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BACKGROUND: We retrospectively evaluated all our cases of re-excised cutaneous squamous cell carcinomas (CSCCs) in the last 10 years to examine whether they change grade in re-excision histology reports. METHODS: The medical files of 525 patients, which had surgical excision of CSCCs in the Plastic Surgery Department of Aristotle University of Thessaloniki between January 2007 and December 2017 were retrospectively evaluated. All primary and recurrent tumours that were incompletely excised were included in the study. The tumour's grade of both the initial and re-excision histological reports (Broders classification: well, moderate, or poor), age, sex, tumour location, size, infiltration borders (deep or lateral), and perineural invasion was documented. RESULTS: From a total number of 525 CSCCs, 24 patients with 24 incompletely excised lesions were identified. Perineural invasion was noticed in 16 (66%) of patients. In 15 cases (62, 5%), poorer differentiation was recorded following re-excision (group A), whilst in nine patients (37, 5%), the grade remained the same (group B). No statistical significance was observed on age (P = 0.106), tumour size (P = 0.382) and perineural invasion (P = 0.658) in both groups. A positive correlation between male gender and infiltrated border location (deep) and change of grade was observed (P = 0.014, P = 0.000). CONCLUSIONS: We would strongly advise re-excision in incompletely excised lesions except in patients that are unwilling or unfit to undergo another surgical procedure as incompletely excised lesions may change into a poorer degree of differentiation in re-excision histology reports.

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The management of craniofacial conditions, especially in the setting of a large general hospital, is ideally achieved by a focused team in a multidisciplinary clinic. The purpose of this article was to present the design, modus operandi and outcomes of a newly formed dedicated craniofacial multidisciplinary outpatients' clinic at the first year of operation endpoint within a public healthcare structure.

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Our aim is to analyze the results of immediate breast reconstruction in women with macromastia after skin-reducing mastectomy (SRM), with an emphasis on complications and risk factors. Between 2008 and 2013, fifty women with hypertrophic breasts, aged 21-74 years, underwent immediate expander-based breast reconstruction after Wise pattern SRM. An inferiorly based de-epithelialized skin flap was sutured to the inferolateral border of the pectoralis major muscle and covered the expander. Thirty-five women had a unilateral and fifteen a bilateral procedure (total 65 breasts). In all cases, Becker-35 expanders of volume ranging from 365 to 685 cc were used. Risk factors (BMI, smoking, expander's size, preoperative irradiation, chemotherapy) and complications were recorded. Follow-up up to 60 months was compiled. In all cases, the myodermal pouch provided safe coverage and support of the expander. Postoperative complications occurred in 18 out of 65 breasts (27.6%) and included skin ischemia in 11 breasts (16.9%), late infection in two (3%), seroma and expander rotation in four and one, respectively (6.1 and 1.5%), and severe peri-prosthetical contraction in five breasts (7.6%). Statistical analysis showed that complications were significantly related to preoperative radiotherapy and smoking; no significant correlation was documented between complication rates and chemotherapy, BMI, age or expander's size. We suggest that the inverted-T SRM, creating a combined "myodermal" flap for the coverage of a Becker expander, is a useful single-stage reconstructive option for patients with macromastia. Preoperative radiotherapy is significantly related to higher postoperative complication rates, and may result in a less optimal reconstructive outcome. 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.

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Early post-burn ischemic necrosis of the skin is of particular interest in modern burn research. The purpose of this study was to test the hypothesis that blood perfusion could be improved by the topical application of vasoactive substances. A sample of 55 wistar rats was used to investigate the effect of 0,4% nitroglycerin ointment (Rectogesic(®)) comparatively to no application and placebo. The beneficiary action of 5% prilocaine/lidocaine cream (EMLA(®)) in burn blood perfusion was also tested comparatively to Rectogesic(®). Both preparations were tested respectively to non burned controls. Laser Doppler assessment of blood flow at 15, 30, 45, 60, 120 and 180 minutes after preparation application, demonstrated that the use of Rectogesic(®) improved perfusion at all measurements compared to placebo and to no preparation application (p&0,05). There was no statistical significant difference in the effect of the two preparations.

La nécrose ischémique précoce de la peau brûlée est d'un grand intérêt dans la recherche actuelle en brûlologie. Le but de cette étude était de vérifier l'hypothèse que la vascularisation peut être améliorée par l'application topique de substances vaso-actives. Un échantillon de 55 rats Wistar a été utilisé pour étudier l'effet de 0,4% onguent à la nitroglycérine (Rectogesic®) comparativement à aucune application d'onguent et un placebo. L'action bénéfique de la crème lidocaïne (EMLA®)( 5% prilocaïne) sur la vascularisation cutanée a également été testé comparativement àvec le Rectogesic®. Les deux préparations ont été testées respectivement sur des témoins non brûlés. Une évaluation Laser Doppler du flux sanguin à 15, 30, 45, 60, 120 et 180 minutes après l'application de la préparation, a démontré que l'utilisation de Rectogesic® améliore la circulation à chaque mesure par rapport au placebo et par rapport à la non application d'onguent (p&0,05). Il n'y avait aucune différence statistiquement significative dans l'incidence des deux préparations.

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BACKGROUND: Benign lesions of the breast in total are much more frequent than malignant ones. However, there are no epidemiologic data on the prevalence of benign or malignant tumours of the nipple, and the bibliography on benign nipple tumours in general is limited. AIMS: To present some rare cases of benign nipple tumours and review the literature. MATERIALS AND METHODS: Four cases of rare benign nipple tumours: neurofibromas, wart, leiomyoma and milium are presented. The literature search on benign nipple tumours was performed using MEDLINE, Pubmed, and Cochrane databases with limits: English language, human species and available abstract. The keyword used was 'benign nipple tumours'. RESULTS: The initial search retrieved 337 articles. The papers were reviewed and the articles that referred to benign lesions that appeared at the nipple specifically were identified. Different entities that were described included: neurofibroma, leiomyoma, milium, florid papillomatosis, syringomatous adenoma, nevoid hyperkeratosis, fibroma, pseudolymphoma and haemangioma. DISCUSSION: Differential diagnosis of benign tumours of the nipple can be demanding for the physicians. Many of the symptoms and signs like pruritus, serosanguinous discharge, lichenification, erosion and nodular enlargement are produced by either malignant or benign nipple lesions. Radiology can be unclear in the diagnosis of nipple abnormalities. CONCLUSION: Histological examination of the lesion can be the only definite answer in these cases.

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The electric fly-swatter is a household device used widely in Greece to kill mosquitoes. It consists of a racket-shaped electrical screen which is free of toxic and other chemicals. When the screen touches the insects, the contact generates an electric flash of light and the insects are incinerated. We present the case of a 15% flame burn caused by the flash of light produced by an electric fly-swatter. According to our review of the literature, this is the second case of burn injury caused by an electric fly swatter.

Le chasse-mouches électrique est un appareil ménager largement utilisé en Grèce pour tuer les moustiques. Il se compose d'un écran électrique en forme de raquette, qui est exempt de produits chimiques toxiques. Lorsque l'écran touche les insectes, le contact génère un flash électrique de la lumière et les insectes sont incinérés. Nous présentons le cas d'une brûlure sur 15% de la surface corporelle causée par le flash de lumière produite par une tapette à mouche électrique. Selon notre revue de la littérature, c'est le deuxième cas de brûlure causée par une tapette à mouche électrique.

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The dorsoradial flap is a recently described cutaneous flap, which is harvested from the distal forearm and indicated for covering dorsal soft tissue defects of the hand and thumb. Vascularization of the flap is assured by a cutaneous branch of the radial artery, which arises at the level of the first intermetacarpal space and supplies the skin of the distal quarter of the forearm dorsum. This area corresponds to the skin island of the dorsoradial flap. We report our clinical experience on seven patients where this flap was used for covering post-traumatic defects of the thumb. Dimensions of the defect varied from 18 to 28 cm(2). The donor site was skin grafted. All flaps survived and provided satisfactory coverage of the defect. Based on a secondary vascular axis, the flap has a large skin paddle and a wide rotation arc that allows soft tissue reconstruction of the dorsal and radiopalmar areas of the thumb.

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Late presentation of extravasation injuries from chemotherapeutic agents is not uncommon. Twenty-four patients with extravasation injuries presented with upper limb extravasation but without any skin necrosis between the second and the fourteenth day following injury day. We flushed out the infiltrated area with 300-500 ml of normal saline through multiple stab incisions. All 24 patients responded well to the procedure and no further complications occurred. The average time for the complete healing of the wounds was 15 days. All the patients were able to continue their chemotherapy treatment without delay. Patients were followed up for a mean period of 13 months. They all recovered with no functional deficit and only mild scarring. Early recognition and immediate treatment of extravasation injuries are of paramount importance. In cases with no evidence of skin necrosis, a delayed wash-out procedure appears to be very effective in removing the extravasated drug and minimizing further tissue damage.

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The quality of life of burn-injured patients can be impaired physically and psychologically. Burn patients who experience facial disfigurement have psychological, social, and economic difficulties living with their appearance in addition to difficulties associated with their medical treatment. The aim of this review was to investigate, within a cognitive behavioural framework, the effect of facial disfigurement on body image and social integration in burn patients. Body image is a complex concept used to express the mental image of a person's physical self. Newell offered a cognitive-behavioural model which drew on clinical studies of phobic disorders, assuming that many of the psychological difficulties in patients who have suffered a threat to their body image are mediated primarily by fear and avoidance. The model proposes two ends of a continuum for disturbed body image: confrontation leading to social integration, and avoidance leading to social isolation. The literature suggests that many of the confrontational and adaptive processes described in the model are likely to be important in addressing facial disfigurement issues in burn patients. However, the conclusions drawn may be entirely speculative until they are confirmed by sufficient robust research evidence.

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Although conservative management is usually proposed for haemangiomas occurring in infancy, the presence of these tumours on the face may result in severe complications and provide an indication for treatment. In this paper, we report 35 patients who underwent surgical treatment for facial haemangiomas. The series consists of 23 females and 12 males, ranging in age from 2.5 months to 35 years. In six patients early surgery, before the age of 2 years, was performed because of severe complications, including visual occlusion, repeated bleeding and distortion of adjacent structures. In 16 children surgical resection of haemangiomas was carried out between 2 and 5 years of age, before complete involution. In 13 patients persisting haemangiomas were surgically treated at an older age. The operative technique depended on the location and size of the lesion, and focused on resection of the tumour and reconstruction of the adjacent structures when necessary. The postoperative outcomes were very satisfactory. Early surgery is mandatory in the management of large periocular haemangiomas, to prevent secondary amblyopia, and proliferative labial tumours, which are prone to bleeding and cause difficulty while eating. Early surgical treatment is also recommended for nasal-tip haemangiomas, which regress very slowly and may result in severe distortion of the cartilaginous framework. In conclusion, facial haemangiomas causing functional disturbance or serious psychological distress deserve surgical excision before the age of expected spontaneous regression; surgery can provide active treatment with excellent results and minimal morbidity.

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Free-fibula transfer has been widely used since 1975. Many modifications have been described; one of them, association of the lateral part of the soleus muscle to the fibula, is reported here through a 14-case series. This composite flap is intended for extensive defects of the lower limbs involving bone and soft tissues. The flap is considered by the authors to be reliable, with a constant vascularization. A 20-cm length offibula may be harvested associated either with the lateral part of the soleus muscle or with the whole muscle. Moreover, the soleus muscle represents a vascular security inasmuch as it preserves both medullar and periosteal bone supply. Fourteen cases have been performed by the authors since 1978 and could be reviewed with a minimum 2-year follow-up. Average length of bone defect was 12 cm, and average length offibula harvested was 18.6 cm. Soft-tissue defect was always associated and ranged from 8 x 4 cm to 20 x 30 cm. The fibula was harvested with the lateral part of the soleus muscle in 10 cases and with the whole soleus muscle in 4 cases. One total treatment failure was reported and was related to intimal degenerative lesions on veins used for arteriovenous bypass. In other patients, mean time for bone healing was 11 months. Patients could walk again, on average, 17 months after reconstruction. Sequelae at the donor site were minimal.

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In the present article, the authors describe a new chondrocutaneous island flap from the ear helix for nose reconstruction. Anatomic studies showed that helix vascularization depends mainly on the superficial temporal vessels. The presence of vascular communications between the anterior frontal branch of the superficial temporal system and the supraorbital and supratrochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. This new flap has been used successfully in seven cases for reconstructing composite defects of the nasal tip and ala. The donor-site defect is repaired with an advancement and rotation flap from the helical rim, leaving an inconspicuous scar and giving an acceptable cosmetic result of the donor area.

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The authors describe a new chondrocutaneous reverse island flap from the ear helix for nose and eyelid reconstruction. Anatomic studies showed that the blood supply of the helix is derived from the superficial temporal system. The presence of vascular communications between the anterior frontal branch of the superficial temporal artery and the supra-orbital and supra-trochlear arterial systems allows this flap to be used in a reverse vascular flow fashion. Three flaps have been successfully used for reconstruction of alar and nose tip defects and in one case for total lower eyelid reconstruction. The donor site is repaired with an advancement and rotation flap from the helical rim giving an acceptable result. In this paper, the authors propose a new pedicle flap for reconstruction of complex nose and eyelid defects.

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Interpositional microvascular grafts are very often required in reconstructive surgery for bridging microvascular defects, particularly in association with replantation of amputated segments and free tissue transplantation. The present experimental study was undertaken to evaluate patency and healing of small-diameter polytetrafluoroethylene (PTFE) prostheses and to compare them with those of microvenous grafts. 10-mm long microarterial PTFE grafts of 1 mm internal diameter were implanted into the femoral artery of the rabbit to restore vascular continuity. Patency was assessed by Doppler ultrasound up to four weeks postoperatively. After harvesting, all grafts were evaluated macroscopically and examined by light and transmission electron microscopy. According to our results, five of 20 re-explored PTFE grafts (25%) remained patent at four weeks, while all microvenous grafts were judged to be patent at the same time. The difference between patency rates was found to be statistically significant (p < 0.0001). Recent literature on the experimental use of microvascular prostheses is reviewed and various factors affecting graft patency are discussed.

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The dorsal digitometacarpal flap or extended distal pedicled dorsal metacarpal flap is a new skin flap, useful in reconstructing large distal defects on the dorsal aspect of the digits. It is raised on the dorsum of the hand, over an intermetacarpal space. Its vascularisation is provided by proximal dorsal cutaneous branches of the digital collateral arteries through the rich, anastomotic arterial network of the webspace. This flap is a useful flap compared to others flaps harvested from the dorsum of the hand, such as the reverse metacarpal flaps. The operative procedure preserves the dorsal interosseous muscles aponeurosis, the junctura tendinum and the dorsal metacarpal artery. Its vascularisation depends on the webspace arterial network; it is constant contrary to the dorsal metacarpal arteries of the ulnar spaces. This flap is indicated to cover distal defects on the dorsum of the digits because of its large rotation arc. The anatomical basis and operative technique of the flap are described. Two out of 22 clinical cases were selected to illustrate the ability of this flap for reconstruction of digital defects.

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Two original operative techniques of raising the extensor digitorum brevis muscle flap are presented. These methods allow for covering distal foot defects that are difficult to cover by other reconstructive means. In the first technique, the flap is based on an extended distal pedicle supplied by the dorsal interosseous artery of the first intermetatarsal space. In the second technique, the flap receives its vascular supply from the medial tarsal artery; this procedure may be valuable when the vascular supply of the dorsalis pedis pedicle has been disrupted. To confirm the availability of these vascular pedicles, cadaver dissections were performed and proved that the extended pedicle dissection enhances the rotation arc of the flap. Four selective clinical cases, in which the flap was successfully used, are discussed. Advantages of these techniques, in reconstructing large defects in the distal foot, are delineated.

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The submental flap is an island myocutaneous flap supplied by the submental artery divided from the facial artery. Large skin paddles (up to 7 x 18 cm.) can be raised, perfectly matching with facial color. As an island flap it allows coverage of the homolateral oral cavity or the homolateral face (except the medial forehead region). Including the facial vessels in its pedicle allows a safe free transfer. A greater are of rotation is obtained transferring the flap on its distal pedicle. One can include in the flap a segment of internal basilar margin. The resulting scar is perfectly hidden under the mandible. The operative protocol is now well defined and makes the flap easy to use. 21 flaps have been transferred, resulting in a single partial necrosis of a flap extremity.

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Bone growth and the development of epiphyseal plates are disturbed after the replantation of amputated extremities in children, but the potential for continued skeletal growth is almost always maintained in the replanted part. In this reported series of 12 children, all younger than 15 years old, 13 amputated parts of the upper limb have been successfully replanted. After long-term follow-up (from 21 to 216 months), bone growth of the replanted parts was clinically and radiologically evaluated. Two different growing segments were distinguished: the proximal bone segment, directly injured from the initial trauma, and the distal replanted part. Average longitudinal growth recorded was 94.5 percent and 92.7 percent, respectively. Two young patients demonstrated overgrowth of the proximal bone segment, which attained 110 percent and 118 percent of expected growth. Although it is difficult to determine all the parameters affecting the prognosis of post-traumatic reactions in growing cartilaginous plates, the level of amputation is considered to be a significant prognostic factor for the epiphyseal growth of the replanted part.

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