Using the Literature to Understand Achilles' Fate.

According to Greek mythology, Achilles was fatally wounded in his heel, bled out, and died. Several unproven hypotheses mention poisoning, infection, allergy, hemophilia, thyrotoxic storm (ie, pain and stress), and suicide. The author, a plastic surgeon who often treats chronic wounds, proposes an additional scenario: Although not mortally wounded, Achilles was considered dead, because in his time a wounded hero was as good as a dead hero, so he lived out the remainder of his life as former hero with a chronic wound far away from everyone. To determine whether his injury was enough to cause fatal bleeding and quick death or if other factors might have been in play, a search of the literature was conducted to enhance what is known about Achilles, basically through the tale related in The Iliad and the clinical impact of an Achilles' injury. Search terms utilized included bleeding tibialis posterior artery (3 manuscripts were found) and chronic wound, Achilles tendon (631 manuscripts were located). Although science may not be able to explain how and why Achilles died, the literature supported the conjecture that Achilles probably had a chronic wound with skin and paratenon defect, de- vitalized tendon tissue, bleeding, granulation, and repeated infections. It is interesting to consider the state of his injury and his mind in the making of this legend.

Clinical and pathological features of the giant, invasive basal cell carcinoma of the scalp.

BACKGROUND: The giant, invasive basal cell carcinoma of the scalp is a rare clinical form of this tumor that appears on the skin, but may spread to some of the following structures: soft tissues of the scalp, bones, meninges, and the brain. In literature, so far, it is known as the GBCC. It is caused by aggressive BCC subtypes. METHODS: We will present here a research of clinical and pathological features of 47 pathological specimens in 31 patients where the following features were examined: the dimension of the tumor, the dimension of the tissue segment, tumor area, segmentation area, resection margin width, microscopic resection margin status, tumor invasion level, and the outcome. RESULTS AND CONCLUSIONS: We have concluded that microscopic resection margin dimensions from 1 to 10 mm are safe and that relapse occurrences in giant, invasive BCCs of the scalp depend on microscopic resection margin dimensions, resection margin status, tumor invasion levels, risky occupation, and risky behavior of the patient.

[Clinical-epidemiologic characteristics of large, invasive basal cell carcinomas of the scalp].

We studied a large, invasive basal cell carcinoma of the scalp in 42 operated patients (53 tumors) of which 26 patients with recurrent and 16 with no recurrence. This is a rare clinical form of this tumor that invades the skin in addition to some or all of the following structure: soft tissue scalp, skull, brain and brain membranes. The literature is known as the Giant basal cell carcinoma according to TNM classification of BCC in pT4 stage. Caused by aggressive subtypes of BCC. Treatment is surgical and involves only large, mutilate surgery and extensive reconstruction. Relapse often occurs. The aim was to analyze clinical and epidemiological characteristics of large, invasive basal cell carcinoma of the scalp, finding the causes of relapse and proposal timely diagnosis. We have concluded that the appearance of tumors in the frontal and pariental region of the scalp is related to the presence of known risk factors, that tumors often penetrate bones and brains resulting in more frequent recurrence in this localization. All tumors were caused by aggressive forms of BCC. Patients in the group with recurrent, previously responded to treatment and had more surgery than patients without recurrence. Treatment-related adverse events occurred in most patients (recurrence and/or death).

Unusual localisation of pressure ulcer--the vulva.

Only a few papers have been published about unusual localisations of pressure ulcer. To date, no papers were published presenting pressure ulcer on external genitals in women. The paper presents the mechanism of origin of vulval pressure ulcer, surgical treatment (excision of lesion tissue of the pressure ulcer) and reconstruction of the vulva. The patient, aged 50, has been paraplegic for 20 years. During the last 3 years she has had a wound which was spreading in the region of the vulva. The pressure ulcer was surgically removed, external female genitals were reconstructed using advancement skin flap and the function and natural appearance of organs were re-established. The presence of all three aetiological factors for the formation of pressure ulcer - presence of prolonged pressure, swelling and infection - were proven in the described patient. For this reason, we are able to claim that this was in fact a pressure ulcer of the vulva. Reconstruction was simple without any complications and donor-site morbidity.