The east-west advancement flap (horizontal advancement flap) to repair a defect on the nose ala.

BACKGROUND: The repair of an alar nasal defect is a frequent challenge for dermatologic surgeons for reasons of the high rate of non-melanoma cancers in the area. OBJECTIVE: Our aim was to describe the use of an east-west cheek-based flap (horizontal advancement flap) to repair a surgical defect on the nose ala. METHODS: Benefits and limits of this surgical procedure are evaluated. RESULT: The resulting S-shaped scar was well-camouflaged among the natural skin lines (melolabial fold and melonasal junction). No architectural distortion of the nose resulted from the procedure. CONCLUSION: In selected patients with small-to-medium-size defects of the nasal ala, the horizontal advancement flap is a simple, reliable and aesthetic reconstruction option.

A "skin helix" flap to correct circular skin loss on the nasal ala.

The surgical treatment of circular skin defects localized on the nasal ala is always extremely challenging. Such lesions can be repaired by using full-thickness skin graft or skin flaps, normally with poor aesthetic outcomes. Skin grafts do not achieve satisfactory aesthetic results because of the unnatural look of the transplanted skin. If a skin flap is chosen, the choice of which one to employ among the many available must be made very carefully in order to obtain the best possible aesthetic outcome. This article describes the clinical case of a localized tumor on the nasal right ala that was surgically removed and satisfactorily treated by employing a "skin helix flap."

Horizontal advancement flap for lateral dorsal nasal defects.

BACKGROUND: Repairing dorsal nasal defects is a frequent challenge for dermatologic surgeons, mainly due to the high frequency of basal cell carcinomas on this site. Obvious scars, mismatched skin and distortion of the nasal contour are the surgical hazards that must be avoided in these cases. AIM: Our aim was to perform surgery involving a simple flap in order to repair medium to large defects on the dorsal side of the nose. METHODS: The dorsal horizontal advancement flap was studied in 12 patients, in order to evaluate the benefits and limits of this surgical procedure. RESULTS: The resulting scars on most of our patients were well-camouflaged among their natural skin lines, and there was neither distortion of the alar contour nor the nostril. CONCLUSIONS: This flap is easy to perform and, in selected cases, provides an outstanding alternative to second-intention healing, full-thickness skin grafts, transposition, rotation and pedicle flaps.

Sutures and Burrow's triangles placed in the red vermilion in the surgery of upper lip defects.

BACKGROUND: In upper lip defects both the design of the flap and the position of the Burrow's triangles may be reversed so as to conceal the scars among skin wrinkles, folds and the mucosal lip to maximize the aesthetic outcome. OBJECTIVE: To report two cases of upper lip defects in which both scars and Burrow's triangles were concealed in the natural folds and the vermilion. METHODS: Both surgeries were performed under local anaesthesia. RESULT: In both patients the scars were successfully concealed and the results aesthetically acceptable. CONCLUSION: The technique described can be used to conceal scars in cases of upper lip defects with aesthetically acceptable results.

[Perianal Bowen's disease: a case report and review of the literature]. / Perianal Bowen's disease: a case report and review of the literature.

Perianal Bowen's disease is a uncommon, slow growing, intraepidermal squamous-cell carcinoma (carcinoma in situ) of the anal region and may be a precursor to squamous carcinoma of the anus. It is associated with cervical and vulvar intraepithelial neoplasia and have human papillomavirus as a common cause. Both sexes and all races are affected, with the highest prevalence in patients aged 20 to 45 years. The symptoms of anal Bowen's disease are unspecific and the clinical findings are uncharacteristic and include pain, itching, bleeding and a disturbing lump. Biopsy and histopathologic examination is required for diagnosis and to distinguish other perianal dermatoses; thus an anogenital warts that fail to respond to conventional therapy, or change in appearance, warrant a biopsy and, where the technique is available, DNA typing to identify the viral pathogen. Infact the etiologic agent, the human papillomavirus (HPV), has been classified by DNA techniques into at least 42 types, of which 16 and 18 are considered to carry a high risk for cancer. The intraoperative findings is a lesion at the anocutaneous line: perianal or intra-anal tumor, erosion or ulceration as well as lichenoid lesion or hyperpigmentation. The disease has a proclivity for recurrence and there are many controversies concerning treatment that effectiveness remains uncertain and range from aggressive wide local excision with skin grafting when necessary to laser vaporization (argon or CO2), radiotherapy or a new immune response modifier (Imiquimod). We report a case of a 50-years-old woman with recurrence of Bowen's disease associated with vulvar HPV infection and review the literature.

Intralesional granulocyte-monocyte colony-stimulating factor followed by subcutaneous interleukin-2 in metastatic melanoma: a pilot study in elderly patients.

AIM AND BACKGROUND: Recent data in the literature indicate that antigen-presenting cells (APC) are inactive in tumour tissue because of local immunosuppression. Tumour-infiltrating lymphocyte (TIL) signal activation transducing mechanisms are also seriously impaired. Administration of granulocyte macrophage-colony stimulating factor (GM-CSF) may lead to APC recovery and interleukin (IL)-2 may restore local TIL activation. Moreover, IL-2 increases the systemic lymphocyte population, an event that seems to correlate with a better prognosis. STUDY DESIGN: The present phase I-II study was carried out to examine whether intralesional injection of GM-CSF followed by subcutaneous IL-2 would induce a clinical response in advanced, pretreated elderly melanoma patients. METHODS: Sixteen patients over 60 years of age received intralesional GM-CSF (150 ng per lesion on day 1), generally divided between the two largest cutaneous lesions, followed by perilesional subcutaneous IL-2 (3,000,000 IU) for 5 days (days 3-7 inclusive) every 3 weeks. RESULTS: Four clinical responses [two partial (PR) and two minimal (MR)] (25%), which also involved lesions that had not been directly treated, and nine cases of stable disease were observed. The response duration for PR and MR was 9, 4, 4 and 2.5 + months, respectively. Stable disease (56%) recorded in the nine patients was short-term (3-6 months). Three patients rapidly progressed after two, two and one therapy cycles, respectively. The patient who reached the best PR had a fairly high absolute lymphocyte count (1600-2400/mm3). The second one, who reached complete remission after subsequent locoregional chemotherapy and hyperthermia, however, had a low absolute lymphocyte count that had doubled by the end of treatment. Blood lymphocyte values in the other patients were too varied to allow any correlation with clinical response. Therapy was well tolerated and only mild fever was observed, with the exception of one patient who had grade 3 fever, with muscle pain and arthralgia. CONCLUSIONS: Considering the very low toxicity observed, this treatment might be indicated in elderly patients for whom systemic therapy is no longer a viable option. Improved scheduling and timing could result from further studies.

Liposuction surgery for the treatment of large hematomas on the leg.

BACKGROUND: Post-traumatic hematomas overlying the muscular fascia on the lateral aspect of the leg are common in elderly patients, particularly those receiving oral anticoagulant therapy. When large collections of blood accumulate within this region, the pressure within the hematomas may exceed the blood pressure in the dermal and subdermal vessels. Large areas of necrosis of the overlying skin may then result. OBJECTIVE: To decrease the pressure of evolving and long-standing hematomas, thereby reducing inflammation and pain. METHODS: Liposuction surgery was employed as a means of decompressing both evolving and long-standing hematomas. RESULTS: Liposuction surgery has been found to be useful in the treatment of hematomas on the leg, and has the added benefit of producing cosmetically elegant results. An elastic compression bandage placed postoperatively reduces the risk of relapse. CONCLUSION: Liposuction surgery may be used to remove large leg hematomas without producing long and cosmetically unacceptable scars. The technique is easy to perform and permits rapid evacuation of hematomas, thereby minimizing patient discomfort.