CASE REPORT Treatment of Otophyma: Case Report and Review of the Literature.

OBJECTIVES: Otophyma is a rare condition that can present as the end stage of any chronic inflammatory disease affecting the ear such as rosacea, eczema, or otitis externa. It can result in conductive hearing loss, low self-esteem, and social embarrassment. This report highlights a case of otophyma treated successfully using a full-thickness skin graft. METHODS: We present a case of a 41-year-old lady referred to our department with a 23-year history of bilateral otophyma. During this time, her hearing progressively diminished as the swelling occluded her external auditory meatus. She had been unsuccessfully managed for years with topical emollients, steroids, and regular ear toileting. RESULT: She was treated by excision of the phymatous tissue and full-thickness grafting, which resulted in a patent external auditory meatus and an improvement in her hearing. CONCLUSIONS: The use of a full-thickness skin graft is one of the many treatment options available for the treatment of otophyma. We present a literature review on this uncommon condition and a discussion on the various treatment options available to the patient.

The Prophylactic Use of Lipid Emulsion Therapy in the Excision of Invasive Malignant Melanoma under Local Anaesthetic in a Morbidly Obese Patient.

We present the first reported case of the prophylactic use of lipid emulsion therapy in the removal of an extensive, circumferential malignant melanoma in a morbidly obese patient, under local anaesthetic. The advantages of this technique allowed the patient to avoid intraoperative invasive monitoring and postoperative critical care admission and assisted during the operation by rotating her leg when needed. This is a useful technique that can be employed in urgent cases where there is a need to excise extensive skin malignancies in patients who are unsuitable for general or regional anaesthesia.

Squamous cell carcinoma arising in epidermoid cysts: report of four cases and review of the literature.

Epidermoid cysts are commonly encountered in clinical practice and while the majority are benign, isolated cases of premalignant and malignant conditions have been identified in their walls. We report four cases of squamous cell carcinoma arising in the walls of epidermoid cysts and review the literature.

Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumour of the skin with high rate of local recurrence and distant metastatic potential leading to poor outcomes. Merkel cells are normally found as innervated clusters of cells around hair follicles in the basal layer of the epidermis and are thought to function as touch receptors. Here, we describe a case of MCC in a 71-year-old female and provide an up-to-date review of the literature pertinent to the management of MCC.

Technique of percutaneous anchoring suture placement.

We describe a technique to assist in the placement of percutaneous anchoring sutures when used in poorly accessible tunnels such as in rhinoplasty by using a sucker tube to guide retrieval and placement of the suture needle. This technique avoids unintended catching of the needle on soft tissue within the tunnel, which could prevent the structure from becoming anchored at other than in its intended location.

The surface anatomy of the germinal matrix of the nail bed in the finger.

Nail spicules result from incomplete excision of the nail matrix of the finger. We report a histological study to delineate the surface anatomy of the nail matrix. Sections were cut longitudinally and transversely in 19 fingertips. The proximal midline extent of the nail matrix was measured and expressed as a ratio of the distance from the nail fold to the distal interphalangeal joint. In the lateral sections, the angle subtended between the midline vertical and the lateral extent of the nail matrix was measured. The mean ratio of the proximal extent was 0.55 in the midline and the lateral angular extent was 66 degrees. The authors recommend that excision of the nail matrix should be rectangular, extending to the midlateral lines and proximally to a point three-quarters of the distance from the nail fold to the distal interphalangeal joint crease.

A method of assessing female breast morphometry and its clinical application.

A series of reproducible measurements have been developed with reference to a single midline datum that describe the position of key landmarks on the female breast. Measurements were made on a 'normal' population of 60 subjects content with their breast shape in order to (1) produce 'normal' reference data for breast shape in a population of varying weight and height; and (2) to evaluate factors which may influence the measurements. The findings show that the vertical positions of the measurements migrate inferiorly with increasing age. With increasing weight, the landmarks (except the medial end of the inframammary crease) migrate inferolaterally. Areolar diameter decreases with increasing age and increases with increasing weight. Only one of the 12 bilateral breast measurement parameters shows a significant mean difference between the right and left breast. However, in a proportion of subjects, individual measurements show fluctuating asymmetry. Subsequently, measurements were made of the breasts of women attending with requests for either reduction (n = 25) or augmentation (n = 6) mammaplasty. Compared with the 'normal' population, the group requesting reduction mammaplasty differed significantly in the majority of measurements. The group of patients requesting breast augmentation showed fewer differences compared with the 'normal' population. The average BMI of women requesting augmentation mammaplasty was significantly less and that of women requesting reduction mammaplasty significantly greater than the normal population. In conclusion, a simple and reproducible method of morphometric measurement of the female breast is described. Application of this method suggests that patients requesting reduction or augmentation mammaplasty on the NHS represent a significant deviation from 'normal' morphometry and do not simply have a subjective distortion of their own body image.

Long term follow-up of dermofasciectomy for Dupuytren's contracture.

During the 4-year period 1980-1983, we carried out 338 operations for Dupuytren's disease of the hand. Of these 46 (13.6%) had a dermofasciectomy and skin graft for recurrent disease. In this sub-group, 34 patients (10.1%) were operated on by the same senior surgeon (H.G.B.). Only these cases were included in this study. Average follow-up was 100 months (range 80-120 months). It was found that graft durability was good, there was no clinical evidence of recurrence beneath grafts, contracture did not exceed 15 degrees at any joint and two point discrimination in the graft was equal to, or better than, 12 mm in the palm and 8 mm in the digit.

Dressings for donor sites.

A comparison of a hydrocolloid dressing and non-medicated tulle gras in the treatment of split-thickness skin graft donor sites.

Salmonella septicaemia in a patient with burns.

A report of a case of salmonella enteritidis which caused septicaemia in a patient who had suffered major burns.

Digital reconstruction using the distally based osteofasciocutaneous radial forearm flap.

The Chinese forearm flap is a versatile flap in hand reconstruction. Five cases are reported. The mechanism and reliability of retrograde venous return is discussed.