open repair. There is only limited evidence for endovascular aortic repair (EVAR) of abdominal aneurysms or thoracic endovascular aortic repair (TEVAR).Conclusion
The progression of the disease with dilatation leads to secondary endoleakage and high reintervention rates with uncertain long-term results. For this reason there is currently consensus that EVAR and TEVAR should be limited to justified exceptional cases and emergency situations in patients with genetically linked aortic diseases.10.
Purpose
Bladder exstrophy is defined by urogenital and skeletal abnormalities with cosmetic and functional deformity of the lower anterior abdominal wall. The primary management objectives have historically been establishment of urinary continence with renal function preservation, reconstruction of functional and cosmetically acceptable external genitalia, and abdominal wall closure of some variety. The literature has focused on the challenges of neonatal approaches to abdominal wall closure; however, there has been a paucity of long-term followup to identify the presence and severity of abdominal wall defects in adulthood. Our goal was to characterize the adult disease and determine effective therapy.Methods
A retrospective review of a consecutive series of six patients was performed.Results
We report and characterize the presence of severe abdominal wall dysfunction in these adult exstrophy patients treated as children. We tailored an abdominal wall and pelvic floor reconstruction with long-term success to highlight a need for awareness of the magnitude of the problem and its solvability.Conclusions
The natural history of abdominal wall laxity and the long-term consequences of cloacal exstrophy closure have gone unexplored and unreported. Evaluation of our series facilitates understanding in this complex area and may be valuable for patients who are living limited lives thinking that no solution is available.11.
12.
Faycal El Majdoub Mario Löhr Mohammad Maarouf Anna Brunn Werner Stenzel Ralf-Ingo Ernestus 《Acta neurochirurgica》2009,151(7):833-835
Purpose
The objective of this work was to present possible, though rare, complications of Neuro-Patch® implantation after brain surgery.Methods
Two patients, aged 62 and 63 years, who had a partial dural substitution with an artificial polyurethane graft after neurosurgical resection of a gross tumour, are presented.Results
In the two patients, the avital tissue was infiltrated by either inflammatory or neoplastic tissue respectively.Conclusions
This report demonstrates a new pathological point of view in using synthetic materials for the reconstruction of dural defects.13.
Background
Although nipple-sharing in unilateral breast reconstruction is no longer a new technique, it offers the potential for an excellent match with the contralateral natural nipple. It also is particularly useful for cases in which a local flap elevation for nipple reconstruction likely would lead to complications. However, the established nipple-sharing techniques cannot be applied to patients who wish to preserve breastfeeding functionality even if the technique would otherwise be considered favorable. To overcome this obstacle, the authors devised a new nipple-sharing technique that does not damage the anatomic structure of the donor nipple for breastfeeding. This report presents this new technique as an option for nipple reconstruction.Methods
The new technique consists of harvesting tissue by the circumcision method of nipple reduction and grafting the tissue in a spiral configuration.Results
The reported technique has been performed for nine patients. All the reconstructed nipples have retained their projection and their suitability as matches for the contralateral nipples throughout a maximum follow-up period of 5 years.Conclusions
The new technique allows nipple-sharing to be applied while preserving the anatomic structure of the donor nipple for breastfeeding.14.
Background
A minority of patients undergoing posterior component separation (PCS) have abdominal wall defects that preclude complete reconstruction of the visceral sac with native tissue. The use of absorbable mesh bridges (AMB) to span such defects has not been established. We hypothesized that AMB use during posterior sheath closure of PCS is safe and provides favorable outcomes.Methods
We performed a retrospective review of consecutive patients undergoing PCS with AMB at two hernia centers. Main outcome measures included demographics, comorbidities, and post-operative complications.Results
36 patients were identified. Post-operative wound complications included five surgical site infections. At a median of 27 months, there were five recurrent hernias (13.9%), 2 of which were parastomal, but no episodes of intestinal obstruction/fistula.Conclusions
Utilization of AMB for large posterior layer deficits results in acceptable rates of perioperative wound morbidity, effective PCS repairs, and does not increase intestinal morbidity or fistula formation.15.
16.
M.S.T. Wähmann M. Rahimi A. Daigeler B. Bickert T. Kremer U. Kneser 《Trauma und Berufskrankheit》2016,18(3):270-276
Background
Necrotizing fasciitis is a rare bacterial infection of the subcutaneous tissue and the fascia, which is associated with a high mortality rate in the case of delayed and inadequate therapy.Pathogenesis
The infection spreading along the fascia is usually caused by minor trauma or soft tissue injuries. Tiny erosions of the skin are sufficient as an entry portal for the pathogenic bacteria. Immunosuppressed patients with risk factors such as diabetes mellitus, renal failure and obesity are frequently affected by this disease.Diagnosis
The diagnosis is established based on the patient medical history and the clinical findings. Initially unspecific symptoms of inflammation are present, such as local redness, swelling, pain and fever. Necrotizing fasciitis is characterized by a rapid progression with blistering, severe pain and systemic effects of sepsis with circulatory depression and depressed consciousness. A diagnosis is confirmed by histopathological and microbiological evaluation of biopsiy samples taken during surgical exploration. Laboratory diagnostics and radiological imaging are often unspecific in the initial phase.Therapy
Necrotizing fasciitis is considered to be a life-threatening condition necessitating immediate surgical treatment to prevent rapid progress. Radical debridement of all affected tissues is of paramount importance with respect to overall survival and functional outcome. In most cases several operations are needed to control the infection. Defect reconstruction requires an individualized surgical strategy and can be achieved using split skin grafts and pedicled or free flaps depending on the defect size and depth. In the acute situation a calculated broad spectrum antibiotic therapy is required (e.g. triple therapy using penicillin, clindamycin and meropenem). In cases with extensive soft tissue defects transfer of the patient to a burn center is indicated for critical care and optimized body surface treament.17.
S. Ochman M. J. Raschke C. Stukenborg-Colsman K. Daniilidis 《Operative Orthopadie und Traumatologie》2016,28(5):352-364
Objective
Debridement of infected tissue with the main aim being the re-establishment of mobilization with preservation of standing and walking ability. Prevention of secondary pressure points or amputations due to inadequate resection or deficient soft tissue cover.Indications
In the case of increasing necrosis of the big toe, surgical abrasion and/or amputation is considered unavoidable. Other indications where surgery could be considered include diabetes and its associated angiopathies together with peripheral arterial angiopathy.Contraindications
In the case of insufficient blood supply an expansion of the resection margins should be taken into account. If there are possible alternatives to amputation. Surgery for patients with renal failure requiring dialysis associated with increased complication rate.Surgical technique
A dorsal cuneiform resection is performed to facilitate implantation of a plantar skin transplant and wound healing. Important is the resection of bone in a slide oblique technique. Amputation scars should be outside pressure zones. Partial amputations in the area of the first ray as exarticulation or via the individual amputated segments possible (as opposed to toes 2–5).Postoperative management
Direct postoperative weight-bearing with rigid insole and dispensing aid for 6–8 weeks. Following complete wound healing, foot support with orthopedic arch and transverse strain relief should be advocated, together with a joint roll in ready-made individual shoes.Results
Both trauma and nontrauma cases were included in our present cohort. A total of 7 cases were surgically revised in 2014 due to superficial skin necrosis that was likely the result of skin tension from the wound stitches.18.
Introduction and hypothesis
Female urethral reconstruction via the traditional routes can be limiting for various reasons. Current literature on the use of acellular biologic grafts derived from viscera for female urethral reconstruction is limited. We present two cases of women with complete loss of their posterior urethra presenting for urethral reconstruction.Methods
Two cases of urethral reconstruction using acellular porcine urinary bladder matrix (UBM), along with labial fat pad transposition and biologic pubovaginal sling are presented.Results
In both cases the UBM graft showed successful conversion to what appeared to be normal urethral mucosa. One woman showed significant improvement in continence and the other showed complete continence.Conclusions
Female urethral reconstruction using acellular porcine UBM is a viable option for patients who have lost a significant portion of their urethra. Both cases demonstrated transition of the graft into the posterior wall of the urethra with significant improvement in continence. Further studies are needed to confirm that acellular porcine UBM can transform to urethral mucosa in women requiring urethral reconstruction.19.
Marc-Daniel Kunze Isabella Maria Mehling Michael Sauerbier 《Trauma und Berufskrankheit》2016,18(3):197-204
Background
Severe soft tissue defects of the hand are often caused by occupational trauma and frequently lead to considerable functional impairment.Objective
Which reconstructive options and what supportive treatment measures are available for severe soft tissue defects of the hand?Material and methods
A representative summary of treatment measures concerning primary care and further covering of defects as exemplified by selected cases from our own patients and additional recommendations for treatment are presented.Results
The reconstruction of severe soft tissue defects of the hand usually consists of several steps and is performed according to individual patient needs. For this purpose, different types of local, pedicled and free flaps are available.Conclusion
Hand surgery provides a wide range of options for the reconstruction of tissue defects of different etiologies. The spectrum of operative procedures encompasses both local and pedicled flaps as well as free flaps taken from other regions of the body with microvascular connection to the recipient region. Free flaps are an essential pillar in the reconstructive treatment and due to the safety in the execution, the application of free flaps should not only be seen as a last resort. Many kinds of free flaps can be harvested with parts from different tissue types or as a combination of several free flaps. As a result individual solutions can be provided depending on patient needs. Supportive measures following free flap surgery can help to improve the postoperative result with respect to blood supply, complaints and function.20.
Sandra Sexton Ryan Tulowitzki Craig A. Jones Silvi Shah George Hajduczok Kenneth W. Gross Mandip Panesar 《Clinical and experimental nephrology》2016,20(2):162-168