The Mercedes flap and its new variants: a 'workhorse' flap for the dermatological surgeon?

BACKGROUND: The plastic reconstruction of defects in problem regions, such as, e.g. the heel, temple, malleolar region, sternum and capillitium, is usually a challenge. OBJECTIVE: We describe the use of the Mercedes flap, a combination of the purse string and advancement flap, and new modifications for use in various body locations. These examples extend the scope of application in tumour surgery of the skin. METHODS: We demonstrate the different techniques and practical application of the repair and evaluate the benefits and limitations. RESULTS: The Mercedes flap and its modifications are an excellent method for repairing various defects in problem locations after tumour surgery of the skin. CONCLUSION: The Mercedes flap and its modifications prove to be a good alternative to other closure types, especially in problem regions such as the shoulder, malleolar region, heel, etc. The procedure is fast and simple, with few side-effects, and proves to be a 'workhorse' flap for the dermatological surgeon.

Chondrocutaneous helix rim advancement flap: two classical and two new modifications for very large defects of the ear.

BACKGROUND: The plastic reconstruction of the ear after microscopically controlled tumor surgery is a particular challenge. The chondrocutaneous helix rim advancement flap (CHRAF) is perfectly suited for the repair of different defects of the helix and even defects beyond. OBJECTIVE: Here, we describe two known and two new modifications of the CHRAF that enlarge the scope of application in tumor surgery of the ear. METHODS: We demonstrate the different techniques and practical application of the repair and evaluate the benefits and limitations. RESULTS: The CHRAF and its modifications is an excellent method for repair of various defects of the helical region of the ear. CONCLUSION: The CHRAF and its modifications proves to be an good alternative to other methods of closure by preserving the anatomical contour and mechanical and acoustic functions in a single-staged procedure with excellent aesthetic results. The two new modifications we introduced here, enlarge the known armentarium for very large defects of the upper pole and the mid-helix of the ear.

[Special indications for negative pressure wound therapy in dermatologic surgery]. / Besondere Indikationen der Vakuumversiegelungstherapie in der Dermatochirurgie.

In recent years negative pressure wound therapy (NPWT) has gained more and more supporters in dermatologic surgery. NPWT has become one of the standard therapeutic options, especially for non-healing diabetic, venous and arterial ulcers of the legs. When managing large wounds after tumor surgery, NPWT is frequently used to induce granulation tissue and reduce wound size before the wound is closed with split- or full-thickness skin grafts or local flaps. In addition to these well-established uses, NPWT can be also employed for a variety of "new" or rare indications, some of which are presented in this review.

[Bitemporal scalp necrosis : a very rare manifestation of giant cell arteritis]. / Bitemporale Skalpnekrose : Eine sehr seltene Manifestation der Riesenzellarteriitis.

A 71-year-old woman developed progressive spreading of bitemporal scalp necrosis within 4 weeks accompanied by headaches, myalgia of the shoulder girdle and muscle weakness that had started a few months previously. No additional diseases were reported. The suspected temporal giant cell arteritis could be confirmed by temporal artery biopsy. Therapy with glucocorticoids led to a rapid resolution of clinical symptoms and was tapered over 18 months. Recovery of the scalp necrosis emerged following second intention healing and split-skin transplantation of necrotic areas after successful wound conditioning. The case study demonstrates a rare and serious complication of temporal arteritis which is often accompanied by a poor prognosis.

[Dermatobia hominis infection in a 3-year-old child]. / Dermatobia-hominis-Infektion bei einem 3-jährigen Kind.

In the context of increasing travel to the tropics, outpatient services are more frequently confronted with non-domestic diseases in Europe. A 3-year old child presented with a painful tumor of the scalp. After incision of the furuncle-like lesion, we extracted a larva of the botfly Dermatobia hominis. Botflies are mainly encountered in Central and South America; they should be considered if patients demonstrate a furuncle-like lesion and have returned from a holiday in these endemic regions.

Loss of interferon-gamma inducibility of the MHC class II antigen processing pathway in head and neck cancer: evidence for post-transcriptional as well as epigenetic regulation.

BACKGROUND: Abnormalities of the major histocompatibility complex (MHC) antigens by tumour cells impair the cellular immune response and promote tumour evasion from immune surveillance. So far, studies analysing the MHC class II expression levels in head and neck cancer have been limited. OBJECTIVES: Therefore, we investigated the constitutive and interferon (IFN)-gamma-regulated expression profiles of MHC class II antigen processing machinery (APM) in various head and neck cancer cell lines and also analysed the MHC class II expression in head and neck cancer lesions. METHODS: Using immunohistochemistry, flow cytometry, and reverse transcriptase-polymerase chain reaction analyses we investigated the expression pattern of various components of the MHC class II APM in biopsies and cell lines from head and neck cancers. Furthermore, we analysed the class II transactivator (CIITA) and HLA-DR promoter activity in head and neck cancer cells by transient transfection of specific luciferase promoter constructs and finally studied the methylation pattern of the CIITA promoter using methylation sensitive restriction enzymes. RESULTS: Head and neck cancer cell lines analysed in vitro lacked constitutive MHC class II surface expression. Despite the IFN-gamma-mediated induction at the mRNA level, six out of 10 cell lines did not show any relevant MHC class II surface expression. This phenomenon might be attributed to a post-transcriptional dysregulation of specific MHC class II APM components. One cell line displayed a loss of IFN-gamma-induced CIITA-expression that corresponded to impaired MHC class II surface expression, which could be linked to hypermethylation of the IFN-gamma-responsive CIITA-promoter IV. In vivo, immunohistochemistry analyses of 35 patients revealed that about 86% of head and neck cancer tissues exhibit a negative or only marginally positive staining, whereas 14% displayed a heterogeneous or highly positive MHC class II surface expression. There was no statistical correlation between tumour differentiation and the MHC class II expression in head and neck cancer lesions. CONCLUSIONS: Taken together these results suggest a high frequency of MHC class II abnormalities in head and neck cancer in vitro and in vivo, which could occur at different steps of the antigen processing pathway. This information may have a significant impact on practical and clinical aspects of tumour immunotherapeutic strategies.

[Postoperative pyoderma gangrenosum of Cullen]. / Postoperatives Pyoderma gangraenosum Cullen.

The clinical picture in pyoderma gangrenosum varies but a typical medical history with resistance to antimicrobial treatment and worsening or first manifestation of disease because of surgical procedures are indications of this diagnosis. We describe the course of a woman patient who had a pyoderma gangrenosum for more than 1.5 years. After confirming the diagnosis an immunomodulating therapy was initiated until complete remission of the ulcers. Differential diagnosis and different clinicopathologic forms of pyoderma gangrenosum are discussed and an overview of the association with internal diseases is provided.