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JAAD Case Reports Feb 2024
PubMed: 38292578
DOI: 10.1016/j.jdcr.2023.11.026 -
Wounds : a Compendium of Clinical... Dec 2023The long-term chronic effect of radiotherapy is commonly referred to as LRTI. Clinical complications such as skin atrophy, tissue fibrosis, endothelial damage, ulcer...
Management of late radiation tissue injury ulcers with continuous topical oxygen therapy supports wound healing in patients of advanced age following Mohs surgery: a case series.
BACKGROUND
The long-term chronic effect of radiotherapy is commonly referred to as LRTI. Clinical complications such as skin atrophy, tissue fibrosis, endothelial damage, ulcer formation, and compromised wound healing are common sequela. Despite advances in medicine over the past decade, there remains a need for effective treatments for LRTI skin necrosis and ulcerations.
MATERIALS AND METHODS
This case series discusses cTOT in 3 patients of advanced age with LRTI wounds having undergone Mohs surgery. All wounds had been recalcitrant to multiple wound care treatments. All patients suffered with significant wound pain as well.
RESULTS
cTOT resulted in complete wound healing in all 3 patient cases. Additionally, all 3 patients reported a significant reduction in wound pain during the course of therapy.
CONCLUSIONS
The positive outcomes exhibited in this case series suggest that cTOT is an effective treatment in the management of Mohs surgery patients with compromised wound healing due to radiation, advanced age, and comorbidities.
Topics: Humans; Ulcer; Mohs Surgery; Oxygen; Wound Healing; Radiation Injuries; Pain
PubMed: 38277630
DOI: 10.25270/wnds/23128 -
JAAD International Mar 2024
PubMed: 38205402
DOI: 10.1016/j.jdin.2023.11.001 -
Cureus Dec 2023Defects with multiple aesthetic subunits may need specific approaches for each subunit. We present a case of a post-surgical defect in a patient who underwent Mohs...
Defects with multiple aesthetic subunits may need specific approaches for each subunit. We present a case of a post-surgical defect in a patient who underwent Mohs micrographic surgery for an invasive melanoma of the earlobe with an exposed parotid gland. We utilized a retroauricular-based rhomboid flap to provide full and immediate coverage for earlobe reconstruction in the setting of insufficient infra-auricular recruitable skin. The addition of Z-plasties at the base of an interpolation flap may reduce rotational restraint, thereby improving perfusion while enhancing flap extension for complete wound coverage where there is a lack of abundant donor tissue. The patient healed appropriately with no evidence of tumor recurrence.
PubMed: 38192968
DOI: 10.7759/cureus.50224 -
NPJ Precision Oncology Jan 2024Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and...
Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.
PubMed: 38172524
DOI: 10.1038/s41698-023-00477-7 -
JAAD Case Reports Jan 2024
PubMed: 38162408
DOI: 10.1016/j.jdcr.2023.11.004 -
The Journal of Dermatological Treatment Dec 2024Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and... (Meta-Analysis)
Meta-Analysis Review
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma with a propensity for recurrence. Its management, particularly in the head and neck (H&N) region, presents unique challenges. This study aimed to evaluate the effectiveness of Mohs micrographic surgery (MMS) compared to wide local excision (WLE) in treating H&N DFSP and its impact on recurrence rates and tissue preservation. A comprehensive search was conducted in PubMed/MEDLINE, yielding 29 relevant studies. We included studies comparing MMS and WLE in adult patients with H&N DFSP and reporting local recurrence outcomes. Data were analyzed using random effects analysis, with a meta-analysis performed for comparative studies. Analysis of studies demonstrated a lower recurrence for MMS. Comparative analysis of five studies involving 117 patients showed a significantly lower recurrence rate in the MMS group (2%) compared to the WLE group (19%). Margin status varied between studies, with some achieving negative margins at shorter distances. In the management of H&N DFSP, MMS has emerged as a superior surgical technique, consistently associated with reduced recurrence rates and the potential for tissue preservation. The adoption of MMS should be considered for its capacity to achieve negative margins with fewer processing steps, particularly in anatomically complex regions like the H&N.
Topics: Adult; Humans; Dermatofibrosarcoma; Mohs Surgery; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms
PubMed: 38146660
DOI: 10.1080/09546634.2023.2295816 -
JAAD Case Reports Jan 2024
PubMed: 38144943
DOI: 10.1016/j.jdcr.2023.10.019 -
Journal of Clinical Medicine Dec 2023Large lateral cheek defects can be challenging to reconstruct. Several approaches to reconstruction of these defects have been reported. In the case presented here, we...
BACKGROUND
Large lateral cheek defects can be challenging to reconstruct. Several approaches to reconstruction of these defects have been reported. In the case presented here, we describe an alternative reconstruction method for this type of surgical defect. Detailed Case Description: We present one patient with a large basal cell carcinoma on his lateral left cheek who underwent a complete tumor removal by Mohs surgery and was left with a defect 6 × 6 cm in size. This large defect was closed by performing a double transposition flap under local anesthesia.
RESULTS
Both flaps survived with no loss. The immediate and long-term outcomes were satisfactory, preserving functionality with good cosmetic results.
CONCLUSIONS
Cheek defect reconstruction with the double transposition flap is simple and reliable, with good aesthetic and functional outcomes. It may be considered as an alternative reconstructive method for this type of defect, in an appropriate context.
PubMed: 38137818
DOI: 10.3390/jcm12247750 -
JAAD Case Reports Dec 2023
PubMed: 38125030
DOI: 10.1016/j.jdcr.2023.09.029