Primary pediatric osteosarcoma of the skull.

A 16-year-old adolescent boy presented with osteosarcoma of the left parieto-occipital bone with no history of radiation, Paget disease, or retinoblastoma. The tumor presented as a painless lump, which he attributed to minor trauma 5 months before presentation. Biopsy of the lesion was inconclusive. Complete surgical resection was attained. Pathology revealed a diagnosis of osteosarcoma, grade 1 to 2/3. Adjuvant chemotherapy commenced after tumor resection. Primary pediatric osteosarcoma of the skull is an exceedingly rare malignancy, with only a handful of cases ever reported. Complete surgical resection with negative margins is the key to optimizing disease-free survival. Adjuvant chemotherapy is recommended for high-grade tumors and in cases of incomplete resection.

"Babysitting" the flap: a novel approach to chimeric flap transfer.

Previous studies have described compound flaps based on the subscapular system for a variety of reconstructive needs. Most commonly, the combination includes the fasciocutaneous parascapular flap with the latissimus dorsi muscle flap used in the reconstruction of extensive lower extremity wounds. Indications for combined flaps are typically restricted to selective and complex reconstructions. Our experience with a novel approach to compound flap transfer in an elderly patient with multiple comorbidities is described.

Hepatocellular carcinoma metastatic to the scalp.

A case of scalp metastasis from hepatocellular carcinoma (HCC) is reported that was initially diagnosed as a soft-tissue tumor. Attempted excision of the lesion resulted in an open wound requiring soft-tissue reconstruction of the scalp. Results of pathologic examination showed metastatic HCC. The patient returned postoperatively with bleeding, which was unable to be controlled, resulting in his death. Scalp metastases from HCC are very rare but must be considered when treating a patient with known cirrhosis, hepatitis, or HCC.

Orbital floor fractures: outcomes of reconstruction.

Since the 1950s, myriad materials have been used to reconstruct orbital floor fractures. Technological advances have afforded new materials for reconstruction. Recent comparisons of materials have not been reported. Retrospective chart review was performed using current procedural terminology coding for orbital floor fractures treated between 1991 and 2009. A total of 510 charts were reviewed; 317 adult patients met criteria. Forty-seven of these patients underwent bilateral floor explorations, yielding 364 orbital floor fractures. Mean age was 33.7 years. Motor vehicle collision, assault, all-terrain vehicles, and falls constituted the majority of injury mechanisms. Impure blowouts were the most common fracture type, and zygomaticomaxillary complex fractures were the most common pattern. Materials included autologous bone, porous polyethylene, titanium, and porous polyethylene with incorporated titanium. Use of bone graft correlated with postoperative orbital dystopia and enophthalmos, as compared with alloplastic implants. Bone rigidity, unpredictable thickness, and resorption may contribute. Once the gold standard of orbital reconstruction, autologous bone may have been eclipsed by modern materials.

Fibroepithelial papillomatosis ("skin tags") in Rabson-Mendenhall syndrome.

Rabson-Mendenhall syndrome is a rare autosomal recessive syndrome in children involving a defective insulin receptor gene. Several phenotypic features are common to this syndrome, including severe hyperinsulinemia, growth retardation, acanthosis nigricans, dental dysplasia, hirsutism, coarse facial features, and pineal hyperplasia. The authors evaluated and treated a patient with Rabson-Mendenhall syndrome who presented with additional notable syndromic sequelae including extensive fibroepithelial papillomatosis ("skin tags"), not previously described to this extent.