Abdominal desmoid tumors. A new reconstructive approach.

INTRODUCTION: Desmoid tumors are rare soft tissue tumors derived from musculoaponeurotic structures of the abdominal wall musculature. Although they are considered benign tumors because they don't metastasize to other parts of the body, they are clinically considered as malignant for their high tendency on infiltrative growth with local invasion and trend to recurrence after local excision. Several reconstructive techniques are proposed in the literature. METHODS: Nine female patients with abdominal desmoid tumors underwent the removal of a mass of tissue running from the skin to peritoneum near the tumor with a safety margin in macroscopically normal tissue at least of 5 centimeters from the edge of the tumor. After wide excision, a polypropylene mesh was placed in the rear muscular pocket without anchoring suture (sliding mesh sutureless hernioplasty) RESULTS: No patients had perioperative complications or abdominal wall weakness or an incisional hernia in the following 5 years. CONCLUSIONS: We consider this technique of abdominal wall reconstruction after desmoid tumor removal a simple procedure that reduces relapsing events and recurrences of abdominal hernia, reducing tension and pain caused by the traditional suture repair technique. LEVEL OF EVIDENCE: IV.

Disfiguring facial hemangioma compromising labial functionality: a case report.

Hemangiomas are proliferative lesions characterized by increased endothelial cell turnover. Lip hemangiomas can distort lip anatomy and are at increased risk of ulceration and/or bleeding, which lead to impaired function and disfigurement. Surgery can provide active treatment but it can be problematic because vermilion tissue is unique and not found elsewhere on the body. Since there is no similar tissue that can easily be used for reconstructing missing vermilion, its preservation is essential for a satisfactory cosmetic result. We present the case of a 74 year old woman suffering from a large hemangioma of the mid-face and particulary with an angiomatous ulcerated lesion at the level of the lower lip. We describe clinical management and surgical treatment of this pathology.

Suspected spinocellular carcinoma of the inferior eyelid resulted multiple chalazion.

Chalazion is a subacute granulomatous inflammation of the eyelid caused by retention of tarsal gland secretions and it's the most common inflammatory lesion of the eyelid. In cases of doubtful clinical presentation the diagnosis with a biopsy and a histopathological examination is important because it can orientate an appropriate surgical treatment. We report a case of a 64-years-old diabetic man, suspected for a spinocellular lesion of the inferior eyelid of the left eye, it resulted unexpectedly a chalazion.

Stapled and conventional Milligan-Morgan haemorrhoidectomy: different solutions for different targets.

PURPOSE: Haemorrhoidal disease is one of the most common anorectal disorders. The aim of this study is to compare the results, over the last 10 years, of stapled haemorrhoidopexy (SH) with those of standard Milligan-Morgan haemorrhoidectomy (M&M). Furthermore, we discuss the proper indications for each technique in terms of the lowest rate of complications and long-term results. METHODS: Three hundred forty-three patients with different degrees of symptomatic haemorrhoids underwent SH or M&M from January 2005 to December 2007. Patients were divided into two groups, age and sex matched. The administration of painkillers drugs, antibiotics and laxatives, complication symptoms and hospital stay in all the patients were recorded after surgical treatment. RESULTS: The mean operative time was shorter in the stapled group compared to that in the open group (31 min versus 40 min). Postoperative pain, hospital stay and return to full activity were shorter in the stapled group. There was a significant difference in the wound healing time between the two groups. We noticed a higher rate of recurrence in patients treated with stapled haemorrhoidectomy for fourth-degree haemorrhoids. CONCLUSIONS: According to our experience, the Longo technique is indicated for the treatment of haemorrhoids of second- and third degree. In the latter grades of prolapse, the Milligan-Morgan haemorrhoidectomy can also be applied with good outcomes. We believe that, in case of irreducible prolapse, the M&M is to be preferred. However, operative management varies according to surgeon's interest and is tailored to meet the individual patient's need.