RESUMEN

This report presents the use of an innervated musculocutaneous submental artery island flap (MSAIF) for the functional reconstruction of a hemiglossectomy defect, with the aim of preserving the volume and mobility of the reconstructed tongue to facilitate swallowing and intelligible speech. A 30-year-old male patient diagnosed with T3N0 stage squamous-cell carcinoma of the tongue underwent hemiglossectomy and ipsilateral I-IV selective neck dissection. For reconstruction, an innervated MSAIF with a 9x4 cm skin paddle, including the left submental vessels, ipsilateral anterior belly of the digastric muscle, mylohyoid muscle, and mylohyoid nerve, was harvested and inserted into the tongue defect. Postoperative healing at both donor and recipient sites proceeded without complications. At a three-year follow-up, the MSAIF has maintained its volume, mobility, and contractility. The patient remains disease-free and reports satisfaction with his swallowing and speech capabilities. The innervated MSAIF represents a reliable and cost-effective reconstruction approach for hemiglossectomy defects, showing favorable results in both swallowing and speech.

RESUMEN

Odontogenic infections can rarely progress to necrotizing soft tissue infections. Cervical necrotizing fasciitis (CNF) is a rare but fulminant infection that spreads along the fascial planes, including connective tissue, muscle, and subcutaneous fat, and is typified by necrosis of the skin and other adjacent tissues. This article aims to present the treatment of a patient with submental skin and soft tissue necrosis due to an odontogenic infection and the subsequent management of the tissue deficit with a vacuum-assisted closure (VAC) system. The patient presented with extensive skin necrosis in the submental area and was immediately hospitalized, and management of the odontogenic infection was performed. When the patients' infection had been sufficiently controlled, a wound VAC device was placed in the deficit. The VAC device was removed after 12 days, and the patient was discharged. In conclusion, VAC can be used to manage tissue deficits with good aesthetic results.

Asunto(s)

Fascitis Necrotizante , Terapia de Presión Negativa para Heridas , Humanos , Fascitis Necrotizante/terapia , Fascitis Necrotizante/cirugía , Infecciones de los Tejidos Blandos/terapia , Infecciones de los Tejidos Blandos/cirugía , Cuello/cirugía , Masculino , Femenino , Infección Focal Dental/complicaciones , Infección Focal Dental/terapia , Persona de Mediana Edad

RESUMEN

Intussusception of the small bowel is an uncommon condition, with the majority of cases being observed during infancy. A number of points are responsible, with benign and malignant lesions of the small intestine being the most common. Herein, we present the case of a 75-year-old male patient with vague abdominal pain and black stool during defecation, who underwent surgery due to jejunal intussusception. Pathology report demonstrated a neuroendocrine carcinoma as the underlying cause for his condition, with no additional metastases during the initial diagnosis. Although a conservative approach for management of intussusception is viable, the possibility of gastric outlet obstruction and the presence of malignancy as the primary point usually lead to urgent surgery. In the case of malignancy, adjuvant chemotherapy or additional symptomatic therapy with close follow-up may be required depending on tumor's grade and aggressiveness.

RESUMEN

INTRODUCTION: Pilonidal sinus disease (PSD) is a highly debatable disorder regarding its surgical management, despite an assortment of surgical techniques described in the medical literature. The aim of this report is to provide an alternate semi-closed surgical method for treatment of PSD, with early recovery and a satisfactory cosmetic result. METHODS: In this retrospective study, 34 patients underwent surgical treatment for primary PSD; 32 male and 2 female. Patients were suffering from primary PSD, with the cyst located in the gluteal midline. Total excision of the cyst was performed, while the skin flaps were fixed on the postsacral fascia using absorbable sutures, leaving the wound semi-closed. RESULTS: Technical success was 100%, with an average operation time of 48.7 ± 3.8 min. No wound dehiscence or infections were recorded postoperatively. One reoperation was performed due to hemorrhage. All patients were discharged on the day after surgery, with a VAS pain score of 1.3 ± 1. Two incidents of late wound dehiscence were recorded at 4th and 6th postoperative day due to strenuous exercise. Patients resumed their work after the 5th postoperative day with no complications. The 6 month follow up was completed in 29 patients, with a VAS cosmetic score of 8.1 ± 0.9. No recurrences were observed during the follow up period. CONCLUSION: The presented semi-closed technique is a viable alternative for surgical management of PSD. It provides patients with a satisfying cosmetic result, while it allows for early and safe return to everyday activities with less pain experienced.

RESUMEN

INTRODUCTION: Morgagni hernia is defined as the intrathoracic protrusion of abdominal viscera through a defect in the anterior diaphragm. It represents an uncommon type of diaphragmatic congenital hernia. CASE PRESENTATION: A 68-year-old female patient was admitted in our department due to progressive epigastric discomfort for the past four months. A preoperative diagnosis of a paraesophageal hernia was set through computer tomography, with gastric portions and parts of small bowel protruding inside the thoracic cavity. Intraoperatively, an excessive diaphragmatic defect was detected in the anterior side of the diaphragm. Reduction of the hernia's contents inside the abdominal cavity was achieved through laparoscopy, with the additional fixation of an intraperitoneal non-absorbable mesh for reinforcement of the diaphragmatic wall. Patient was discharged uneventfully on the 4th postoperative day. DISCUSSION: Morgagni hernias refer to a rare type of diaphragmatic congenital hernias, usually identified during childhood, leaving only a small number of cases observed in the adult population. Its diagnosis can pose a challenge due to the non-specific and usually asymptomatic presentation. An early surgical management is advised due to an increased number of potentially lethal complications, such as gastric incarceration and obstruction. Treatment consist of open surgical techniques through a trans-thoracic or a trans-abdominal approach, although a paradigm shift in the 21st century considers minimal invasive laparoscopic surgery the treatment of choice. CONCLUSSION: A high index of clinical suspicion is required for diagnosis of Morgagni hernias, while prompt management is advised. Laparoscopy is considered the best approach in the hands of an experienced surgeon.