Complete surgical excision versus Penrose drainage for the treatment of elbow hygroma in 19 dogs (1997 to 2014).

OBJECTIVES: To report results of surgical excision and Penrose drainage for the treatment of elbow hygromas in dogs. MATERIALS AND METHODS: Retrospective review of the clinical records of 19 dogs with elbow hygromas treated with Penrose drainage or surgical excision between 1997 and 2014. The data retrieved from the records included breed, gender, age, duration of clinical signs, weight, historical data, complete blood count and serum biochemistry, physical examination findings, diameter of the hygroma, cytology of needle aspirates, method of treatment, histological findings, postsurgical complications and their management and outcome. RESULTS: Twenty-one hygromas were treated in 19 dogs. Eleven were right-sided, six were left-sided and four were bilateral. First-line treatment was Penrose drain placement in 12 and complete surgical excision in nine. Bilateral hygromas were addressed simultaneously. Four of the 12 hygromas managed with Penrose drain recurred and one developed ulceration over the olecranon. Recurrent hygromas were treated by surgical excision. The ulceration was surgically excised and reconstructed with a thoracodorsal axial pattern flap. No further complications developed. All the dogs were clinically healthy after a median follow-up of 16 months. CLINICAL SIGNIFICANCE: Surgical excision of canine elbow hygroma is an effective technique that appears to have fewer postoperative complications than Penrose drain placement.

Cutaneous squamous cell carcinoma with incomplete margins demonstrate higher tumour grade on re-excision.

BACKGROUND: We retrospectively evaluated all our cases of re-excised cutaneous squamous cell carcinomas (CSCCs) in the last 10 years to examine whether they change grade in re-excision histology reports. METHODS: The medical files of 525 patients, which had surgical excision of CSCCs in the Plastic Surgery Department of Aristotle University of Thessaloniki between January 2007 and December 2017 were retrospectively evaluated. All primary and recurrent tumours that were incompletely excised were included in the study. The tumour's grade of both the initial and re-excision histological reports (Broders classification: well, moderate, or poor), age, sex, tumour location, size, infiltration borders (deep or lateral), and perineural invasion was documented. RESULTS: From a total number of 525 CSCCs, 24 patients with 24 incompletely excised lesions were identified. Perineural invasion was noticed in 16 (66%) of patients. In 15 cases (62, 5%), poorer differentiation was recorded following re-excision (group A), whilst in nine patients (37, 5%), the grade remained the same (group B). No statistical significance was observed on age (P = 0.106), tumour size (P = 0.382) and perineural invasion (P = 0.658) in both groups. A positive correlation between male gender and infiltrated border location (deep) and change of grade was observed (P = 0.014, P = 0.000). CONCLUSIONS: We would strongly advise re-excision in incompletely excised lesions except in patients that are unwilling or unfit to undergo another surgical procedure as incompletely excised lesions may change into a poorer degree of differentiation in re-excision histology reports.

Becker Expander-Based Breast Reconstruction Following Wise Pattern Skin-Reducing Mastectomy: Complication Rates and Risk Factors.

Our aim is to analyze the results of immediate breast reconstruction in women with macromastia after skin-reducing mastectomy (SRM), with an emphasis on complications and risk factors. Between 2008 and 2013, fifty women with hypertrophic breasts, aged 21-74 years, underwent immediate expander-based breast reconstruction after Wise pattern SRM. An inferiorly based de-epithelialized skin flap was sutured to the inferolateral border of the pectoralis major muscle and covered the expander. Thirty-five women had a unilateral and fifteen a bilateral procedure (total 65 breasts). In all cases, Becker-35 expanders of volume ranging from 365 to 685 cc were used. Risk factors (BMI, smoking, expander's size, preoperative irradiation, chemotherapy) and complications were recorded. Follow-up up to 60 months was compiled. In all cases, the myodermal pouch provided safe coverage and support of the expander. Postoperative complications occurred in 18 out of 65 breasts (27.6%) and included skin ischemia in 11 breasts (16.9%), late infection in two (3%), seroma and expander rotation in four and one, respectively (6.1 and 1.5%), and severe peri-prosthetical contraction in five breasts (7.6%). Statistical analysis showed that complications were significantly related to preoperative radiotherapy and smoking; no significant correlation was documented between complication rates and chemotherapy, BMI, age or expander's size. We suggest that the inverted-T SRM, creating a combined "myodermal" flap for the coverage of a Becker expander, is a useful single-stage reconstructive option for patients with macromastia. Preoperative radiotherapy is significantly related to higher postoperative complication rates, and may result in a less optimal reconstructive outcome. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Rare benign tumours of the nipple.

BACKGROUND: Benign lesions of the breast in total are much more frequent than malignant ones. However, there are no epidemiologic data on the prevalence of benign or malignant tumours of the nipple, and the bibliography on benign nipple tumours in general is limited. AIMS: To present some rare cases of benign nipple tumours and review the literature. MATERIALS AND METHODS: Four cases of rare benign nipple tumours: neurofibromas, wart, leiomyoma and milium are presented. The literature search on benign nipple tumours was performed using MEDLINE, Pubmed, and Cochrane databases with limits: English language, human species and available abstract. The keyword used was 'benign nipple tumours'. RESULTS: The initial search retrieved 337 articles. The papers were reviewed and the articles that referred to benign lesions that appeared at the nipple specifically were identified. Different entities that were described included: neurofibroma, leiomyoma, milium, florid papillomatosis, syringomatous adenoma, nevoid hyperkeratosis, fibroma, pseudolymphoma and haemangioma. DISCUSSION: Differential diagnosis of benign tumours of the nipple can be demanding for the physicians. Many of the symptoms and signs like pruritus, serosanguinous discharge, lichenification, erosion and nodular enlargement are produced by either malignant or benign nipple lesions. Radiology can be unclear in the diagnosis of nipple abnormalities. CONCLUSION: Histological examination of the lesion can be the only definite answer in these cases.

Electric fly swatter: potentially harmful not only for insects?

The electric fly-swatter is a household device used widely in Greece to kill mosquitoes. It consists of a racket-shaped electrical screen which is free of toxic and other chemicals. When the screen touches the insects, the contact generates an electric flash of light and the insects are incinerated. We present the case of a 15% flame burn caused by the flash of light produced by an electric fly-swatter. According to our review of the literature, this is the second case of burn injury caused by an electric fly swatter.

Le chasse-mouches électrique est un appareil ménager largement utilisé en Grèce pour tuer les moustiques. Il se compose d'un écran électrique en forme de raquette, qui est exempt de produits chimiques toxiques. Lorsque l'écran touche les insectes, le contact génère un flash électrique de la lumière et les insectes sont incinérés. Nous présentons le cas d'une brûlure sur 15% de la surface corporelle causée par le flash de lumière produite par une tapette à mouche électrique. Selon notre revue de la littérature, c'est le deuxième cas de brûlure causée par une tapette à mouche électrique.

Soft tissue reconstruction of the thumb with the dorsoradial forearm flap.

The dorsoradial flap is a recently described cutaneous flap, which is harvested from the distal forearm and indicated for covering dorsal soft tissue defects of the hand and thumb. Vascularization of the flap is assured by a cutaneous branch of the radial artery, which arises at the level of the first intermetacarpal space and supplies the skin of the distal quarter of the forearm dorsum. This area corresponds to the skin island of the dorsoradial flap. We report our clinical experience on seven patients where this flap was used for covering post-traumatic defects of the thumb. Dimensions of the defect varied from 18 to 28 cm(2). The donor site was skin grafted. All flaps survived and provided satisfactory coverage of the defect. Based on a secondary vascular axis, the flap has a large skin paddle and a wide rotation arc that allows soft tissue reconstruction of the dorsal and radiopalmar areas of the thumb.

The use of a detachable anvil enables an easier and safer stapled hemorrhoidopexy.

Following the excision of hemorrhoidal nodes during hemorrhoidectomy, intense pain is reported to be the main postoperative problem, which can last for several weeks. Hemorrhoidopexy, an alternative treatment for hemorrhoids introduced in the late nineties, replaced hemorrhoid excision by a reduction of the hemorrhoids to their normal anatomical position, via an excision of a mucosal ring above the internal hemorrhoidal cushions. The latter excision results in minimal or no postoperative pain. In 2010, a new variant of the hemorrhoidopexy set was introduced in the European market. The variations of this set, including a detachable anvil and a lined proctoscope, aid the surgeon in performing an easier and safer hemorrhoidopexy.