Large solitary scalp metastasis of renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) can metastasize to various organs of the body. The skin is an uncommon site for metastasis. However, if metastasis to skin occurs, scalp is a common area. We present a 77-year-old male patient, with a 12-year history of RCC. In the current presentation, he was hospitalized due to hematuria, fatigue, electrolyte imbalance, and deteriorating kidney functions. After the patient was stabilized, he was referred to the plastic surgery clinic due to an unusual, extremely large, hemorrhagic, ulcerative, and vegetative mass on his scalp. Total excision of the scalp mass was performed and, it was noted that the calvarium was intact and the defect was grafted. Histology report of the specimen confirmed to metastatic RCC. Clinicians need to keep in mind that large cutaneous lesion can be a metastasis from an internal malignancy.

Salvage local fasciocutaneous flap for T-junction tissue defect in inverted T-scar reduction mammoplasty.

Macromastia can cause serious psychological problems in women as well as psychosocial problems due to esthetic appearances. For this reason, proper technique in breast reduction surgery yields a dramatic physical and psychological improvement for the patient. Inverted T-scar breast reduction using the inferior pedicle technique is the most commonly used breast reduction method. The most common complication in this technique regards wound healing at the T-junction area. There are no literature reports citing the use of local flaps for the repair of tissue defects in the T-junction area following reduction mammoplasty. In this study, we present a case of using a salvaged local, Limberg-like fasciocutaneous flap for tissue defect repair at the T-junction area after the inverted T-scar reduction mammoplasty using an inferior pedicle.

Lip reconstruction using a functioning serratus anterior free flap: preliminary study.

Reconstructive surgery to the lips requires the replacement of defective tissues with similarly functioning tissues. While non-dynamic free tissue transfers provide adequate lower lip reconstruction, improved benefits may be obtained with innervated free muscle flaps. This study reports the use of innervated serratus anterior muscle free flaps for lip reconstruction in five patients. All patients had squamous cell carcinoma of either the upper or lower lip. After resection of the tumours, the resultant defects comprised two-thirds of the lips. The innervated serratus anterior muscle free flap was transferred to the lip and an end-to-end vascular anastomosis on the facial artery was performed. The marginal mandibular branch of the facial nerve was preferred for nerve coaptation. The inner and outer surfaces of the flaps were grafted with a split-thickness skin graft. Concentric needle electromyography of the orbicularis oris and frontal muscles was performed for all patients in the preoperative, postoperative, and follow-up periods. All patients survived the surgical operation. Three patients achieved perfect oral sphincter function without drooling. Electromyography at 1 year postoperative demonstrated the successful reinnervation of the serratus anterior muscle. This study demonstrates that lip reconstruction using an innervated serratus anterior muscle free flap is a reliable method, providing a functional lower lip.