Marios Frangoulis

Management of external ear keloids using form-pressure therapy

Keloids are a frequent finding after physical trauma. Keloids of the pinna (helix and antihelix) as a complication of ear‐piercing are the most difficult cases. Clinicians have tended to avoid the surgical approach, preferring local conservative treatment with corticosteroids or other treatments. We report use of intrakeloid resection and a form‐pressure device to treat pinna keloids and avoid recurrence. The purpose is to maintain the form of the folds of the pinna. The recommendation for this therapy is to maintain the pressure at 24–30 mmHg, and the duration of the form‐pressure therapy in our patients was about 25 weeks.

Orbitopalpebral repair after 835 excisions of malignant tumours

Repair of any defect in the eyelid depends on its size and position and the state of the surrounding tissues. Basal cell carcinoma (BCC) is the most common malignant tumour of the eyelids, and squamous cell carcinoma (SCC), mixed carcinomas or basosquamous cell carcinomas (BSC), and cutaneous melanomas (CM), also invade the eyelids and periocular zones. Reconstruction of the eyelids and associated orbital structures after resection requires a complete understanding of the anatomy. The adequacy of the reconstruction is judged by the quality of functional restoration and the aesthetic appearance. The purpose of this study was to document various, simple or complex reconstructive procedures that may be used after excision of malignant tumours of the eyelids and to assess the outcome of surgical treatment.

One‐stage reconstruction of the antihelix and concha using postauricular island flap

Tissue defects in the antihelix and the concha due to oncological resection and trauma can be successfully repaired with a subcutaneously based postauricular island flap. Alternative methods of regional reconstruction usually need two stages or may require grafts in some patients. We present the one‐stage technique, as described by Masson, without grafts, to provide adequate reconstruction and aesthetic restoration of the area, illustrated by 62 patients. In all patients there has been a follow‐up period of 12 months. This report provides evidence for the aesthetic superiority of this method. An excellent aesthetic outcome was achieved in 46 patients, an adequate outcome in 15 patients, and a poor result in only 1 patient. No flap necrosis was observed. The method has considerable advantages for the repair of anterior conchal and antihelical defects.

Double scalping flap: a versatile technique in scalp reconstruction.

Scalp reconstruction is a challenging area in plastic surgery. The susceptibility of potentially exposed brain tissue is almost always a concern along with the provision of adequate soft tissue coverage in cases of full-thickness defects. The applied reconstructive strategy also affects efficiency in malignant disease treatment providing both local control of the disease and vigorous monitoring for recurrence or metastasis. The general condition of the patients presenting with malignant lesions of the scalp is often impaired because of old age or concomitant disease. Therefore, demanding, long-lasting, or multistage procedures may often be undesirable. The double scalping flap comprises a 1-stage procedure, which can be used in most full-thickness defects of the vertex of the scalp. Some of the primary advantages of the double scalping flap procedure are its versatility and arc of rotation, its minimal donor site morbidity, being relatively simple, and being a short technique. Disadvantages that may be considered are the loss of hair-bearing skin at the occipital region and the poor color and texture match between scalp skin and the split-thickness skin graft that is used on the donor site. We present 2 patients with exemplary case of neglected malignancy of the scalp and their successful treatment using the double scalping flap. Comparison and contrast of alternative reconstructive procedures are also included to further investigate scalp reconstruction.

Keystone Perforator Island Flap as an Alternative Reconstructive Option for Partial Thickness Alar Defects Up to 1.5 Centimeters.

Introduction:The ala is a unique landmark of the nose disposing aesthetic and functional properties. The head and neck area is the main site of appearance of nonmelanoma skin cancer. One third of them are located in the nose with an alar preponderance compared with other nasal subunits. Correction of alar defects is a challenging reconstructive task. The keystone perforator island flap (KPIF) was introduced as an alternative in nasal reconstruction by senior authors. In the present case series, KPIFs’ application is introduced into the alar subunit as an alternative, versatile, and reproducible reconstructive option, even for the novice plastic surgeon. Materials and Methods:From April 2014 to September 2015, patients presenting with partial thickness alar defects (⩽1.5 cm) secondary to tumor extirpation sustained reconstruction with different types of KPIF. Results:A total of 31 patients (mean age of 72 years) were treated with various types of KPIF. The mean diameter of the defect was 1.14 cm. The vast majority of reconstructions concerned a type IV KPIF (18/31 or 58.1%). Sometimes an upward alar retraction was noted. A minimal rim wedge excision was performed (⩽0.3 mm) using counterbalancing correcting sutures. All flaps survived without any sign of venous congestion, whereas the rim healed uneventfully. The mean follow-up period was 6.5 months. Conclusions:KPIF was introduced as a single-stage alternative reconstructive option for partial thickness alar defects, completing authors experience with this flap into such a challenging and aesthetically critical anatomic area.

The keystone perforator island flap in nasal reconstruction: An alternative reconstructive option for soft tissue defects up to 2 cm

AbstractThe aim of this study was to present our experience with the use of the Keystone Perforator Island Flap (KPIF) in a case series of patients with small size (diameter ⩽2 cm) nasal defects which will be useful prospectively to assist plastic surgeons in planning a reconstructive strategy that will work. The KPIF was utilized in 30 patients with nasal defects post tumor extirpation. More than one type of KPIF (type I or type III) was used following the nasal subunit principle or a modified version of it. The mean follow-up period was 10.5 months. Overall good outcomes were achieved, with no major complications encountered, except minor wound dehiscence in 3 cases. It is the first time that the utilization of this flap is reported in nasal reconstruction. The versatility of the KPIF makes it a safe technique even in the hands of inexperienced surgeons under guidance for nasal defects up to 2 cm in diameter.

Primary cutaneous melanoma of the breast region

BackgroundPrimary cutaneous malignant melanoma of the breast is a rare entity, accounting for less than 5% of all malignant melanomas.Description of CaseA 74-year-old woman was seen for a lesion in the breast. Clinical examination and laboratory results confirmed the diagnosis of a primary cutaneous melanoma of the breast. The tumour was excised along with the axillary lymph nodes and supraclavicular lymph nodes. All tissues were sent for histological evaluation.ConclusionDespite its rareness, primary cutaneous melanoma of the breast region can be managed using the same techniques as for other skin parts. Wide three-dimensional local excision and sentinel lymph node biopsy is the selected treatment.

Diabetic foot disease: Surgery and multidisciplinary treatment

Aim-BackgroundTo propose efficient therapeutic approaches leading to the control of the disease with the lowest possible impact on patients’ quality of life during and after the treatment.Patients-MethodsDuring the last two decades, 259 patients with diabetic foot disease have been treated. Due to the multiple locations of the ulcer sites in some patients, the overall number has risen to 264. Evaluation and classification according to stage was performed. Two hundred and twelve (80%) ulcers were neuroischaemic and 52 (16.5%) neuropathic. One hundred and forty-eight patients (57%) were men, with a mean age of 61.2 years, and 111 (43%) were women, whose mean age was 65.3 years. Surgical debridement and healing at secondary intention was followed in 152 cases. Primary amputations were performed in 71 (27%) cases. Reconstruction ranged from the use of skin grafts to free tissue transferResultsThe follow-up period ranged from 10 to 24 months (mean 17 months). Control of the disease was achieved in 146 (96%). In 13 of the patients that had previously undergone amputation, a second amputation procedure at a more proximal level proved necessary. In 41 (15.5%) patients, various reconstruction procedures were primarily performed, in 4 of which flap necrosis was observed due to thrombosis, leading to subsequent amputation. Oedema and venous congestion were minimal. No infection was observed.ConclusionsLimiting the number of amputations, following strong evidence-based criteria, and providing a functional lower limb in the best possible way constituted primary priorities in the current study. Achieving effective control of the disease, improving hospitalization conditions and minimizing overall hospital stay, offering functional and aesthetically appealing outcomes were main goals in the provided treatment. Our proposed algorithm regarding diabetic foot disease management is also included. A multidisciplinary approach was a prerequisite towards increasing patients’ postoperative quality of life.