Levator anguli oris muscle based flaps for nasal reconstruction following resection of nasal skin tumours

<p>Abstract</p> <p>Background</p> <p>surgical excision remains the best tool for management of skin tumors affecting nasal skin, however many surgical techniques have been used for reconstruction of the nasal defects caused by excisional surgery. The aim of this work is the evaluation of the feasibility and outcome of levator anguli oris muscle based flaps.</p> <p>Methods</p> <p>Ninety patients of malignant nasal skin tumours were included in this study. Age was ranged from four to 78 years. For small unilateral defects affecting only one side ala nasi, levator anguli oris myocautaneous (LAOMC) flap was used in 45 patients. For unilateral compound loss of skin and mucus membrane, levator anguli oris myocautaneous mucosal (LAOMCM) flap was used in 23 patients. Very large defects; bilateral either LAOMC or LAOMCM flaps combined with forehead glabellar flaps were used to reconstruct the defect in 22 patients.</p> <p>Results</p> <p>Wound dehiscence was the commonest complication. Minor complications, in the form of haematoma and minor flap loss were managed conservatively. Partial flap loss was encountered in 6 patients with relatively larger tumours or diabetic co-morbidity, three of whom were required operative re-intervention in the form of debridement and flap refashioning, while total flap loss was not occurred at all.</p> <p>Conclusions</p> <p>Immediate nasal reconstruction for nasal skin and mucosal tumours with levator anguli oris muscle based flaps (LAOMC, LAOMCM) is feasible and spares the patient the psychic trauma due to organ loss.</p

Total breast reconstruction using thoracodorsal artery perforator (TDAP) flap with or without implants: Two centers experience

Introduction: The thoracodorsal artery perforator (TDAP) flap has been increasingly used for breast reconstruction mainly due to reduced donor site morbidity compared to latissimus dorse (LD) flap. TDAP flap was mainly described for partial reconstruction of breast defects following breast conserving surgery. This study describes the use of the TDAP flap in total breast reconstruction with or without synthetic implants in two breast units. Methods: Between June 2017 and June of 2022, seven patients were included. Six patients from the Oncology Center, Egypt and one patient from Cambridge Breast Unit. Preoperative perforator mapping method was recorded. Patients’ demographic data, type of mastectomy and reconstruction and surgical outcome were recorded. Results: Five patients had total breast reconstruction without implants, whilst two patients had implant-enhanced TDAP reconstruction. The mean age of was 39 years (31-43), and the mean mean body mass index (BMI) was 28 kg/m2 (23-36). Median hospital stay was 3 days. All patients had immediate breast reconstruction following mastectomy without the need for contralateral symmetrization or corrective surgery. No seroma was reported. Only one patient had complete flap loss, while one patient who had minor wound infection.&nbsp

Total breast reconstruction using thoracodorsal artery perforator (TDAP) flap with or without implants: Two centers experience

Introduction: The thoracodorsal artery perforator (TDAP) flap has been increasingly used for breast reconstruction mainly due to reduced donor site morbidity compared to latissimus dorse (LD) flap. TDAP flap was mainly described for partial reconstruction of breast defects following breast conserving surgery. This study describes the use of the TDAP flap in total breast reconstruction with or without synthetic implants in two breast units. Methods: Between June 2017 and June of 2022, seven patients were included. Six patients from the Oncology Center, Egypt and one patient from Cambridge Breast Unit. Preoperative perforator mapping method was recorded. Patients’ demographic data, type of mastectomy and reconstruction and surgical outcome were recorded. Results: Five patients had total breast reconstruction without implants, whilst two patients had implant-enhanced TDAP reconstruction. The mean age of was 39 years (31-43), and the mean mean body mass index (BMI) was 28 kg/m2 (23-36). Median hospital stay was 3 days. All patients had immediate breast reconstruction following mastectomy without the need for contralateral symmetrization or corrective surgery. No seroma was reported. Only one patient had complete flap loss, while one patient who had minor wound infection.&nbsp

Versatility in Mandibular Reconstruction after Ablative Tumor Surgery, Single Center Experience

Mandibular reconstruction using vascularized osteocutaneous flaps is necessary to improve functional outcomes, such as jaw movement and mastication, and aesthetics after the wide resection of the mandible [1]. Bone grafts had been widely used for reconstruction, with the advent of microsurg ry, such as rib [2], metatarsal [3], radial [4], scapular [5], iliac [6], and fibular [7,8]. Using the fibula for re on truction of mandibular defects&nbsp; through microvascular technique was first described by Hidalgo in 1989 [9]. This microvascular flap depends on peroneal artery and the&nbsp; accompanying veins. This flap is characterized by rich vascularity&nbsp; with a long and wide pedicle as the vascular nourishment to this bone comes through both segmental and intraosseous ways, so, it can withstand multiple osteotomies without fear from any ischemic complications [10]. This makes reconstruction of large defects after radical tumor resection more easy.</p

Alterations of PTEN and SMAD4 methylation in diagnosis of breast cancer: implications of methyl II PCR assay

Abstract Background Diagnosis of breast cancer is more complicated due to lack of minimal invasive biomarker with sufficient precision. DNA methylation is a promising marker for cancer diagnosis. In this study, authors evaluated methylation patterns for PTEN and SMAD4 in blood samples using EpiTect Methyl II QPCR assay quantitative PCR technology. Results Methylation status for PTEN and SMAD4 were statistically significant as breast cancer patients reported hypermethylation compared to benign and control groups (77.1 ± 17.9 vs. 24.9 ± 4.5 and 15.1 ± 1.4 and 70.1 ± 14.4 vs. 28.2 ± 0.61 and 29.5 ± 3.6, respectively). ROC curve analysis revealed that both PTEN (AUC = 0.992) and SMAD4 (AUC = 0.853) had good discriminative power for differentiating BC from all non-cancer individuals (benign and healthy combined) compared to routine tumor markers CEA (AUC = 0.538) and CA15.3 (AUC = 0.686). High PTEN methylation degree was associated with late stages (84.2 ± 17.4), positive lymph node (84.2 ± 18.5), positive ER (81.3 ± 19.7), positive PgR (79.5 ± 19.1), and positive HER2 (80.7 ± 19.0) vs. 67.4 ± 13.8, 70.6 ± 14.8, 72.8 ± 14.9, 72.5 ± 14.7, and 70.2 ± 13.5 in early stages, negative lymph node, negative ER, negative PgR, and negative HER2, respectively. Similar results were obtained regarding SMAD4 methylation. Sensitivity, specificity, positive and negative predictive values, and accuracy for methylated PTEN were 100%, 95%, 99.1%, 100%, and 95%, respectively when differentiated BC from all-non cancer controls. Interestingly, PTEN could distinguish early BC stages with good sensitivity 84.4%, 51.4%, 69.1%, 72%, and 70%, respectively. Conclusion Methylation status of PTEN and SMAD4 is a promising blood marker for early detection of breast cancer. Future studies are needed for their role as prognostic markers