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1.
Ann Surg Oncol ; 24(2): 355-361, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27660259

ABSTRACT

BACKGROUND: Accurate preoperative lymphoscintigraphy is vital to performing sentinel lymph node biopsy (SLNB) for cutaneous malignancies. Potential advantages of single-photon emission computed tomography with integrated computed tomography (SPECT/CT) include the ability to readily identify aberrant drainage patterns as well as provide the surgeon with three-dimensional anatomic landmarks not seen on conventional planar lymphoscintigraphy (PLS). METHODS: Patients with cutaneous malignancies who underwent SLNB with preoperative imaging using both SPECT/CT and PLS from 2011 to 2014 were identified. RESULTS: Both SPECT/CT and PLS were obtained in 351 patients (median age, 69 years; range, 5-94 years) with cutaneous malignancies (melanoma = 300, Merkel cell carcinoma = 33, squamous cell carcinoma = 8, other = 10) after intradermal injection of 99mtechnetium sulfur colloid (median dose 300 µCi). A mean of 4.3 hot spots were identified on SPECT/CT compared to 3.0 on PLS (p < 0.001). One hundred fifty-three patients (43.6 %) had identical findings between SPECT/CT and PLS, while 172 (49 %) had additional hot spots identified on SPECT/CT compared to only 24 (6.8 %) additional on PLS. SPECT/CT demonstrated additional nodal basins in 103 patients (29.4 %), compared to only 11 patients (3.1 %) with additional basins on PLS. CONCLUSIONS: SPECT/CT is a useful adjunct that can help with sentinel node localization in challenging cases. It identified additional hot spots not seen on PLS in almost 50 % of patients. Because PLS identified hot spots not seen on SPECT/CT in 6.8 % of patients, we recommend using both modalities jointly. Long-term follow-up will be required to validate the clinical significance of the additional hot spots identified by SPECT/CT.


Subject(s)
Lymphoscintigraphy/methods , Sentinel Lymph Node/diagnostic imaging , Skin Neoplasms/diagnostic imaging , Tomography, Emission-Computed, Single-Photon/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Merkel Cell/diagnostic imaging , Carcinoma, Merkel Cell/pathology , Carcinoma, Merkel Cell/surgery , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Lymph Node Excision , Male , Melanoma/diagnostic imaging , Melanoma/pathology , Melanoma/surgery , Middle Aged , Prognosis , Radiopharmaceuticals , Retrospective Studies , Sarcoma/diagnostic imaging , Sarcoma/pathology , Sarcoma/surgery , Sentinel Lymph Node/pathology , Sentinel Lymph Node/surgery , Sentinel Lymph Node Biopsy , Skin Neoplasms/pathology , Skin Neoplasms/surgery , Young Adult
2.
J Burn Care Res ; 38(4): e772-e775, 2017.
Article in English | MEDLINE | ID: mdl-27893570

ABSTRACT

Tracheocutaneous fistula (TCF) is a complication occurring after decannulation of a long-term tracheostomy and can lead to significant morbidity. We describe a case of a TCF in a burn patient treated without surgery. No previous cases have been described. A 65-year-old woman presented with symptomatic hypertrophic burn scar contractures of the anterior neck 6 months after undergoing excision and grafting of full-thickness burns to the neck and chest. She had a history of tracheostomy placement at the time of burn. Two months later, she was decannulated with no evidence of TCF. She subsequently underwent excision of hypertrophic burn scar contractures of the neck with placement of bilayer wound matrix followed by split-thickness skin grafting. Postoperatively she was noted to have a TCF with subgraft emphysema and difficulty in phonation and respiration. With local wound care, the TCF closed spontaneously and a new skin graft was placed uneventfully. At 18 months postoperatively, fistula closure was maintained with good functional and aesthetic outcome. Conservative management of an iatrogenic TCF in a burn patient may result in adequate soft-tissue coverage and allow for subsequent successful skin grafting. This method affords minimal morbidity to the patient and is a viable alternative to more elaborate flap reconstruction.


Subject(s)
Burns/complications , Burns/surgery , Cutaneous Fistula/therapy , Neck Injuries/surgery , Postoperative Complications/therapy , Tracheal Diseases/therapy , Aged , Cutaneous Fistula/diagnosis , Cutaneous Fistula/etiology , Female , Humans , Neck Injuries/complications , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Tracheal Diseases/diagnosis , Tracheal Diseases/etiology
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