Radiation therapy for squamous cell cancer of the skin in a patient with xeroderma pigmentosum.

Xeroderma Pigmentosum is an autosomal recessive disease characterized by increased sensitivity to ultraviolet radiation. Adjuvant radiotherapy (RT) is an important locoregional treatment modality for high-risk skin squamous cell cancers (SCCs). We present a case of an adult with high-risk skin SCC treated with standard adjuvant RT and followed-up for >4 years with acceptable side effects.

Anatomical Landmarks of the Beard Region.

BACKGROUND: With recent advancements in hair restoration techniques, hair can be transplanted into nonscalp areas, such as the beard region, and the result looks natural. Although scalp zones and landmarks have been available for planning and designing the hairline, landmarks that will determine the beard lines are yet to be presented and made known for clinical practice. OBJECTIVE: This study aimed to determine and analyze the beard lines and anatomical boundaries of the beard area to provide a more natural restoration/reconstruction appearance. MATERIALS AND METHODS: The soft-tissue landmarks of the face that will enable physicians to create natural-looking beard lines were determined. Based on these important points, beard lines were analyzed with anthropometric methods by using the photographs of 32 male volunteers. RESULTS: The ideal upper and lower beard lines and the anatomical boundaries of the beard area were determined using these landmarks. CONCLUSION: These lines ensure that beard restoration/reconstruction provides a more natural appearance.

A Distinct Technique of Intermaxillary Fixation Screw Application to Condylar Process to Fracture Reduction in Open Approach of Condylar Fracture Treatment.

ABSTRACT: The aim of this letter is to present the surgical experience obtained from a patient, in whom the proximal segment was better manipulated for precise alignment after application of the intermaxillary fixation screw.

Traumatic Avulsion of Upper Eyelid Skin Following Surgery in a Patient With Multiple Myeloma and Amyloid Light-chain Amyloidosis.

Multiple myeloma (MM) is a common hematologic malignancy. Primary systemic amyloidosis or amyloid light-chain (AL) amyloidosis is a rare disease. PURPOSE: This article presents the case of a patient with MM and AL amyloidosis who experienced a severe case of medical adhesive-related skin injury. CASE STUDY: A 64-year-old man with MM, AL amyloidosis, and diabetes presented with a necrotic wound on his left heel that required surgical debridement. The patient experienced a traumatic avulsion of the right upper eyelid skin during the removal of the corneal abrasion preventive tape as well as traumatic avulsion of the left upper eyelid skin while the patient's face was being cleansed. The avulsed right upper eyelid skin above the tarsus was repaired with a full-thickness skin graft. The partly avulsed left upper eyelid skin was repositioned, and an excisional biopsy was taken. Both upper eyelids healed uneventfully. The biopsy specimen revealed increased amyloid deposition in the dermis, subcutaneous tissue, and areas surrounding the veins and sweat glands. CONCLUSION: This case illustrates the increased risk of medical adhesive-related skin injury and other skin damage in patients with MM and AL amyloidosis. In these patients, the use of tape should be avoided to prevent intraoperative corneal abrasion.

Correction of Brassiere Strap Grooves with Fat Injections.

BACKGROUND: The size and weight of hypertrophied breast can cause both physical and psychological problems. Although the majority of these problems can be solved with breast reduction surgery, the particular problem of development of brassiere strap grooves on the shoulders due to the weight of the breasts cannot be corrected with this method. OBJECTIVES: Breast reduction surgery focuses only on the increased dimensions of breasts: fullness of the thoracic wall lateral to the breasts, as well as the appearance of brassiere strap grooves, need to be taken into consideration to obtain a better upper body image. Therefore, we present a series of 10 female patients who were treated with fat injections for the correction of brassiere strap grooves. METHODS: Reduction mammaplasty and fat injections into the brassiere strap grooves were performed during the same session. RESULTS: Dramatic changes are obtained with judicious placement of fat into the bra strap grooves. CONCLUSIONS: A more aesthetic and harmonious look can be obtained with using these combined aesthetic procedures in appropriately selected patients. LEVEL OF EVIDENCE: 4 Therapeautic.

Brassiere strap groove deformity: definition and classification.

UNLABELLED: Brassiere strap grooves develop mostly on the shoulders of women with hypertrophied breasts. Varying degrees of the deformity are observed in such cases. To date, there is no universally accepted definition and classification for brassiere strap groove deformity. In this study, we aimed to define and classify the deformity in order to inform consultants and future surgeons. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Repair of a postappendectomy massive ventral hernia using tissue expanders.

Reconstruction of large abdominal wall defects is a challenging problem. Various reconstructive techniques have been described in the surgical literature each with its advantages and disadvantages. In this report we describe our experience in treating a patient with large abdominal wall defect by staged abdominal wall reconstruction utilizing prosthetic mesh in conjunction with tissue expanders. A 41-year-old male presented with abdominal pain. Exploratory laparotomy showed perforated appendicitis with intraabdominal abscess of 1,500 mL. Postoperatively, he developed intraperitoneal sepsis. To prevent abdominal compartment syndrome, he was reoperated and left with "open abdomen". After several open abdomen lavages, his abdominal wall defect was allowed to granulate. After epithelization of the defect, the abdominal wall was reconstructed using prosthetic mesh and tissue expanders. The tissue expansion process was well tolerated. We suggest that the use of tissue expanders provides reliable and well-vascularized soft-tissue coverage in abdominal wall reconstruction.

Release of the postburn contractures on the lower abdomen and inguinal regions using modified abdominoplasty.

To return the patient to normal function while maximizing aesthetic appearance is the most important issue in burn management. Although many techniques such as pressure garments and silicone dressings are used in the initial scar management to optimize final appearance, avoiding residual scarring is impossible after extensive burns. The changes in appearance and limitations imposed by the burn scar contribute to a negative body image. Burn patients frequently require numerous procedures over many years to achieve optimum function, but aesthetic needs are often overlooked in these patients. By assessing such patients with regard to their body image and aesthetic needs, patients who will benefit from a combined aesthetic procedure with burn contracture release are easily identified. The author presents a female patient who underwent modified abdominoplasty for releasing burn scar contractures, providing the dual benefit of improved body contour and burn scar release.

Effects of insulin-like growth factor-I and platelet-rich plasma on sciatic nerve crush injury in a rat model.

OBJECT: Local administration of insulin-like growth factor-I (IGF-I) has been shown to increase the rate of axon regeneration in crush-injured and freeze-injured rat sciatic nerves. Local administration of platelet-rich plasma (PRP) has been also shown to have a measurable effect on facial nerve regeneration after transection in a rat model. The objective of the study was to compare the effects of locally administered IGF-I and PRP on the parameters of the Sciatic Function Index (SFI), sensory function (SF), axon count, and myelin thickness/axon diameter ratio (G-ratio) in a rat model of crush-injured sciatic nerves. METHODS: The right sciatic nerve of Wistar albino rats (24 animals) was crushed using a Yasargil-Phynox aneurysm clip for 45 minutes. All animals were randomly divided into 3 groups: Group 1 (control group) was treated with saline, Group 2 was treated with IGF-I, and Group 3 was treated with PRP. Injections were performed using the tissue expander's injection port with a connecting tube directed at the crush-injured site. Functional recovery was assessed with improvement in the SFI. Recovery of sensory function was using the pinch test. Histopathological examination was performed 3 months after the injury. RESULTS: The SFI showed an improved functional recovery in the IGF-I-treated animals (Group 2) compared with the saline-treated animals (Group 1) 30 days after the injury. In IGF-I-treated rats, sensory function returned to the baseline level significantly faster than in saline-treated and PRP-treated rats as shown in values between SF-2 and SF-7. The G-ratios were found to be significantly higher in both experimental groups than in the control group. CONCLUSIONS: This study suggests that the application of IGF-I to the crush-injured site may expedite the functional recovery of paralyzed muscle by increasing the rate of axon regeneration.

Delayed neuropathy due to organophosphate insecticide injection in an attempt to commit suicide.

Organophosphates (OPs) are commonly used as pesticides throughout the world. Exposures to OPs cause a significant number of poisonings and deaths every year. Organophosphate-induced delayed polyneuropathy is a sensory-motor distal axonopathy which usually occurs after exposure of certain OP insecticides. Neuropathies due to ingestion of OPs have rarely been reported in the literature. Moreover, until now, there is no report of a patient developing organophosphorus injection-induced delayed neuropathy in the literature. We report a patient with serious organophosphorus-induced delayed neuropathy due to malathion injection. The patient was a 32-year-old female who self-injected undetermined amounts of malathion over the median nerve trace on the forearm crease in a suicide attempt which resulted in peripheral neuropathy.

Concomitant cutaneous metastatic tuberculous abscesses and multifocal skeletal tuberculosis.

Tuberculosis, one of the oldest diseases known to affect humans is caused by the bacteria mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one third of cases, other organs are involved. Metastatic tuberculosis abscess is a rare form of skin tuberculosis. It is characterized by nodule and abscess formation throughout the body after hematogenous spread of mycobacterium tuberculosis from a primary focus during a period of impaired immunity. Tuberculosis osteomyelitis is also a rare form of extrapulmonary tuberculosis in pediatric age group. Skeletal tuberculosis pathogenesis is related to reactivation of hematogenous foci or spread from adjacent paravertebral lymph nodes. Weight-bearing joints are affected most commonly. Bilateral hand and foot bone involvement is rarely reported. We present a five-year-old girl with two very rare presentations of the disease such as osteomyelitis and metastatic skin abscess.

Surgical treatment of giant pyogenic granuloma of the upper eyelid.

Pyogenic granuloma (PG), also known as lobular capillary hemangioma, is a benign acquired vascular lesion of the skin and mucous membranes. Diagnosis is aided by history of surgery, trauma or inflammation and characteristic clinical appearance, whereas, definitive diagnosis is made by histopathologic findings. PG is most often located on the head, neck, extremities, and upper trunk. From an ophthalmic perspective, a PG may be located on the eyelids, conjunctiva or rarely on the cornea. We present a case of surgically treated giant pyogenic granuloma of the upper eyelid, and we describe a technique of reconstruction of the upper eyelid skin by bilateral advancement flaps that allows the coverage of small- to medium-sized defects of this region with satisfactory esthetic and functional results.

Ear deformity due to neurofibromatosis type 1.

Neurofibromatosis is an autosomal dominant neurogenetic disorder. It is associated with significant morbidity and results in substantial loss of function as well as significant cosmetic problems. Elephantiasis neurofibromatosa is the most impressive manifestation of the disease because of its size. In this setting, the lesion leads to massive overgrowth of both the skin and the associated soft tissue, causing disturbing deformities. The reported patient had huge plexiform neurofibromas involving both the external right ear and neck regions. Deformed external ear and neck regions were restored surgically with satisfactory cosmetic results.

Monosymptomatic hypochondriacal psychosis presenting with recurrent oral mucosal ulcers and multiple skin lesions responding to olanzapine treatment.

Monosymptomatic hypochondriacal psychosis (MHP) is a form of psychosis characterized by the delusional idea that there is a serious problem in the skin or other body parts. Because MHP patients believe that their complaint is dermatological, not psychiatric, they often admit to several other medical disciplines before coming to a psychiatry clinic. This leads to a series of time-consuming examinations and treatment interventions. In this case report, we emphasize the importance of diagnosing the illness correctly and referring the patient to a psychiatrist. The patient presented in this report has been treated with a new generation neuroleptic, olanzapine. This treatment has led to complete resolution of delusional symptoms. Therefore, we conclude that knowing that MHP is a psychiatric illness allows early establishment of diagnosis and successful treatment.

Giant verruca vulgaris.

BACKGROUND: Common warts (verrucae vulgares) are hyperkeratotic papulonodules that are most often seen on the hands, arms, and legs, but they can be seen anywhere on the glabrous skin. Common warts represent the most frequent clinical lesions produced by the human papillomavirus (HPV). OBJECTIVE: Although they are diagnosed easily, giant, chronic, isolated, solitary, recalcitrant verruca vulgaris involving nail and nail bed on the digits can be misdiagnosed, and the differential diagnosis should be made carefully and verified by biopsies. METHOD: A 50-year-old male patient had a giant periungual verruca vulgaris on his left second finger. It was present for 2 years, was unresponsive to any treatment modality, and was treated by surgical excision. RESULTS: After 18 months of follow-up, there was no evidence of recurrence, and both aesthetic and functional results were quite satisfactory. CONCLUSION: Lesions of long duration generally lose their characteristic histopathologic features, and HPV cannot be detected in these lesions by polymerase chain reaction. Therefore, multiple sections should be examined histopathologically, and extreme care should be taken in order to avoid misdiagnosis.

Effects of granulocyte macrophage colony stimulating factor on random flap healing and immune profile in rats with impaired wound healing by glucocorticoids.

Wound healing involves inflammation, cell proliferation, matrix deposition, and tissue remodeling. Priming the tissue to be incised with proinflammatory cytokines offers a new approach to wound healing. This has been studied mostly in incisional wounds till now. This study was designed to investigate the role of granulocyte macrophage colony stimulating factor (GM-CSF) priming of planned incision lines in random flaps in rats with impaired wound healing due to glucocorticoid administration, and immune profiles of rats were also evaluated. GM-CSF priming of incision lines in immunosuppressed rats was shown to improve the wound healing parameters, hydroxyproline levels, breaking strength, flap survival, and immune profile, although all of the parameters were somewhat lower than those of control group. The findings of this study suggest that wound healing can be accelerated and thus morbidity lowered by making use of the immunomodulator effects of GM-CSF in cases where wound healing is impaired due to systemic disease or drug use and flap reconstruction is necessary.