ABSTRACT
Pilomatrixoma is a benign skin tumor that originates from the hair matrix. It usually appears in children and young adults and is preferably in the head and neck region. It clinically presents as an asymptomatic firm, solitary subcutaneous mass of less than 3 cm. When located in the preauricular area, it is often misdiagnosed as benign or malignant parotids, skin tumors, or sebaceous cysts. Its treatment of choice is surgery, and recurrence is due to incomplete excision. We present a case of a male referred to our hospital with a diagnosis of recurrent pilomatrixoma in its giant form. The lesion was fully excised with no signs of recurrence and no functional impairment.
ABSTRACT
INTRODUCTION: The Portuguese experience in microsurgical reconstruction of the head and neck after oncological surgery is scantly described. The primary aim of this study was to characterize the use of microvascular reconstruction after head and neck tumor resection in a Portuguese tertiary oncological centerMaterial and Methods: The authors retrospectively evaluated 114 microvascular free flap procedures performed for head and neck reconstruction after oncological resection in a department of Head and Neck Surgery of a Portuguese tertiary oncological center. Patients were operated on from January 2012 to May 2018. Data on patient demographic features, tumour characteristics, perioperative complications, postoperative aesthetic and functional results, survival time and time to recurrence were extracted. RESULTS: Most tumours mandating microsurgical reconstruction were mucosal squamous cell carcinomas (85%) and were located in the oral region (95.6%). Around 45% of the patients had a T4a tumour and 30% a T2 tumour. Cervical metastases were present in 45.6% of the cases. The radial forearm flap and the fibular flap were the most commonly used microsurgical reconstructive options (58% and 41%, respectively). More than 80% of patients had no post-operative complications. Partial necrosis of the flap occurred in 6.1% of patients, while total flap necrosis occurred in 3.5% of cases. Aesthetic and functional results were considered at least satisfactory in all patients in which the flaps survived. DISCUSSION: This study is by far the largest series of microsurgical head and neck reconstruction after oncological surgery reported by a single tertiary centre in Portugal. Survival and functional benefits are similar to those reported in other large oncological centres in the world. CONCLUSION: Microvascular reconstruction seems like a reliable treatment option in head and neck oncological surgery at our institution.
Introdução: A experiência portuguesa na reconstrução microcirúrgica da cabeça e pescoço após cirurgia oncológica está escassamente descrita. O objectivo deste estudo foi caracterizar a reconstrução microcirúrgica da cabeça e pescoço num centro de referência terciário português. Material e Métodos: Os autores avaliaram retrospetivamente 114 procedimentos de retalhos livres microvasculares realizados para reconstrução de cabeça e pescoço após ressecção oncológica num departamento de Cirurgia de Cabeça e Pescoço de um centro oncológico terciário português. Os doentes foram operados no período de janeiro de 2012 a maio de 2018. Foram registadas as características demográficas dos doentes, as características do tumor, as complicações peri operatórias, os resultados estéticos e funcionais pós-operatórios, bem como o tempo de sobrevida e o tempo de recorrência. Resultados: A maior parte dos tumores estava localizada na região oral (95,6%), sendo o carcinoma de células escamosas o tipo histológico mais frequente. Os retalhos antebraquial radial e fibular foram as opções reconstrutivas mais usadas (58% e 41%, respetivamente). Mais de 80% dos doentes não apresentaram complicações pós-operatórias. A necrose parcial do retalho ocorreu em sete doentes (6,1%), enquanto a necrose total do retalho ocorreu em apenas quatro casos (3,5%). Os resultados estéticos e funcionais foram considerados pelo menos satisfatórios em todos os doentes em que os retalhos sobreviveram. Discussão: Este trabalho, que descreve a maior série de casos de reconstrução microcirúrgica após cirurgia oncológica da cabeça e pescoço, identificou benefícios funcionais e de sobrevivência semelhantes aos descritos em outros centros oncológicos mundiais. Conclusão: A reconstrução microvascular parece ser uma opção fiável e eficaz no âmbito da cirurgia oncológica de cabeça e pescoço na nossa instituição.
