Penile Melanoma In Situ: Long Term Follow Up.

Penile melanoma in situ is extremely rare. Various treatments have been reported with good success, however follow up is generally limited to 1 year or less. The optimal treatment regimen, pattern of disease progression and utility of sentinel lymph node biopsy are not established.

Melanoma of the ear: results of a cartilage-sparing approach to resection.

Melanoma of the ear is often treated by composite resection of the skin and cartilage and, occasionally, by total auriculectomy. This review analyzes the oncologic, functional, and esthetic results of cartilage-sparing wide local excision for melanoma of the ear. This retrospective study reviewed patients with ear melanoma treated between 1997 and 2002.

The role of lymphatic mapping and sentinel lymph node biopsy in the staging and treatment of melanoma.

The incidence of malignant melanoma is increasing at an alarming rate, doubling in women and growing by more 300% in men during the past 25 years. The importance of diagnosing nodal metastatic disease, with the ability to detect smaller and smaller volumes of tumor in the sentinel lymph nodes (SLNs) biopsied using immunohistochemical staining, has impacted the accurate staging and stratification of melanoma patients. The role that elective lymph node dissection now plays in staging the melanoma patient and determining subsequent treatment has been greatly diminished in favor of less morbid and less invasive techniques that have a higher degree of accuracy in detecting occult nodal disease.

Electrically stimulated rectus abdominis muscle flap to achieve enterostomal continence: development of a functional canine model.

Background: Dynamic myoplasty has many clinical applications and has proven to be a versatile surgical procedure with great promise. This procedure has been used to achieve fecal/urinary continence, as in the dynamic graciloplasty, and to augment cardiac ventricular function, as is commonly seen with dynamic latissimus cardiomyoplasty. In the present study, the authors describe a functional innovative island flap sphincter created from the rectus abdominis muscle in a large-animal model to provide stomal continence for future clinical studies.

The acute and delayed effects of hydrostatic dilation on rat femoral arteries.

The technique of intraoperative vessel dilation is sometimes used to facilitate microvascular anastomosis and prevent vasospasm. Although this technique is not new, its application has not gained widespread acceptance mainly due to concerns raised about potential damage to the vessels acutely and during the postoperative period, leading to decreased vessel patency. The goal of this study was to determine the acute and delayed histologic effects of hydrostatic dilation on rat femoral arteries and to compare the response of dilated arteries to vasodilating and vasoconstricting agents.

Lymphadenectomy prior to rat hind limb allotransplantation prevents graft-versus-host disease in chimeric hosts.

In previous rat studies, the use of mixed allogeneic chimerism (MAC) to induce host tolerance to hind limb allografts has resulted in severe graft-versus-host disease (GVHD). The purpose of this study was to determine if immunocompetent cells in bone marrow (BM) and/or lymph nodes (LNs) of transplanted limbs were responsible for inducing GVHD in mixed chimeric hosts. [ACI-->Wistar Furth] chimeric rats received ACI hind limbs that were non-irradiated, irradiated (1050 cGy) or lymphadenectomized.

Incidence of nonlocalization of sentinel lymph nodes using preoperative lymphoscintigraphy in 74 consecutive head and neck melanoma and Merkel cell carcinoma patients.

Introduction: Lymphatic drainage pathways in the head and neck region are more variable than in any other location of the body. Occasionally, head and neck lymphoscintograms fail to identify a definitive lymphatic drainage pattern, making preoperative and intraoperative identification of sentinel nodes very difficult. The purpose of this study was to determine the incidence of nonlocalization on lymphoscintigraphy of sentinel nodes in patients with head and neck cutaneous malignancies.

The use of selective lymphadenectomy in malignant blue naevus of the scalp.

Malignant blue naevus (MBN) is a rare cutaneous tumour with a close biological resemblance to malignant melanoma. MBN spreads to regional lymph nodes, creating a dilemma in managing patients with clinically negative nodal basins. Sentinel lymph node (SLN) biopsy has evolved as a powerful staging tool by identifying occult metastatic nodal disease in patients with cutaneous malignancies.

Sentinel lymph node biopsy for head and neck melanomas.

Background: Sentinel lymph node (SLN) biopsy for head and neck (H&N) melanomas may be more technically challenging compared with other locations because of complex lymphatic drainage patterns. This analysis was performed to compare the results of SLN biopsy for H&N, truncal, and extremity melanomas.

Methods: The Sunbelt Melanoma Trial includes patients aged 18 to 70 with melanomas > or = 1.

Preconditioning of latissimus dorsi muscle flaps with monophosphoryl lipid a.

The use of dynamic myoplasty to restore function to failing organs is an exciting new application of skeletal muscle flaps. A complication of large flap elevation that can compromise flap function is ischemia-induced necrosis; one approach to minimizing this is to pretreat tissues with ischemic preconditioning. The purpose of this study was to determine whether systemic administration of monophosphoryl lipid A, a drug known to mimic late-phase ischemic preconditioning in the heart, could reduce ischemia-induced necrosis in latissimus dorsi muscle flaps.

Analysis of fiber type transformation and histology in chronic electrically stimulated canine rectus abdominis muscle island-flap stomal sphincters.

Dynamic skeletal muscle flaps are designed to perform a specific functional task through contraction and relaxation of their muscle fibers. The most commonly used dynamic skeletal flaps today are for cardiomyoplasty and anal or urinary myoplasty. Low-frequency chronic stimulation of these flaps enables them to use their intrinsic energy stores in a more efficient manner through aerobic metabolic pathways for increased endurance and improved work capacity.

Successful treatment of 19 consecutive groin lymphoceles with the assistance of intraoperative lymphatic mapping.

Postoperative groin lymphoceles that fail to resolve spontaneously or with interventional therapy present a formidable problem that is associated with a high degree of morbidity. Numerous interventional methods and operative techniques have been described to treat these fluid collections, yet recurrence rates remain high. The use of lymphatic mapping has gained widespread use in the treatment of cutaneous malignancies and breast cancer and has been proven effective in delineating the course of lymphatic channels.

Intraoperative lymphatic mapping to treat groin lymphorrhea complicating an elective medial thigh lift.

Groin lymphoceles and lymphorrhea are a rare complication of medial thigh lift procedures. The author describes a case in which a very thin patient developed groin lymphorrhea after an uncomplicated medial thigh lift procedure. Initial treatment interventions, including edema control and the placement of a drain with surgical exploration, failed to control the lymphatic leak.

Dynamic rectus abdominis muscle flap for intestinal stomal continence: a systematic approach.

Several attempts to create a continent stomal sphincter using dynamic myoplasty with limited success have been reported. Denervation atrophy and early muscle fatigue have plagued all reported attempts to make a continent stoma a reality. To address this problem in a series of experiments, we designed a stomal sphincter using the most caudal segment of the rectus abdominis muscle.

Analysis of chronic morphologic changes of small bowel in electrically stimulated canine island-flap rectus abdominis muscle stomal sphincters.

Purpose: Dynamic myoplasty to achieve fecal continence has been used in humans with varying results. A potential complication of the use of dynamic skeletal sphincters to attain fecal continence is the development of ischemic strictures within the bowel encircled by the functional sphincter. This study examines the histologic changes present in the bowel wall used to create a functional dynamic island-flap stomal sphincter in a chronic canine model.

Dynamic rectus abdominis muscle sphincter for stoma continence: an acute functional study in a dog model.

Fecal stomal incontinence is a problem that continues to defy surgical treatment. Previous attempts to create continent stomas using dynamic myoplasty have had limited success due to denervation atrophy of the muscle flap used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation. To address the problem of denervation atrophy, a stomal sphincter was designed using the most caudal segment of the rectus abdominis muscle, preserving its intercostal innervation as well as its vascular supply.

Use of the rectus abdominis muscle for abdominal stoma sphincter construction: an anatomical feasibility study.

Permanent fecal abdominal stomas significantly decrease quality of life. Previous attempts to create continent stomas by using dynamic myoplasty procedures have resulted in disappointing outcomes, primarily owing to denervation atrophy of the muscle flap that was used in the creation of the sphincter and because of muscle fatigue resulting from continuous electrical stimulation that is received by the flap to force contraction. On the basis of these problems, we designed two separate studies: an anatomical study addressing flap denervation and a functional study addressing muscle fatigue.

Necrotizing infection of the face secondary to intranasal impaction of "crack" cocaine.

"Crack" is a crystalline form of cocaine that is readily available and sold in the form of small granules. The authors report a unique case of forced intranasal impaction of crack cocaine with subsequent extensive necrosis of the nose and upper lip accompanied by a necrotizing infection of the subcutaneous soft tissue of the cheeks, forehead, and temporal regions. The treatment of extensive facial necrosis resulting from infection and ischemia centers around the early diagnosis of the infectious process, prompt and aggressive surgical debridement, and the administration of broad-spectrum antibiotics.

Parotid selective lymphadenectomy in malignant melanoma.

Malignant melanoma of the head and neck can metastasize to lymph nodes within the parotid gland. Selective lymphadenectomy is the modern method of staging regional lymph node basins in clinically localized melanoma. This procedure involves intraoperative lymphatic mapping and directed, selective removal of the first draining nodes or sentinel lymph nodes (SLNs).

Benign symmetric lipomatosis (Madelung's disease).

Benign symmetric lipomatosis, also known as Madelung's disease, is a rare condition characterized by massive fatty deposits arranged symmetrically around the neck, shoulders, and arms. These patients might present for liposuction and body contouring. Although infrequently encountered in the average plastic surgeon's practice, this condition should be considered when evaluating candidates for these procedures.

Diagnosis and treatment of retrobulbar hematoma resulting from blunt periorbital trauma.

Retrobulbar hematoma is a rare complication of blunt periorbital trauma with the potential disastrous consequence of visual impairment and blindness. The preoperative assessment, diagnostic symptoms and signs, as well as the treatment of this condition are reviewed. The patients presented as well as a review of the literature confirm that although retrobulbar hematoma is a rare complication of blunt periorbital trauma, irreversible visual sequelae can be prevented by prompt diagnosis and immediate surgical and pharmacological therapy.