[Pyoderma gangrenosum following breast surgery]. / Pyoderma gangrenosum na mammachirurgie.

Pyoderma gangrenosum is a rare, destructive ulcerative condition of the skin. The painful ulcers may occur spontaneously, or result from a minor injury or surgery. The clinical presentation can mimic a necrotizing bacterial infection; however, no micro-organisms can be cultured from the skin lesions and the ulcers fail to respond to antibiotic therapy. Surgical interventions can aggravate the disease process. We describe 2 patients, a 22-year-old woman and a 45-year-old woman, with ulcerative wound abnormalities after breast surgery. After failure of antibiotic therapy and standard wound care, tissue biopsy of the wounds confirmed the clinical diagnosis 'pyoderma gangrenosum'. Wound healing began after systemic steroid treatment. Delays in diagnosis and treatment of pyoderma gangrenosum may result in extensive ulceration and scarring. It is, therefore, important to recognise the characteristic clinical features at an early stage and to start appropriate treatment immediately.

Functional and aesthetic outcome and survival after double free flap reconstruction in advanced head and neck cancer patients.

BACKGROUND: Extensive composite defects in the head and neck area may require the use of double free flap reconstructions. These reconstructions are not only surgically challenging but also challenging to patients. A realistic perspective on general outcome for the patient seems important. METHODS: From January of 2002 to August of 2003, double free flap reconstructions were used in 12 patients with extensive composite head and neck defects following malignant tumor (n = 7) and osteoradionecrosis (n = 5) resection. Six patients had a standardized interview, physical examination, and clinical photographs. RESULTS: All reconstructions were performed using an osteocutaneous fibula flap in combination with an anterolateral thigh flap (n = 8), a radial forearm flap (n = 1), or a lateral thigh flap (n = 1). The total flap survival rate was 96 percent. Mean mandibular bone defects were 10 cm. Mean skin island sizes of osteocutaneous fibula flaps were 67 cm. Mean external skin reconstruction flap sizes were 117 cm. Mean overall survival time was 20 months in patients with malignant tumors. Patients with osteoradionecrosis reconstruction survived free of disease for an average period of 38 months. Three patients (50 percent) were very satisfied, one was neutral, and two were very dissatisfied with their functional and aesthetic results. Objective evaluation of function showed mainly deteriorated speech (83 percent) and oral incontinence (67 percent). Objective evaluation of aesthetics showed mainly color mismatch (67 percent) and flap contracture of external flaps (50 percent). CONCLUSIONS: Reconstruction of these major composite through-and-through defects will often result in a modest functional and aesthetic outcome. Because selected patients require these procedures, the authors give information that matches with realistic expectations.

Anterolateral thigh flap reconstruction of large external facial skin defects: a follow-up study on functional and aesthetic recipient- and donor-site outcome.

BACKGROUND: The purpose of this study was to investigate the subjective and the objective functional and aesthetic follow-up results of the recipient and donor sites after reconstruction of extensive facial defects with the anterolateral thigh flap. METHODS: Between December of 2001 and April of 2003, the anterolateral thigh flap was used to reconstruct large facial skin defects after malignant tumor resection in 23 white patients. All patients had a standardized interview, physical examination, and clinical photographs. RESULTS: The mean flap size was 108 cm2. Fasciocutaneous anterolateral thigh flaps were used in 15 patients and musculocutaneous flaps were used in eight patients with exposed dura, open sinuses, or orbital defects. An extra free osteocutaneous fibula flap was necessary to reconstruct the affected mandible in 10 patients. The donor site was skin grafted in 18 patients. The flap survival rate was 96 percent. At follow-up, color mismatch (71 percent) and flap bulkiness (50 percent) were encountered most often. Four of five patients with speech problems had received an additional free osteocutaneous fibula flap. Three flap contractures were seen in the neck region. A contour defect of the upper leg was encountered in five patients. Sensory disturbances of the upper leg were observed in 12 patients. Cold intolerance occurred three times after skin grafting. No significant impairment was found in range of motion and muscle strength of the donor leg. CONCLUSIONS: Careful patient selection may further improve aesthetic outcome of the anterolateral thigh flap. The versatility in design and composition of the anterolateral thigh flap and the low donor-site morbidity and satisfactory recipient-site outcome make it a valuable option in reconstruction of external skin defects in the head and neck region.