The Efficacy of Hydrodilatation for the Prevention of Vasospasm following Microsurgical Anastomosis.

BACKGROUND: Vasospasm is a major problem following microsurgical reconstruction which can result in the partial or complete loss of the flap tissue. The aim of this study was to investigate the efficiency of hydrodilatation for the prevention of vasospasm. METHODS: Thirty male Wistar rats were used for this experimental study. Femoral arteries of were exposed, photographed, and transected. In group 1, group 2, and group 3 papaverine solution, hydrodilatation, and minimal mechanical dilatation (control group) was performed, respectively. The anastomosis was completed and the arteries were photographed again 10 minutes after completion of the anastomosis. Following 7-day period samples for transmission electron microscopy (TEM) and light microscopy were obtained. RESULTS: The mean vessel diameters prior to transection were 0.43, 0.45, and 0.52 mm in the papaverine, hydrodilatation, and control groups, respectively. The mean vessel diameter 10 minutes following the completion of anastomosis was 0.76, 0.75, and 0.51 mm in the papaverine, hydrodilatation, and control groups, respectively. Median score for papaverine group regarding histological parameters of regular endothelial lining and lumen, neutrophil infiltration, vascular congestion, and edema in tunica adventitia was 2, 3, 2, and 3 positive, respectively. Median score for the papaverine group regarding histological parameters of regular endothelial lining and lumen, neutrophil infiltration, vascular congestion, and edema in tunica adventitia was 3, 3, 3, and 3 positive, respectively. All the histological scores were negative in the control group. The difference between the control group and the experiment groups 1 and 2 was significant regarding all four histological parameters (p < 0.05). CONCLUSION: Hydrodilatation and papaverine application were both effective in preventing vasospasm following microsurgical intervention but papaverine caused slightly less damage to the endothelial lining and less edema in the tunica adventitia when compared with the hydrodilatation. Hydrodilatation group showed a vasodilatory effect that was statistically similar to that of papaverine, which has a proven efficacy.

Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease arising from the hair follicles in apocrine gland-rich areas. It is also one of the most common indications for axillary surgery. Reconstruction of the axillary region after such surgery must be performed meticulously due to its critical location and crucial content. In this report, we present our experience of reconstruction of axillary defects with posterior arm perforator flaps (PAPF) following radical excisions. METHODS: A total of 14 patients (9 male, 5 female) aged between 16 and 49 years who had presented with HS in the axillary region and, after surgery, underwent reconstruction with either island or skin bridge posterior arm flap between January 2015 and October 2016 were included in the study and evaluated retrospectively. All of the defects were reconstructed with PAPF following wide excision. RESULTS: Five of the flaps (over 4 patients) were designed as flaps with skin bridges, while the remaining 12 flaps in 11 patients were raised as island flaps. The flaps had areas ranging from 20 to 84 cm2 (mean 39.5 cm2), depending on the size of the defect after excision. The mean follow-up time after the operation was 6 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis during the postoperative period; no other complications were observed. CONCLUSION: Posterior arm perforator flaps can provide sufficient amounts of soft tissue to cover axillary defects and should be considered as the flap of choice in axillary reconstruction.

INTRODUCTION: La maladie de Verneuil (MV), ou hidrosadénite suppurée, est une maladie inflammatoire chronique qui touche les follicules pileux situés près des glandes apocrines. C'est également l'une des indications les plus courantes de chirurgie axillaire. Il faut procéder à une reconstruction méticuleuse de la région axillaire après l'opération en raison de son emplacement difficile et de son contenu crucial. Dans le présent rapport, les auteurs présentent leur expérience de reconstruction des anomalies axillaires à l'aide de lambeaux perforants du bras postérieur (LPBP) après des excisions radicales. MÉTHODOLOGIE: Au total, 14 patients (neuf hommes, cinq femmes) de 16 à 49 ans atteints d'une MV dans la région axillaire qui ont subi une reconstruction par lambeau en îlots ou par pont cutané prélevé sur le bras postérieur entre janvier 2015 et octobre 2016 ont participé à l'étude et fait l'objet d'une évaluation rétrospective. Les chirurgiens ont reconstruit toutes les anomalies à l'aide de LPBP après une large excision. RÉSULTATS: Cinq des lambeaux (sur quatre patients) étaient sous forme de ponts cutanés, et les 12 autres (sur 11 patients) ont été prélevés en îlots. Les lambeaux étaient d'une taille de 20 à 84 cm2 (moyenne de 39,5 cm2), en fonction de la dimension de l'anomalie après l'excision. Le suivi moyen était d'une durée de six mois après l'opération. Un patient a présenté une déhiscence de la plaie et un autre, une nécrose marginale pendant la période postopératoire. Aucune autre complication n'a été observée. CONCLUSION: Le LPBP peut fournir une quantité suffisante de tissus mous pour couvrir les anomalies axillaires. Il faut le considérer comme le lambeau de première intention lors d'une reconstruction axillaire.

Comparison of Aesthetic Quality of the Final Scar in Abdominoplasty with Conventional and Mini Inverted t-Scar.

Background and objectives: Abdominoplasty is one of the most commonly performed cosmetic procedures. The excess skin in the conventional abdominoplasty is transversely excised and a single horizontal scar is formed. The mini inverted t-scar abdominoplasty is a modification of the "Fleur-de-lis" technique and involves the use of a small vertical incision in comparison to the long vertical incision. The aim of this technique is to lower the position of the final abdominal scar instead of addressing the horizontal laxity. In this study, we have compared the aesthetic satisfaction, width and the position of the scar with conventional abdominoplasty and mini inverted t-scar abdominoplasty. Materials and Methods: Thirty patients undergoing abdominoplasty and breast reconstruction with transverse rectus abdominis flap (TRAM) and deep inferior epigastric flap (DIEP) were included in the study. In 15 patients, abdominal closure with the conventional transverse scar was performed. In the remaining 15 patients, closure with a mini inverted t-scar was performed. Scar width, scar height and satisfaction scores were evaluated in both groups. Results: Scar widths, scar heights and patients' and as well as surgeons' satisfaction scores were better in the mini inverted t-scar group than the conventional group. Conclusions: The visibility of the vertical scar alone should not be a reason to avoid mini inverse t-scar abdominoplasty. Mini inverted t-scar can be an option to achieve a better hidden high-quality scar.

Comparison of incisional delay patterns on a rat random flap model.

One of the simplest form of surgical delay can be performed by placing an incision around the flap without undermining, prior to flap elevation. In this study, we have compared the efficiency of different patterns of skin incision to improve flap survival. Twenty-eight animals were used in four groups. Incisional delay was performed prior to flap elevation in the three experiment groups. Complete incision of the three flap edges was performed in the all experiment groups with the exception of an intact skin section on the middle 1/3rd of the bilateral edges in group 1 (bilateral skin edge preserved delay: BSEPD), of a unilateral edge in group 2 (unilateral skin edge preserved delay: USEPD) and of the superior edge in group 3 (superior skin edge preserved delay: SSEPD) without any undermining. Two weeks following the delay procedure, dorsal skin flaps were raised and reinserted back to their place. The results were evaluated with the measurement of necrotic flap area, microangiographic imaging and histological evaluation. The mean percentage of necrotic flap area to whole flap area was 16.94%, 7.54%, 23.34% and 50.6% in the BSEPD, USEPD, SSEPD and control groups, respectively. In selected microangiographic images, vessels were more prominent in the delay groups. The results of the study indicate that three sided incision with an intact skin on the superior edge is not effective in providing a sufficient delay and flap survival improvement when compared to incisions with intact skin on the unilateral and bilateral edges.

The beneficial effects of subcutaneous Allium cepa injection on random flap survival in rats.

Random flaps are frequently used in the practice of reconstructive surgery. The aim of this experimental study was to investigate the effects of Allium cepa on random flap survival in rats. Fourteen Wistar rats were used for this experimental study. The subjects were divided into experiment and control groups. Rats in the experiment group received daily injections of A. cepa extract for 7 d before the elevation of the flaps. Following the treatment period, elevation and reinsertion of the dorsal flaps were performed. Necrotic and total flaps areas were marked and calculated 7 d after the flap elevation. Histological examinations and microangiography were performed to evaluate the results. The mean value of the proportion of necrotic flap areas to the total flap area was 25.06 and 50.6% in the A. cepa and control group, respectively (p = .0079). In the histological examination, number of vessels identified in the dermis were 23.75 ± 0.7 and 33.75 ± 9 in the A. cepa and control group, respectively (p = .7457). In angiographic images, vessels formations were more noticeable in the A. cepa group. We conclude that preoperative subcutaneous A. cepa injection increases dorsal flap survival in rats.

Tip Reinforcement Flap: An Original Technique for Improving Nasal Tip Support and Definition.

BACKGROUND: Middle crura support deficiency and short middle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip. METHODS: Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created from the excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps. RESULTS: There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21 months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34) mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for the middle crura and increased definition, projection, and stability to the domal area. CONCLUSIONS: The tip reinforcement flap technique offers advantages for tip plasty in those cases with middle crural deficiency, short middle crura, and middle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty.

Background: The umbilicus is an indicative aesthetic component of the abdomen. Many umbilicoplasty techniques have been defined and the most commonly used method is the round incision technique. In this paper, we present a new umbilicoplasty technique involving the use of a three-armed star flap and compare it with the round technique. Methods: Forty-eight female patients who underwent umbilicoplasty during abdominoplasty and free deep inferior epigastric perforator flap (DIEP) procedures between February 2011 and December 2016 were included in the study. Twenty patients had round umbilicoplasty, whereas in the remaining 28 patients the three armed star flap technique was used. Aesthetic outcomes of both techniques were evaluated by a questionnaire which was completed by the patients and two independent surgeons. Results: The mean follow-up period was 22 months. Hypertrophic scarring was seen in one patient with the three armed star flap technique and in two patients with the round technique and a cicatricial ring formation occurred in one patient with the round technique. The patient and surgeon questionnaire scores were significantly higher in the 3-armed star flap group. (p < .05) Conclusion: In this study, round umbilicoplasty technique has been compared with the three armed star flap technique. Patient satisfaction surveys and evaluation by two independent surgeons revealed better cosmetic results with the new technique. We believe that this new technique could be preferred over the round technique since it prevents stenosis, circular scar contraction and provides a natural contour between the umbilicus and abdomen.

Results of Surgical Treatment of Patients with Malignant Eccrine Poroma.

OBJECTIVES: Malignant eccrine poroma is a rare cutaneous malignancy. This study was a review of a series of patients with malignant eccrine poroma who underwent surgical treatment conducted in order to evaluate the management techniques and outcomes of treatment modalities. METHODS: All cases of surgically excised malignant eccrine poroma performed in a single clinic between 2012 and 2018 were included in the study. The details of patient age, gender, anatomical location of the tumor, histopathological features, and treatment modalities were analyzed. RESULTS: The average tumor size was 2.53 cm (range: 0.3-7 cm). The average tumor thickness was 3.06 mm (range: 2.5-4 mm). The mean clean tumor margin after the first excision was 1.28 mm and the mean tumor margin after the second excision was 8.83 mm. No recurrence or distant metastasis was detected in any of the patients during the follow-up period. CONCLUSION: Unlike frequent skin cancers, rare skin cancers, like malignant eccrine poroma, don't have definite treatment algorithms constituted from randomized trials. The findings of patient series are very useful to guide physicians in these cases.

Patient Reported Quality of Life and Aesthetic Satisfaction with Latissimus Dorsi Flap in Immediate Partial and Delayed Total Breast Reconstruction.

OBJECTIVES: Latissimus dorsi (LD) muscle flap can be used as an alternative to abdominal flaps for autologous breast reconstruction. The aim of the present study was to present the results of the quality of life and aesthetic satisfaction of breast reconstruction surgeries with LD flap and implants. METHODS: Sixteen patients who had undergone LD flap breast reconstruction were included in the study. Patients were surveyed on the quality of life and aesthetic satisfaction 12 months following breast reconstruction. RESULTS: There were no major complications observed following surgeries. All of the patients included in the study were highly satisfied with the final aesthetic results. There was no difference in satisfaction rate between partial versus total reconstructions and between reconstruction with or without implant. CONCLUSION: LD flaps can be a good alternative to abdominal flaps for autologous breast reconstruction for both partial and total breast reconstruction and can achieve similar aesthetic results.

Approach to Patients with Malignant Melanoma of Unknown Primary Origin.

OBJECTIVES: Although malignant melanoma accounts for 3% of skin cancers, it is responsible for 75% of deaths associated with skin cancer. In our study, all melanoma cases diagnosed and treated at our clinic were retrospectively reviewed, and the cases of unknown primary origin among them were examined in detail in terms of diagnosis and treatment. METHODS: The patients with malignant melanoma treated at the inpatient services of our clinic between January 1991 and April 2017 were retrospectively screened in the records. These patients were evaluated for age, sex, tumor type, Breslow depth, metastasis, and treatment. Among these patients, four cases of unknown primary origin were examined in detail. RESULTS: During January 1991 and April 2017, 173 patients received inpatient care for malignant melanoma at our clinic. As regards to the melanoma subtypes, nodular type in 45 patients, acral lentiginous type in 43 patients, superficial spreading type in 63 patients, lentigo maligna melanoma in 15 patients, subungual type in 7 patients, and either unidentified melanoma or other subtypes in 10 patients were identified. CONCLUSION: The ideal treatment of a patient with melanoma is multidisciplinary, with plastic surgery having a central role.

Comparison of piezosurgery, percutaneous osteotomy, and endonasal continuous osteotomy techniques with a caprine skull model.

BACKGROUND: Osteotomy is a crucial step in rhinoplasty, which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and endonasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques. MATERIALS AND METHODS: This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals, namely, endonasal continuous, external perforating, and piezosurgery groups. All the groups were evaluated for bone gaps, comminuted fractures, and nasal mucosa damage. RESULTS: There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group than in the other groups. The time required for the osteotomy was shorter in the endonasal group, similar to that in the external and piezo groups. CONCLUSION: New techniques are constantly being developed to achieve better results in rhinoplasty. As a natural consequence to technological developments, new devices are being introduced to rhinoplasty practice. Piezo is one such device. We have found that piezo osteotomy has resulted in lower amounts of nasal mucosal damage and comminuted fractures. We believe that piezo can safely be used in rhinoplasty practice until newer and more reliable technologies are being developed.

Subdermal nitrous oxide delivery increases skin microcirculation and random flap survival in rats.

Random skin flaps are essential tools in reconstructive surgery. In this study, we investigated the effect of subdermal nitrous oxide (N2O) application on random flap survival. In this experimental study, we used 21 female rats in three groups. In the N2O and air groups, gases were administrated under the proposed dorsal flap areas daily for seven days. Following the treatment period, flaps were raised and inserted back into their place from the dorsal skin. In the control group, the flaps were elevated and inserted back to their place without any pretreatment. Calculation of necrotic flap areas, histological examination and microangiography was performed to evaluate the results 7 days after the flap surgery. The average of necrotic flap area in the N2O, air and control group was 13.45%, 37.67% and 46.43%, respectively. (N2O vs air p = .044; N2O vs control p = .003). The average number of capillary formations identified in the histological analysis was 7.0 ± 1.58, 3.75 ± 2.36 and 4.4 ± 0.54 in the N2O, air and control group, respectively. (N2O vs air p = .017; N2O vs control p = .037). The average number of capillary structures identified in the angiography images were 6.3 ± 1.52, 1.6 ± 1.15 and 1.3 ± 0.57 in the N2O, air and control group, respectively. (N2O vs air p = .04; N2O vs control p = .02). We conclude that subdermal N2O application increases random flap survival through an increase in the skin microcirculation and could be promising for future clinical applications.

Aneurysmal fibrous histiocytoma.

Aneurysmal fibrous histiocytoma (AFH) is a type of fibrohistiocytic tumour. We present a case of a patient who presented with a skin papule on the thigh region. Histopathological examination following total excision of the lesion revealed an AFH. No sign of recurrence was present 6 months after surgery.

A New Technique in Management of Depressed Posttracheostomy Scars.

BACKGROUND: The goals of tracheostomy scar revision are filling of the depressed area, providing easy sliding of skin over the trachea. There are various techniques described to correct this situation. In this article, a modification of split sternocleidomastoid (SCM) muscle flap used in the correction of posttracheostomy defects is described. METHODS: Thirteen patients who had depressed scars after tracheostomy are included in this study. The mean patient age was 44 years (range, 27-56 years). All patients who suffered from tracheal tug, dysphagia, and bad appearance are included in the study. The area with the depressed scar is de-epithelialized after incising around the depression. Bilateral SCM muscles are split in the coronal plane toward superior half of the muscle while leaving the posterior part of the muscle attached to the bone. After elevation, both SCM muscle flaps are overlapped in the midline. RESULTS: The mean follow-up period of the patients was 11 months (range, 5-20 months). Tracheal tug and dysphagia complaints were resolved in all patients. The depressed area due to the scar was either reduced or completely recovered in all the patients. Apart from 1 hematoma case, none of the early or late complications such as infection, wound dehiscence, skin necrosis, seroma, recurrence, or neck contracture was seen. CONCLUSIONS: We think that this technique, which gives functionally and aesthetically satisfying results, can be used safely in depressed scars formed after tracheostomy and treatment of functional impairment due to this procedure.

Use of Roof-Shaped Costochondral Cartilage for Correction of Saddle Nose Deformity.

BACKGROUND: Cartilage grafts are routinely used in secondary and posttraumatic rhinoplasty. However, in most cases, there are weak areas in the nasal bones and upper lateral cartilages. The purpose of this study was to seek a solution for the keystone area and dorsum of the nose in revision and posttraumatic rhinoplasty cases, and reconstruction of saddle nose deformity including upper lateral cartilage with a roof-shaped graft. METHODS: A retrospective review of reconstructive rhinoplasties performed for saddle nose deformities was conducted. A part of the costochondral graft was carved and thinned (roof graft) for reconstruction of the keystone area and upper lateral cartilages, and another portion was used for making a neoseptal (reconstructed septum) graft and strut graft. The roof graft was capped onto the neoseptal graft with sutures, and this cartilage framework was adapted with fitting the cranial edge of the neoseptal cartilage between the nasal bones. Finally, the strut graft was fixed to the cartilage framework. RESULTS: A significant improvement in nasal shape and overall appearance was achieved in all cases, and 71.42 percent of patients recovered from nasal obstruction. No gross absorption, graft exposure, or recurrence of deformities was observed. CONCLUSIONS: Surgical correction of a saddle-shaped nose should be an acceptable and uncomplicated technique, and the cosmetic result should be totally acceptable. There are many management options for a saddle-shaped nose. Use of roof grafts (shrunk gull-wing grafts) with neoseptal and strut grafts enables simulation of the internal nasal valve and results in a natural nasal position. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Beneficial effects of Salvia miltiorrhiza in the healing of burn wounds: an experimental study in rats.

INTRODUCTION: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing. MATERIAL AND METHODS: Twenty rats were included in this study and divided into two groups. 3 × 2 cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1 ml/day saline and 1 g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas. RESULTS: Neovascularization was increased in the SM group when compared with the control group (p = 0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p = 0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p = 0.0002). CONCLUSION: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats.

PURPOSE: To investigate the effect of subcutaneous sildenafil on random flap survival. METHODS: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. RESULTS: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). CONCLUSION: The subdermal high dose sildenafil has a positive effect on flap survival.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats

Abstract Purpose: To investigate the effect of subcutaneous sildenafil on random flap survival. Methods: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. Results: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). Conclusion: The subdermal high dose sildenafil has a positive effect on flap survival.

Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes.

OBJECTIVE: Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. MATERIAL AND METHODS: 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. RESULTS: Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. CONCLUSION: Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.

Intravascular Papillary Endothelial Hyperplasia of the Foot.

A case of intravascular papillary endothelial hyperplasia is presented. This proliferation usually forms inside thrombotic processes. It is critical to be able distinguish these lesions from low-grade angiosarcomas because they can have similar pathologic findings.