Combined perforator flaps for total breast reconstruction-a narrative review and insights from massive weight loss cases.

Background and Objective: Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These versatile techniques can be utilized in massive weight loss (MWL) patients, effectively addressing both functional and aesthetic challenges by using their excess skin. This review aims to explore literature on combined pedicled and free perforator flaps for total breast reconstruction, and share our own experience in the field. Methods: A PubMed search up to June 2023 employed Medical Subject Headings (MeSH) terms such as (("combined") OR ("stacked") OR ("conjoined") AND ("perforator flaps")) AND ("breast reconstruction"). Publications in English and Scandinavian languages were manually screened for relevance, and supplemental sources were also reviewed. Key Content and Findings: Limited studies exist on using combined pedicled and free flaps for total breast reconstruction, although combined free flaps are more common. Perforators around the breast base, offer multiple flap options for single or combined use. In our series of 10 women, four underwent total breast reconstruction with a combination of flip-over internal mammary artery perforator (IMAP) flap and thoracodorsal artery perforator (TDAP) flap. Another subset of four, who were MWL patients, received combined TDAP and superior epigastric artery perforator (SEAP) flaps, along with body contouring procedures such as upper body lifts and vertical abdominoplasties, addressing excess skin and improving silhouette. One remaining MWL patient had deflated breasts restored using TDAP and SEAP flaps, along with an upper and lower body lift and vertical abdominoplasty. The last MWL patient underwent a risk-reducing mastectomy, also reconstructed with TDAP and SEAP flaps, and received an upper body lift and vertical abdominoplasty. Conclusions: Combined perforator flap techniques for combined body contouring and breast reconstruction seems safe and especially suitable for MWL patients. They offer a surgical alternative merging body contouring and breast reconstruction in cases where free flap procedures seem less favorable due to skin laxity and deflation of donor sites. However, limited literature on the topic calls for further studies.

[Necrobiotic xanthogranuloma misdiagnosed as a planocellular carcinoma].

In this case report, an 89-year-old woman presented with a subcutaneous tumour in the orbital region. Fine needle aspiration showed no signs of malignancy. Following progressive tumour growth and cutaneous manifestation, an incisional biopsy was taken, which showed squamous cell carcinoma. The tumour was excised, and the patho-logical report showed necrobiotic xanthogranuloma being a rare histiocytic disease characterised by slow growth of nodules and plaques. Because it is rare, it can pose a diagnostic challenge, which is why, this report is an attempt to shed light on the disease and to aid its diagnosis.

Malignant transformation of a non-healing traumatic wound on the lower extremity: A case report.

OBJECTIVE: Malignant transformation of chronic non-healing wounds is often overlooked. If a chronic wound fails to heal, or if there are changes in the characteristics of a wound, a biopsy should be performed. METHODS: This case is presented in line with SCARE guidelines. PRESENTATION OF CASE: We present a case of a man with a non-healing traumatic wound over two years in which a basal cell carcinoma was diagnosed by biopsy. The basal cell carcinoma was radically excised and the defect was closed using a split thickness skin transplant. DISCUSSION: The term Marjolin's ulcer, pathophysiology and recommended treatment. CONCLUSION: Delayed diagnosis of malignancy in chronic wounds can lead to a worsened prognosis and therefore it is important to exclude a malignant aetiology. Malignant transformation of chronic wounds is not common but Marjolin's ulcer should be considered.

[Breast abnormalities in women].

Breast abnormalities in women are common and may have physical as well as psychological consequences. Many of the conditions can be treated surgically. It is important, that the patients are correctly diagnosed and referred to the appropriate department for further evaluation and treatment. This review discusses the most common breast abnormalities to ensure awareness among general practitioners and correct referral for treatment.

[Penis arcuatus].

Deviation of the penis may be congenital or acquired. The latter, also known as Peyronie's disease, is seen in 0.4-9% of patients. The aetiology is not fully understood, but the hypothesis is that microtrauma leads to scar tissue formation, plaques, which deform the penis. The disease is divided into a first, painful, progressive, inflammatory phase and a latter, steady, chronic phase. The symptoms are mainly sexual dysfunction and psychological problems. Surgery is recommended in congenital cases and in the chronic phase of Peyronie's disease, where the medical treatment has not been convincing.

Sarcomatoid Tumor following Radium Treatment.

Haemangiomas are benign skin lesions that usually regress spontaneously, but radiotherapy has previously been used to assist the regression and healing of the lesions. Radium and X-rays were used as a treatment for benign skin lesions such as haemangioma until the carcinogenic effect of ionising radiation in humans was described. We report a patient diagnosed with a sarcomatoid carcinoma. Her past history was of particular interest since she had received radium treatment for a haemangioma at the same location more than 70 years before.

Cutaneous Metastases from Salivary Duct Carcinoma of the Submandibular Gland.

Salivary duct carcinoma is a rare and highly aggressive malignant neoplasm that frequently metastasises to other organs, but cutaneous metastasis is uncommon. There are only 6 cases reported in the literature with metastases to the skin and in all cases the tumour originates from the parotid gland. We present a case of skin metastases from the submandibular gland that was mistaken for basal cell carcinoma. To the best of our knowledge, this is the first reported case of salivary duct carcinoma arising from the submandibular gland with cutaneous metastases.