ABSTRACT
Microcystic adnexal carcinoma (MAC) is a rare and locally aggressive adenocarcinoma with low-grade malignancy. The present study describes the first reported case and treatment of a Chinese male with a MAC located on the nasal dorsum and nosewing. A 44-year-old man presented with a nasal deformity caused by local repeated infections following an accidental injury to the nose 20 years previously. The nose had been injured by a brick, and treatment at a local hospital 12 years previously had resulted in a nasal scar and a gradually enlarging mass. A physical examination revealed a hypertrophic deformity of the nose and an indurated scar plaque, measuring 2.0×2.0 cm, on the nasal dorsum and nosewing. Microscopic examination revealed a tumor consisting of solid cell nests and a cystic structure with a capsular space. In addition, ductal cells of an adnexal cell origin were visible in the outer epithelium. The medial portion exhibited a microductal structure and invasion of deeper tissues without evident atypia. The tumor cells presented normal nuclear to cytoplasmic ratios and minimal mitotic activity. Pathological examination verified that the tumor was a MAC of low-grade malignancy. A complete surgical resection was performed via Mohs micrographic surgery (MMS), and reconstruction was achieved using an expanded rotational forehead skin flap. No tumor recurrence was detected after a three-year follow-up period. Therefore, for effective treatment of similar MAC cases, complete surgical resection using MMS is recommended, and successful reconstruction may be achieved using an expanded skin flap.
ABSTRACT
OBJECTIVE: To evaluate the effect of use of deltopectoral flaps with delayed expansion in repairing large scar on face. METHODS: Thirteen patients with large scars on face received above-mentioned surgery. The cutaneous branches of thoracoacromial artery and transverse cervical artery of patients were divided when the expander was implanted. As a result, the blood supply of expanded deltopectoral flaps principally depended on the second and third intercostal branches of internal thoracic artery, and a delaying effect was achieved. The distribution of vascular net in the flap and the state of blood supply of the flap were observed to evaluate the effect of delaying. RESULTS: The vascular net of expanded flap increased and thickened. No blood supply disorder occurred at the distal end of the transferred flap. Patients were followed up for 4 to 18 months. The outline of the burn side of face was in accord with the opposite side, which was not fat and clumsy. The complexion of the flap was similar to that of normal skin of the face, and the flap was soft in texture. CONCLUSIONS: The application of delaying can better ensure the blood supply of transferred deltopectoral flap. The result of applying delayed expansion of deltopectoral flaps in repairing large scars on face was good.
