RESUMO
Nocardia brasiliensis is recognized in the United States as an infectious agent of the skin that may present as an abscess, ulcer, or granuloma with or without "sporotrichoid" spread, and rarely causes systemic disease. Treatment with trimethoprim/sulfamethoxazole is usually curative. We present a patient with multiple erythematous, painful, draining nodules that developed thirty-six months after trauma and subsequent contamination with soil in Bermuda. A foreign body granuloma was suspected clinically, and excision was performed followed by recurrence of the lesions. Histologic examination and culture were consistent with nocardiosis. Differential diagnosis of foreign body granulomas also should include infection with N. brasiliensis even after a long incubation period. Culture and drug susceptibility testing of affected tissue should be performed for diagnosis and management.
Assuntos
Corpos Estranhos/diagnóstico , Granuloma/diagnóstico , Dermatoses da Perna/diagnóstico , Nocardiose/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Dermatoses da Perna/microbiologia , Dermatopatias Bacterianas/microbiologia , Microbiologia do SoloRESUMO
The extended deep inferior epigastric artery (DIEA) flap was used in 4 patients with traumatic mid upper extremity wounds. Although there are numerous flaps available for resurfacing upper extremity defects, including the groin, thoracoepigastric, and a host of microvascular flaps, in each of these patients a preoperative consideration necessitated a novel approach. The DIEA flap is based on an axial vascular watershed resulting in a long, thin, well-vascularized, supple skin flap, which proved extremely effective in solving the reconstructive needs of these patients. The flap is technically simple to elevate and quite versatile. In all patients, the flaps survived and healing of the wounds was achieved. The DIEA flap should be considered a valuable reconstructive alternative when faced with elbow and forearm defects.
Assuntos
Músculos Abdominais/irrigação sanguínea , Retalhos Cirúrgicos/métodos , Ferimentos e Lesões/cirurgia , Adulto , Braço/cirurgia , Artérias , Contratura/cirurgia , Humanos , MasculinoRESUMO
Noncaseating granulomas present as a delayed foreign-body reaction to retained pencil-core fragments. The clinical appearance of the lesion can closely resemble melanoma. Surgeons who use pencils as surgical marking implements should be aware that there is a potential risk of developing late pencil-core granulomas. This risk can be reduced by carefully removing any pieces of pencil lead from the wound.
Assuntos
Granuloma de Corpo Estranho , Adulto , Granuloma de Corpo Estranho/patologia , Granuloma de Corpo Estranho/cirurgia , Humanos , MasculinoRESUMO
Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics.
Assuntos
Clavícula/cirurgia , Osteomielite/cirurgia , Abscesso/complicações , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Lesões por Radiação/cirurgia , Infecções Estafilocócicas , Retalhos CirúrgicosRESUMO
Necrotizing sialometaplasia is a benign disorder that histologically can mimic carcinoma. It is thought to develop as a result of ischemia or adjacent tissue injury. A patient is described who underwent a Mohs' micrographical fresh-tissue excision of one-third of the upper lip for basal cell carcinoma. By the time she was ready for reconstruction, a marked eczematous reaction developed to a polymyxin neomycin preparation (Neosporin ointment) at the wound edges. Reexcision of the wound margins before a flap reconstruction revealed necrotizing sialometaplasia on histopathological examination. This incidental finding fortunately was not mistaken for residual tumor. To prevent over-diagnosis and over-treatment of presumed malignancies, an awareness of necrotizing sialometaplasia is essential for all surgeons operating on mucosal surfaces in the head and neck.
Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Labiais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/patologia , Doenças das Glândulas Salivares/patologia , Sialometaplasia Necrosante/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lábio/patologia , Reoperação , Sialometaplasia Necrosante/cirurgia , Retalhos Cirúrgicos , CicatrizaçãoRESUMO
A patient with severe amniotic band syndrome and true proximal syndactyly of the hand and foot is presented. The occurrence of these two seemingly unrelated anomalies may be pathologically linked with amniotic band syndrome in some as yet unexplained way or less likely may occur with amniotic band syndrome coincidentally.