Chest Wall Reconstruction Utilizing Ovine-derived Reinforced Tissue Matrix.

BACKGROUND: Chest wall reconstruction can be a challenge. The perfect material does not exist to restore chest wall stability. Synthetic materials have been the mainstay for reconstruction. Biological material use has increased. Recently, we initiated the use of a biosynthetic material for chest wall reconstruction that is composed of ovine-derived extracellular tissue matrix and monofilament polypropylene suture. METHODS: We respectively reviewed all patients who underwent chest wall reconstruction with a biosynthetic material from January 2020 to June 2021. RESULTS: Twenty-five patients underwent chest wall reconstruction. Median age was 35 years (range, 18 to 68); 64% were men. Indication for reconstruction was tumor resection in 10, chest wall defect after pectus repair in 7, radiation necrosis in 5, chest wall infection in 2, and lung herniation in 1. Infection was present in 28%. Median chest wall defect was 7 × 10 cm (range, 3.5 to 22.5 cm). Bioabsorbable bars were used in combination with the biosynthetic material patch in 15 patients (60%) and biosynthetic material alone in 10; 5 patients underwent myocutaneous advancement flaps. There were no operative deaths. Postoperative complications occurred in 6 patients (24%). Median hospital stay was 5 days (range, 3 to 14). Late complications occurred in 4 patients (16%). No patient had paradoxical motion, chest wall instability, or required biosynthetic material removal at a median follow-up of 12 months (range, 1 to 18). CONCLUSIONS: This novel biosynthetic material combines the benefits of biologic material and polymer reinforcement to provide a more natural chest wall reconstruction compared with mesh products made of synthetic material alone. Early results are promising in this first series in the literature.

Bilateral Lymphatic Spread of Metastatic Basal Cell Carcinoma.

Herein, we report a case of a patient with an abnormal skin lesion that remained unchecked by medical professionals for approximately 20 years. Upon physical examination in the emergency department for a fractured hip, an infiltrative mass was incidentally discovered. The neoplasm was noted to have progressed from an eraser-sized mass to a 3.5-cm invasive lesion. Initial surgical intervention was believed to have been successful in removal, as margins were clear with the exception of 1 indeterminate segment. However, subsequent 1-year follow-up revealed recurrence of the disease with bilateral axillary node and deep muscle involvement. This prompted a more extensive surgical approach complemented with radiation therapy. The patient had remained disease-free for a year.

Reconstruction of a large external hemipelvectomy defect after chordoma resection using a 5-component chimeric rotational flap.

Management of complex lumbosacral neoplastic disease presents unique challenges and requires a multidisciplinary approach. Large pelvic tumors may require external hemipelvectomy where an entire lower extremity including the hemipelvis is removed with disarticulation of the sacroiliac joint and symphysis pubis. When external hemipelvectomy is performed, the reconstructive surgeon must consider osseous reconstruction for structural pelvic support, the elimination of dead space, protection of implanted hardware, intra-abdominal support, and skin coverage. Reconstruction must minimize wound healing morbidity, operative time and the number of operative sites, and maximize the potential for rehabilitation. We present a case demonstrating use of a rotational chimeric flap for the reconstruction of an external hemipelvectomy defect.

Intra-flap thrombosis secondary to acute sickle crisis: a case report.

We present the case of a 40-year-old patient with sickle cell trait who underwent bilateral breast reconstruction with microvascular TRAM flap transfer. Intraoperatively, the patient developed arterial anastomotic thrombosis of the right breast flap. The left breast flap had already been harvested and was placed on ice. Both anastomoses were then successfully completed. Postoperatively, the patient developed a pulmonary embolism and heparin-induced thrombocytopenia. On postoperative day 12, the left cutaneous Doppler signals were lost, and exploration revealed a thrombosed pedicle and nonviable left breast flap. Pathologic specimen evaluation revealed sickled cells within the flap microvasculature. We believe that prolonged ischemia time and hypothermia precipitated erythrocyte sickling within the flap, causing intra-flap thrombosis that propagated to the pedicle. While sickle cell diseases are not a contraindication to free tissue transfer, we believe that flap cooling should be utilized with caution in this circumstance.

Can the DermaClose device contribute to periwound tissue ischemia and necrosis: a case presentation and discussion?

The anterolateral thigh flaps allows for a large amount of vascularized skin and subcutaneous tissue for transfer as a locoregional flap or for microvascular free tissue transfer. In the settings of a large flap, primary closure of the donor site can be difficult. Multiple techniques, including the use of tissue expansion, can be used to assist with donor site closure. The DermaClose external tissue expander can be employed in such situations. We describe two cases with a unique use of the DermaClose system and postoperative complications.

Head and neck cancer screening in homeless communities: HEAL (Health Education, Assessment, and Leadership).

Homeless persons are at high risk for medical illness, particularly for head and neck cancers, but they face several barriers to receiving adequate health care. We conducted cancer screening and education about head and neck cancer risk factors in one such population (n = 325). Although 41.4% of the participants reported at least 1 otolaryngologic sign or symptom, and 8.6% reported having 2 or more symptoms, most of them (72.3%) had received no medical care. The symptom reported most often was a change in voice (17.2%). In all, 11% of the participants were referred for head or neck cancer evaluation, and 9% of those undergoing biopsy had a malignancy that was later treated. Nearly 75% of participants had at least a ninth-grade education. However, although 71.2% knew that the use of tobacco can lead to lung cancer, 78.9% did not recognize that it can also lead to head or neck cancer. In this population, cigarette smoking was associated with more than doubled odds of follow-up medical care (odds ratio, 2.31). Head and neck cancers cause substantial morbidity and mortality. Community outreach programs can be an excellent starting point to improving early detection and health education for underserved communities.

Verrucous carcinoma of the paranasal sinuses: a case report.

Verrucous carcinoma is a low-grade variant of squamous cell carcinoma reported to occur in all anatomic sites in the head and neck region, most commonly the oral cavity. The tumor grows locally invasive but is histologically benign and metastasizes rarely. To date, 22 cases of verrucous carcinoma involving the nasal cavity and/or the paranasal sinuses have been reported. We present a case of verrucous carcinoma involving the paranasal sinuses, nasal cavity, cranium, and orbit. This case highlights the difficulty of pathologic diagnosis and management options for a rare neoplastic lesion.

Pediatric airway consultation survey in a tertiary care children's hospital: an interobserver analysis.

We conducted a prospective analysis to independently observe the initial opinion of: (1) consulting pediatric residents (postgraduate year 2 [PGY-2]), (2) corresponding consulting attending physicians (general pediatric or pediatric emergency medicine), and (3) consulting otolaryngology PGY-2 residents when assessing patients for "noisy breathing." Each was asked to define the type of noisy breathing present and to formulate a diagnosis based on a limited set of choices. The final diagnosis was determined by a single attending pediatric otolaryngologist (S.E.S.) at the completion of the diagnostic workup. The accuracy for characterization of breath sounds for the pediatric residents, attending pediatricians, and otolaryngology residents were 26.1%, 23.5%, and 98.6%, respectively. The positive predictive values for the determination of diagnosis were 71.6%, 69.4%, and 76.6%, respectively. These findings indicate that pediatric residents and attending pediatricians may be deficient in their ability to characterize the breath sounds commonly seen in patients with noisy breathing. Further education of pediatricians may lead to a more accurate diagnostic evaluation of a child with noisy breathing.

The coexistence of anaplastic and papillary carcinomas of the thyroid: a case presentation and literature review.

Papillary carcinomas of the thyroid are the most common malignant growth affecting the thyroid, currently representing 60-65 per cent of malignant thyroid neoplasm. Although the etiology of this neoplasm is unknown, they are thought to be related to neck irradiation, adenoma transformation, and Hashimoto thyroiditis. Papillary carcinomas are usually purely papillary but occasionally have areas of histologically different neoplasm, most commonly follicular. Overall, these carcinomas represent an indolent group of neoplasm and have an excellent prognosis. The occurrence of an anaplastic area in a papillary carcinoma represents the dedifferentiation of the primary neoplasm. This is an extremely rare occurrence and is considered to have negative prognostic significance. The purpose of this presentation is to discuss an unusual clinical case of a coexisting anaplastic and papillary carcinoma of the thyroid, diagnosed by fine needle aspiration (FNA) analysis presenting in a 67-year-old African-American woman. Evaluation and treatment will be discussed.