ABSTRACT
BACKGROUND: The principles of perineal reconstructive surgery comprise adequate filling of the defect along with stable and durable skin coverage, with a low morbidity rate. Two-flap perineal reconstruction is a simple, fast and reliable technique that uses a single donor site. This improves scar position with low morbidity. It is based in the use of 2flaps; one flap fills the defect with a «turn over¼ technique and the other is a rotation - advancement flap for skin coverage. CLINICAL CASE: A 52-year-old male diagnosed with Lynch syndrome who underwent laparoscopic abdominoperineal amputation for adenocarcinoma of the lower rectum and developed recurrence 2years later over the perineal scar that required radical resection and perineal reconstruction. CONCLUSION: The use of this approach facilitates perineal reconstruction and enables treatment of patients with large and complex defects in frequently irradiated tissues where wound dehiscence and infection are common.
Subject(s)
Adenocarcinoma, Mucinous/surgery , Neoplasm Recurrence, Local/surgery , Perineum/surgery , Plastic Surgery Procedures/methods , Rectal Neoplasms/surgery , Salvage Therapy/methods , Surgical Flaps , Adenocarcinoma, Mucinous/drug therapy , Adenocarcinoma, Mucinous/genetics , Adenocarcinoma, Mucinous/radiotherapy , Amputation, Surgical , Cicatrix/surgery , Colorectal Neoplasms, Hereditary Nonpolyposis , Humans , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Seeding , Rectal Neoplasms/drug therapy , Rectal Neoplasms/genetics , Rectal Neoplasms/radiotherapy , Ultrasonography, InterventionalABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Osteomyelitis/surgery , Surgical Flaps , Clavicle/surgery , Mammary Arteries , Risk Factors , Anti-Bacterial Agents/therapeutic useSubject(s)
Plastic Surgery Procedures , Rectal Neoplasms/surgery , Surgical Flaps , Vagina/surgery , Adult , Buttocks/surgery , Debridement , Fascia/transplantation , Female , Humans , Suture TechniquesABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Sarcoma/physiopathology , Sarcoma/surgery , Sarcoma , Myocutaneous Flap/pathology , Myocutaneous Flap/surgery , Myocutaneous Flap , Thigh/pathology , Thigh/surgery , Thigh , Groin/physiopathology , Groin/surgery , Groin , Rectus Abdominis/pathology , Rectus Abdominis/surgery , Magnetic Resonance Imaging , Magnetic Resonance SpectroscopyABSTRACT
BACKGROUND: The aim of this study was to evaluate the results of sentinel lymph node biopsy (SLNB) in cutaneous melanoma at our institution. MATERIALS AND METHODS: 128 patients with primary cutaneous melanoma who underwent SLNB between April, 2004, and August, 2010 were studied. Univariate and multivariate analysis was performed to explore the effect of variables on mortality and sentinel node status. Survival analysis was performed using the Kaplan-Meier approach. RESULTS: Positive SLNB were detected in 35 (27.3%) of 128 cases. Mean Breslow depths were 3.7 mm for SLNB positive patients and 1.99 mm for SLNB negative patients. False negative rate was 1%. The recurrence rate was 40% for positive patients and 6.5% for negative patients (odds ratio 9.7 [confidence interval 95 % 3.3-28.1]). 33 patients (29%) had an ulcerated melanoma, 12 (10.5%) in the positive group and 21 (18.5%) in the negative group. The disease recurred in a 48.5% of patients with ulcerated melanoma, but only in a 2.5% of patients with non-ulcerated melanoma. Upon multivariate analysis, only Breslow thickness (P = 0.005) demonstrate statistically significance for SLNB status. Multivariate analysis for clinicopathologic predictors of death demonstrate statistically significance for Breslow thickness (P = 0.020), ulceration (P = 0.030) and sentinel node status (P = 0.020). CONCLUSIONS: This study confirms that the status of the sentinel node is a strong independent prognostic factor with a higher risk of death and lower survival. Patients with ulcerated melanoma are more likely to develop recurrence, and also higher risk of death than patients with non-ulcerated melanoma.
