Surgical Management of Infantile Hemangioma Using the Purse-String Technique: Impact on the Scar

PURPOSE: To assess scar size reduction (after surgery) using the Purse-String (PS) technique compared to elliptic resection for Infantile Hemangioma (IH). METHODS: Retrospective study of 431 patients with IH or its sequelae, referred to the multidisciplinary Center for Vascular anomalies between 2005 and 2012. Photographs taken before and after management were analyzed. Statistical analyses were conducted considering each tumor independently. The study was accepted by our local ethics committee. 126 patients underwent surgery, 57 were treated using the PS technique. Fourteen patients could not be used for analysis due to lack of information and two patients were operated using a PS for more than one IH. All tumors were measured by estimating the two diameters of an elliptic form covering the majority of the lesion. The scar length of an elliptic resection was estimated using the double of the length of the shortest diameter. The scar lengths of both techniques were compared using a Paired Sample T-Test. RESULTS: The 48 IH reviewed in our study had a mean surface before surgery of 8.68 cm2 (±7.43 cm2). 41 IH operated by PS presented a mean scar length of 2.57 cm (±1.25 cm) compared to a scar length estimation for an elliptic resection of 5.95 cm (±2.50 cm) (Paired T-test, P-Value < 0,001). Seven scars (n=7/48, 14.58%) suffered from scar widening and the mean scar surface was 3.51 cm2 (±2.72 cm2) opposed to an initial mean surface of 6.26 cm2 (±2.37 cm2) before surgery (Paired T-test, P-Value = 0,019). Four patients needed scar revision and three patients underwent subsequent lipofilling. CONCLUSION: The Purse-String technique is a useful tool in the surgical management of infantile hemangioma. Sometimes used for partial resection, it can be used alone or in combination with other techniques

Hydrosurgery, a new therapeutic perspective in early care of giant congenital nevi: A preliminary series of four cases

Summary Background: Congenital melanocytic nevi are present at birth or may appear in the first weeks of life. Small and medium-size lesions are relatively common, affecting approximately 1% of newborns; large or giant melanocytic nevi occur in 1/20,000e1/500,000 births. The main concern raised by these lesions is their potential risk of degeneration which is strongly size-dependent and estimated in the literature between 0% and 40% over a lifetime. Although multiple treatment modalities have been described, to date there is no consensus regarding their optimal management. Patients and methods: Four neonates (three females and one male) presenting giant congenital nevi with a mean age 12 days (7e24 days) were referred to our Plastic Surgery department for treatment from 2012 to 2013. All patients underwent an alternative dermabrasion procedure with the innovative use of hydrosurgery. All procedures were performed under general anaesthesia by the same senior operator (Dr. B.Bayet). Results: The mean operating time was significantly reduced compared to conventional techniques. No complications were observed in the postoperative course. Good final results were obtained in three patients after a mean follow-up of respectively 11, 8 and 4 months. The first operated neonate showed a complete recurrence of pigmentation of the treated areas after 6 months. Conclusions: The need for early treatment in giant congenital nevi is admitted by all. Hydrosurgery is easy to use and allows to achieve a selective and symmetric resection with an obvious cleavage plane and clean-cut borders. Furthermore, this procedure has convinced us with its speed of use, ensuring significant time saving, and therefore less morbidity for the neonate. Aesthetic results as well as recurrence rate may be comparable to conventional techniques. However, regular follow-up to detect any malignancy is necessary

Histiocytoid Ductal Carcinoma In Situ of the Breast: Not All Intraductal Foamy Cells Are Macrophages!

With the advent of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has increased. DCIS accounts for around 20% of breast cancers diagnosed at present. The histiocytoid variant of clear cell DCIS is a rare subtype of DCIS, characterized by epithelial cells with a clear and foamy cytoplasm. Histiocytoid DCIS serves as a potential diagnostic pitfall, since it can be easily mistaken for intraductal collections of foamy macrophages. In this article, we report a particular case of biphasic DCIS, characterized by an extensive histiocytoid-type clear cell component and a conventional "non-clear" cell component. Both components presented with HER2 protein overexpression. We discuss the diagnostic challenge and differential diagnosis of clear cell DCIS, as well as the role of HER2 overexpression in DCIS pathogenesis

The use of MATRIDERM as a single stage salvage procedure to cover exposed dura Mater.

Reconstruction of large full-thickness scalp defects with exposed cranial bone or dura are usually performed with free flaps. However, certain medical conditions in fragile patients may contraindicate this type of surgery. In those circumstances, Dermal Regeneration Templates (DRTs) can provide an alternative solution to flap surgery. We here report the case of a 79-year old woman presenting with a large cranial defect and exposed dura mater after developing postsurgical Pyoderma Gangrenosum and subsequent free flap failure. A one-stage salvage reconstruction was successfully performed with MATRIDERM (MedSkin Solutions Dr. Suwelack AG, Germany) and a split-thickness skin graft (STSG) with a Vacuum-Assisted Closure (VAC) dressing

Prepectoral immediate breast reconstruction with polyurethane foam-coated implants: Feasibility and early results in risk-reducing and therapeutic mastectomies.

There is a renewed interest for prepectoral reconstruction. We aimed to describe the feasibility and the early complications associated with immediate one-stage direct-to-implant (DTI) reconstruction using prepectoral anatomical polyurethane (PU) foam-coated implants alone, for women with breast cancer or mutation carriers undergoing risk-reducing surgery. We performed a single-center, retrospective review of 50 patients (mean age of 49 years), who underwent skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) and immediate prepectoral PU implant-based reconstruction. All procedures were performed by the same senior operator, from July 2018 to March 2020. A total of 64 mastectomies (25 SSMs and 39 NSMs) with one-stage prepectoral PU foam-coated implant reconstruction were performed. Out of 50 patients, 6 required surgical revision within 30 days, because of hematoma (2), wound dehiscence (2) infection (1), and full thickness nipple-areolar complex (NAC) necrosis (1). Four patients developed a cutaneous rash with spontaneous resolution. Statistical analysis showed a significant influence of hypothyroidism and previous radiotherapy on the risk of complications. The association with prior radiotherapy (pRT) was not significant using binary logistic regression. When excluding oncological reasons and patient's wish for NAC excision, our decision to perform an NSM was influenced by breast cup size, preoperative measurements, and breast weight. Early experience with immediate prepectoral DTI reconstruction with PU-covered implants alone suggests that it is a reliable procedure. Prior breast irradiation does not increase postoperative complication rates in our series. NAC preservation was decided according to preoperative lower breast measurements

M-Y Plasty: a Simple Technique for the Reconstruction of Small Periorbital Defects

The goal of this case series analysis is to demonstrate that peri-orbital small to medium-sized skin defects can be treated by a direct closure associated with a M-Y plasty. By crossing the orbital eyelid, this technique allows to avoid large undermining and longer scars that are usually associated with the use of local flaps in this region. Twenty patients were operated on between May 2018 and November 2019, for the removal of periorbital skin tumors. Eleven were at high risk of developing delayed healing, post-operative hematoma, or showed a very thin skin, poorly prone to tolerate a large undermining. Defect size was between 1.5 to 13 cm2. All the defects underwent a direct closure with a M-Y plasty. Eighteen patients healed without any complication. Two had a delayed healing at the Y junction. No hematoma, abscess, cutaneous necrosis, or unaesthetic deformity were recorded. The majority of our patients had significant comorbidities, so that a flap reconstruction was considered too aggressive. We here demonstrate that through a direct closure associated with a plasty, they could all benefit from a oncological excision, with a safe reconstruction and very few complications

Pyoderma gangrenosum with severe systemic features, after augmentation mammoplasty

We report a rare life-threatening presentation of postsurgical pyoderma gangrenosum (PG) after augmentation mammoplasty in a 32-year-old woman. Six days after surgery, the patient presented with fever and erythema at surgical wounds. In view of a suspected postsurgical infection, the patient was first treated with antibiotics and removal of breast protheses. In spite of this treatment, in a few days the patient developed a state of shock with multiorgan failure. The antibiotic coverage was broadened several times and multiple extensive surgical debridement with resection of the mammary glands were performed but did not improve the clinical situation. Twelve days after admission, the diagnosis of PG with systemic features was suspected and clinical improvement was observed within 24 h of methylprednisolone administration. PG can mimic the cutaneous and systemic features of necrotizing wound infection of surgical site. Biopsy and culture are critical to differentiating necrotizing neutrophilic dermatosis from necrotizing infection. The diagnosis of this less common form of PG is challenging and this case highlights how the frequent misdiagnosis with infection may result in ineffective antibiotic treatment and how the unnecessary surgical debridement may prolong and exacerbate the condition

High-grade primary angiosarcoma of the breast with MYC amplification: case-report of a 16-year-old patient and review of the literature

Primary angiosarcoma of the breast is a rare but aggressive disease with a poor 5-year survival. An early and precise diagnosis has to be made in order to improve prognosis. A large vascular breast mass should therefore always be considered as an angiosarcoma until proven otherwise. Referral to tertiary care centre and multidisciplinary management are strongly recommended. There is no standard therapeutic approach but surgery remains the mainstay of angiosarcoma treatment. Patients need a close follow-up because recurrence is frequent and often precocious. We report the rare case of a 16-year-old patient presenting a primary angiosarcoma of the breast with MYC amplification. Such cases should always be reported, as MYC amplification could in a close future be routinely used as a marker of disease aggressiveness and possibly as a therapeutic target