RESUMO
An unusual case is presented of a young adult patient with two black-stained, radio-nucleotide tracer-active sentinel lymph nodes biopsied following her primary cutaneous melanoma treatment. This was subsequently confirmed to be secondary to cutaneous tattoos, averting the need of an elective regional node dissection. History of tattooing and tattoo removal should therefore be obtained as a routine in all melanoma patients considered for sentinel node biopsy (SLN). SLN biopsy and any subsequent completion node dissection should be strictly staged so that proper histologic diagnosis of the sentinel node is available for correct decision making and treatment.
Assuntos
Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Tatuagem , Adulto , Cor , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Imuno-Histoquímica , Antígeno MART-1/metabolismo , Proteínas S100/metabolismo , Biópsia de Linfonodo Sentinela , Tatuagem/efeitos adversosRESUMO
Pelvic extenuative surgery produces good long term outcomes in advanced pelvic malignancies. We evaluate the use and clinical outcomes of the Vertical Rectus Abdominus Myocutaenous (VRAM) flap as a reconstruction technique in a heterogenic cohort of patients with advanced colorectal cancer in whom neo-adjuvant chemo-radiotherapy had been performed pre-operatively. Analysis of patients having VRAM flaps for pelvic reconstruction in a tertiary referral centre from 2001 to 2010 was conducted. 37 patients (23 female, 14 male) underwent pelvic extenuative surgery of which 22 (60%) had recurrent pelvic disease. All surgical and medical complications were analysed. Major flap complications were defined as 'requiring return to the operating theatre at any stage' and these occurred in 6 (16%) patients. There were 7 (19%) minor flap complications defined as 'requiring conservative non surgical treatment' The total global re-intervention rate of patients requiring return to theatre for re-operation as a result of their exenteration and reconstruction was 6 (16%). We highlight the merits and versatility of the VRAM flap in advanced pelvic malignancy in obtaining stable and supple reconstructive cover and the relative low morbidity in this difficult group confirms out strong support for immediate VRAM reconstruction in pelvic exenterative procedures.
Assuntos
Neoplasias Pélvicas/secundário , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida , Reto do Abdome/transplante , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia/métodos , Estudos de Coortes , Colectomia/métodos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Pélvicas/mortalidade , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/cirurgia , Reto do Abdome/irrigação sanguínea , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Reino UnidoRESUMO
This case report describes the use of a double-free, flow-through flap as a valuable tool in reconstruction following oncological resection of a large, fungating, squamous cell carcinoma extending through the scalp, forehead, skull, and dura. An anterolateral thigh flap was utilized to supply: soft tissue for the forehead reconstruction, vascularized fascia lata for the dural repair, and to act vascular conduit to supply a distally placed latissmus dorsi flap for total scalp reconstruction. We believe this is the first time this combination of double-free, flow-through flap design has been published for the reconstruction of complex, composite scalp and calvarial defects.
