RESUMEN
Ranula is a benign cystic lesion caused by the escape and collection of salivary mucus. Classically, it is divided into simple ranulas, a cystic mass in the floor of the mouth, and diving/plunging/cervical ranulas, a submandibular mass without apparent intraoral involvement. Although plunging ranula is a well-documented cause of neck swelling, its association with the presence of ectopic sublingual glands is extremely rare, with less than five cases reported. Other cervical cystic lesions may have the same clinical aspect; therefore, advanced diagnostic techniques like a CT scan or MRI play a critical role in early diagnosis. Different approaches have been used to treat ranulas, including non-invasive, minimally invasive, and surgical techniques. The purpose of this paper is to highlight a case report of a giant plunging ranula due to an anatomical aberration of the right sublingual gland, along with a significant literature review.
RESUMEN
Multiple trichoepithelioma syndrome is a rare entity, and little is known about its epidemiological features. Patients usually present with multiple nonsuspicious skin lesions. Surgical excision is the mainstay of treatment, and diagnosis is usually made after the first pathology report. Once the diagnosis is established, patients are kept under clinical surveillance, and surgery is performed again if tumor burden and/or size justifies it. The authors present a male patient who presented to our outpatient clinic for the first time in 36 years without any relevant medical history, medication, or allergies. The patient had complaints of multiple skin lesions spreading across the head and neck regions. Surgical excision of the affected area and resurfacing using local advancement flaps were performed. Pathology reports were always consistent with trichoepitheliomas. No pathology of spiradenoma or cylindroma was ever reported. Usually, tumors are small enough for simple excision and primary closure. However, in the presented case, the size of the tumor and the involvement of central facial aesthetic units demanded a more complex approach.
RESUMEN
BACKGROUND: Implant-based submuscular breast reconstruction (SBR) can be performed with the aid of acellular dermal matrices (ADM) for implant coverage on their inferolateral pole, aiming at providing a biological interface for hiding the implant and therefore reducing the risk of complications. The purpose of this study is to assess the long-term post-operative outcomes obtained using the SBR-specific Native® ADM (DECO med s.r.l., Marcon, Venice, Italy). METHODS: All cases of Native®-assisted immediate SBR performed at our institution between October 2016 and March 2020 were retrospectively analysed. Demographic and surgical data were collected, and post-operative outcomes, including minor and major complications, were evaluated. Particular attention was paid to complications emerging before and after patient discharge. Dependence analyses were performed to uncover statistically significant relationships between risk factors and reconstructive outcomes. RESULTS: Data on 100 patients were collected, for a total of 128 breasts. The mean age of the cohort was 49.5 years, the mean BMI was 23.4 kg/m2, and the mean follow-up was 24 months. Out of this, 14.1% of patients received pre-operative radiotherapy, while 16.4% underwent post-mastectomy radiotherapy. Breasts appeared to develop short-term minor complications more likely during hospitalisation (11.7% vs. 7.8%), while short-term major complications occurred more often after discharge (7.8% vs. 15.6%). The most frequent long-term complications were capsular contracture and contour defects (both 9.4%). Risk factors that showed a statistically significant relationship with complications were pre- and post-mastectomy radiotherapy and post-operative chemotherapy. CONCLUSIONS: The retrospective analysis showed results in line with clinical outcomes reported in the literature for the same reconstructive technique. The use of Native® ADM in SBR is safe and effective in the long term.
RESUMEN
Lymphedema is a manifestation of lymphatic system disturbance and deranged lymph transport, with resultant swelling, a proliferation of parenchymal and stromal elements, and excess deposition of the extracellular matrix. It may occur in any part of the body, most frequently in the limbs. Staging ranges from inconspicuous lymphatic system derangement to lymphatic elephantiasis. Surgical treatment is the preferred modality. This case report is of a 36-year-old male patient with morbid obesity with a five-year-long history of penoscrotal volume increase without any apparent trigger. Patient observation revealed a frankly enlarged scrotum involving the penis, with distortion and an increase in urinary meatus diameter. The penis was palpable but hardly observable. Neither testicle was palpable. Scrotal tissue was hardened and sclerotic. We performed surgical excision of all swollen tissue while identifying and preserving the penis and both testicles. Local advancement flaps were used to create a neoscrotum. Resurfacing of the penis was accomplished with split-thickness skin grafting harvested from a small part of healthy skin included in the excised tissue and held in place during the first week with negative pressure therapy. There are no signs of local or distant relapse, and the patient mentions a dramatic improvement in urinary flow, quality of life in terms of ambulation, everyday tasks, and self-esteem. We present a very rare clinical case of exuberant penoscrotal lymphedema in a young patient with very few risk factors. Given the extent and time of presentation, microsurgery of the lymphatics was not indicated, and thus, a Charles procedure was undertaken. Even so, patient quality of life was significantly improved, and no recurrences have been reported so far.