Treatment algorithm for abdomino-torso body contouring in massive weight-loss patients in the presence of scars--a comprehensive review.

BACKGROUND: Patients requiring surgical skin excision after massive weight loss are challenging and require a structured approach. The characteristic abdominal deformity includes a draping apron of panniculus, often extending to the glutaeal, back and thigh areas. Occasionally, these deformities are associated with previous surgical scars in the upper abdomen resulting from open gastric bypass surgery or from other procedures, such as open cholecystectomy. These scars can compromise the blood supply of the abdominal skin. For adequate and safe body contouring, both the excess skin and fat as well as the remaining perfusion of the remaining tissues must be addressed to achieve satisfactory results. METHOD: We propose an algorithmic treatment approach for body contouring of the abdomino-torso area in the presence of scars in the upper abdomen. RESULTS: The key to satisfactory results is a thorough analysis of the horizontal and vertical skin and fat excess of the abdomino-torso, buttock and flank areas and choosing an adequate and safe procedure addressing the respective areas of skin and fat excess while preserving the blood supply of the abdomino-torso area in a scarred abdomen. Our algorithmic approach can help in achieving these goals. CONCLUSION: Our algorithmic approach enables the surgeon to perform safe abdomino-torso body contouring through a structured analysis of the fat and skin excess in the respective body areas even in the presence of surgical scars in the upper abdomen.

Marjolin's ulcer revisited--basal cell carcinoma arising from grenade fragments? Case report and review of the literature.

BACKGROUND: Marjolin's ulcer is a rare and often aggressive cutaneous malignancy arising in previously traumatized or chronically inflamed skin. CASE REPORT: A 79-year-old World War II veteran developed basal cell carcinoma (BCC) at the site of a war wound. The tumour developed in relation to several metal grenade fragments. With a disease-free interval of 61 years between injury and onset of complications the patient had one of the longest latency periods of tumour development described so far. RESULTS: Review of the literature reveals only five cases of relation between grenade fragments and malignancy formation. Presence of foreign bodies has been described as possible aetiology for malignancy development. Explosives and additives contain several mutagenic and tumourigenic substances. We hypothesize a causal connection between the grenade fragments and the development of BCC. Considering the long period of latency between injury and tumour development we suggest grenade injury with left fragments in soft tissue to be a new origin of Marjolin's ulcer.

Prognostic factors in necrotizing fasciitis and myositis: analysis of 16 consecutive cases at a single institution in Switzerland.

Necrotizing fasciitis and myositis are life-threatening infections involving the superficial fascia and musculature, respectively. Outcome depends on early diagnosis and aggressive treatment. Here, we aimed to determine prognostic factors for necrotizing soft tissue infections.The medical records of 16 consecutive patients diagnosed with necrotizing fasciitis (n = 13) and necrotizing myositis (n = 3) from 1999 to 2004 were retrospectively reviewed. Overall survival was 81.3% for necrotizing soft tissue infections, 84.6% for necrotizing fasciitis, and 66.7% for necrotizing myositis. Injection drug use was the most common cause of infection (31.3%). Frequent comorbidities were diabetes mellitus and hepatitis B and C (25.0%). As infectious agents, group A streptococci (GAS) were identified in 10 patients and multiple pathogens in 6 patients. Lethal outcome was always associated with GAS infection and streptococcal toxic shock syndrome (STSS). In our patients, myonecrosis, GAS infection, and STSS appeared to be negative prognostic factors for survival in necrotizing soft tissue infections.

PAR1-type thrombin receptor stimulates migration and matrix adhesion of human colon carcinoma cells by a PKCepsilon-dependent mechanism.

The proteinase-activated receptor1 (PAR1) was characterized as a functional receptor for thrombin in cells from different tumor entities. In colon carcinoma, its function has to be defined. In this study we demonstrate that the PAR1-selective agonist peptide TFLLRN induced activation of protein kinase C isoenzymes alpha and epsilon in human HT-29 colon carcinoma cells expressing PAR1 endogeneously. On the cellular level, TFLLRN and thrombin prompted HT-29 cell migration and matrix adhesion by a PKCepsilon-dependent mechanism as concluded because of the inhibition of PAR1-mediated effects by the PKC inhibitor bisindolylmaleimide I and the PKCepsilon translocation inhibitory peptide EAVSLKPT but not by the PKC inhibitor Gö 6976. In addition, blockade of PAR1 by RWJ 56110, a selective PAR1 antagonist, fully abolished the effect of thrombin on HT-29 cell migration and adhesion. Therefore, PAR1 seems to be the responsible receptor for thrombin-induced migration and adhesion of human colon carcinoma cells including PKCepsilon as an essential signal transducer.