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Shim HS, Ryoo HJ, Choi JS, Park JA, Kim YH. Principles and Clinical Application of Free-Style Capillary Perforator-Based Flap for Coverage of Facial Skin Cancer Defects. Cancers (Basel) 2024; 16:2206. [PMID: 38927912 PMCID: PMC11201941 DOI: 10.3390/cancers16122206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm2. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.
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Affiliation(s)
- Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Hyun-Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Jae-Seon Choi
- Department of Plastic and Reconstructive Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea; (H.-J.R.); (J.-S.C.)
| | - Ji-Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul 04763, Republic of Korea;
| | - Youn-Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
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Dubois M, Abi Rached H, Escande A, Dezoteux F, Darloy F, Jouin A, Kyheng M, Labreuche J, Dziwniel V, Mirabel X, Mortier L. Outcome of early stage Merkel carcinoma treated by exclusive radiation: a study of 53 patients. Radiat Oncol 2021; 16:90. [PMID: 33990201 PMCID: PMC8120723 DOI: 10.1186/s13014-021-01815-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Early stage Merkel cell carcinoma (MCC) is a rare and aggressive primary skin cancer. The standard of care for MCC is broad excision and adjuvant external beam radiation therapy (EBRT). However, for some patients, anesthesia is contraindicated, while others run the risk of serious aesthetic sequelae. In such cases, exclusive radiotherapy is an interesting alternative to surgery. Though limited data is available, this study evaluates exclusive radiotherapy for MCC, using data from the largest retrospective study to date. Methods All patients who were followed in our center between 1989 and 2019 for histologically proven early stage MCC were included in the study. They were treated either by surgery with a 2-cm clear margin followed by adjuvant radiotherapy (RT) or by exclusive RT. Survival rates with adjuvant and exclusive EBRT were analyzed using Cox model and Fine and Gray model depending on the type of survival. p value < 0.05 was considered significant.
Results Eighty-four patients treated for MCC were included. Fifty-three of them (63.1%) were treated by exclusive RT, and 31 (36.9%) had surgical excision followed by adjuvant RT. Local relapse rate was 13.7% (95% CI 8.0–43.7) in the RT monotherapy group (group A) and 25.8% (95% CI 10.3–56.2) in the surgery + RT group (group B) (p = 0.42). No statistical difference was found for nodal relapse (p = 0.81), metastatic relapse (p = 0.10), disease free survival (p = 0.83) or overall survival (p = 0.98).
Conclusion Our study suggests that exclusive radiotherapy for early Merkel cell carcinoma leads to a similar oncological outcome as combined treatment, with fewer aesthetic sequelae. The approach is interesting for elderly patients with comorbidities or patients for whom surgery would cause significant functional or aesthetic sequelae. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01815-4.
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Affiliation(s)
- Manon Dubois
- CHU Lille, Service de Dermatologie, 59000, Lille, France.
| | - Henry Abi Rached
- CHU Lille, Service de Dermatologie, 59000, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000, Lille, France.,H. Warembourg, School of Medicine, University of Lille, Lille, France
| | - Alexandre Escande
- H. Warembourg, School of Medicine, University of Lille, Lille, France.,University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France.,CRIStAL Laboratory, UMR 9189, University of Lille, Villeneuve d'Ascq, France
| | - Frédéric Dezoteux
- CHU Lille, Service de Dermatologie, 59000, Lille, France.,H. Warembourg, School of Medicine, University of Lille, Lille, France
| | - Franck Darloy
- Radiotherapy Center, Centre Léonard de Vinci, Dechy, France
| | - Anaïs Jouin
- Radiotherapy Center, Centre de Cancérologie Les Dentellières, Valenciennes, France
| | - Maeva Kyheng
- Department of Biostatistics, CHU Lille, 59000, Lille, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Julien Labreuche
- Department of Biostatistics, CHU Lille, 59000, Lille, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Evaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Véronique Dziwniel
- Languages Department, Centrale Lille Institut, Villeneuve d'Ascq, France
| | - Xavier Mirabel
- University Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Laurent Mortier
- CHU Lille, Service de Dermatologie, 59000, Lille, France.,Univ. Lille, Inserm, CHU Lille, U1189 - ONCO-THAI - Assisted Laser Therapy and Immunotherapy for Oncology, 59000, Lille, France.,H. Warembourg, School of Medicine, University of Lille, Lille, France.,CARADERM Network, Lille, France
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Safety and efficacy concerns of modern strategies of local anesthetics delivery. 3 Biotech 2020; 10:333. [PMID: 32656066 DOI: 10.1007/s13205-020-02309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022] Open
Abstract
In the last few decades, several formulations have evolved to realize better efficacy of administered anesthesia. These innovative formulations have facilitated surgeons to perform operations under purely local anesthesia, which provides extra protection and comfort to patients. Ease of delivery of local anesthesia is the need of the current generation, because some of the standard procedures are performed without the use of any sedative agent. Therefore, we are presenting here the various approaches of administration of local anesthetics by the surgeons. To construct a comprehensive report on various methods of anesthesia, we followed a systematic literature search of bibliographic databases of published articles recently in the international journals and publishers of repute. A comprehensive study of several reports of the field indicates that there are significant progresses towards developing novel formulations of anesthesia drugs as well as strategies of delivery. Among formulations, nanoparticle-based delivery approaches, including polymeric, liposomal, and micellar structures, have offered the much needed efficacy with low toxicity. Therefore, several of such techniques are at various stages of clinical trials. Nanotechnology-based delivery approaches have significantly emerged in recent past due to the low systemic toxicity and better efficacy of the nonconventional local anesthetics. The other methods of local anesthesia delivery such as transdermal, magnetophoresis, electrophoresis, and iontophoresis are frequently used due to them being minimally invasive and locally effective. Therefore, the combination of the nanotechnological methods with above mentioned techniques would significantly enhance the overall process of local anesthesia delivery and efficacy.
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Chamseddin BH, Le LQ. Management of cutaneous neurofibroma: current therapy and future directions. Neurooncol Adv 2020; 2:i107-i116. [PMID: 32642736 PMCID: PMC7317049 DOI: 10.1093/noajnl/vdz034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a life-long neurocutaneous disorder characterized by a predisposition to tumor development, including cutaneous neurofibroma (cNF), the hallmark of the disease. cNF is a histologically benign, multicellular tumor formed in virtually most individuals with NF1. It is considered the most burdensome feature of the disorder due to their physical discomfort, cosmetically disfiguring appearance, and psychosocial burden. Management of cNF remains a challenge in the medical field. Effective medicinal treatment for cNF does not exist at this time. Trials aimed at targeting individual components of the neoplasm such as mast cells with Ketotifen have not shown much success. Physical removal or destruction has been the mainstay of therapy. Surgical removal gives excellent cosmetic results, but risk in general anesthesia may require trained specialists. Destructive laser such as CO2 laser is effective in treating hundreds of tumors at one time but has high risk of scarring hypopigmentation or hyperpigmentation that alter cosmetic outcomes. A robust, low-risk surgical technique has been developed, which may be performed in clinic using traditional biopsy tools that may be more accessible to NF1 patients worldwide than contemporary techniques including Er:YAG or Nd:YAG laser. In this review, specific recommendations for management of cNFs are made based on symptoms, clinical expertise, and available resources. Additionally, antiproliferative agents aimed at stimulating cellular quiescence are explored.
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Affiliation(s)
- Bahir H Chamseddin
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lu Q Le
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
- Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Neurofibromatosis Clinic, University of Texas Southwestern Medical Center, Dallas, Texas
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Gilliam EA, Zuber SM, Grikscheit TC. Thermal Injection Measurement (TIM) Adds Accuracy to Injections and Can Assess Cold Chain Management. J Surg Res 2020; 255:261-266. [PMID: 32570129 DOI: 10.1016/j.jss.2020.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/02/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inaccurate assessment of injected drug delivery may increase cost and morbidity or reduce efficacy. Yet currently most injections are evaluated solely by the formation of a visible wheal that might not truly estimate the actual area of effect. We hypothesized that thermal injection measurement (TIM) might verify appropriate temperature at the time of injection, as required for some temperature-sensitive vaccines and provide more accurate information about the area of delivery. METHODS 0.1 mL of either iced (n = 11) or room temperature (n = 17) methylene blue solution was injected subcutaneously in mice under anesthesia and photos taken with an iPhone 7 built-in camera and Thermal Seek Camera phone plug-in. After 5 min, true values were determined at necropsy. RESULTS TIM was closer in value to the measured area at necropsy than the area of the visualized skin wheal at both ice temperature and room temperature. The difference between the true value and thermal area assessment of iced solution averaged 0.15 cm2 as compared with the difference between the true value and wheal size, which averaged 0.27 cm2 (P = 0.04). At room temperature, this was maintained for thermal and visible wheal differences, 0.23 cm2 and 0.65 cm2, respectively (P = 0.0006). CONCLUSIONS TIM can assess temperature at the time of injection and is more accurate than visual inspection. TIM could be applied to colorless injections and areas that are hard to visualize such as scar. As a portable phone plug-in, it might be a useful adjunct to aid the evaluation of injected drug delivery including in resource-limited settings.
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Affiliation(s)
- Elizabeth A Gilliam
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California
| | - Samuel M Zuber
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California.
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Liu GL, Bian WC, Zhao P, Sun LH. Delivery of Local Anesthesia: Current Strategies, Safety, and Future Prospects. Curr Drug Metab 2019; 20:533-539. [PMID: 31187706 DOI: 10.2174/1389200220666190610155049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The systemic administration of anesthesia is associated with severe and undesirable side effects such as sedation, vomiting, nausea, allergies, respiratory problems, and neutrophil dysfunction. With the increase in the procedures of limb surgery, cosmetics, facial, skin, and cancer reconstruction, the demand for local anesthesia has increased multifold during the last one decade. Therefore, novel, safe, and cost-effective methods are being developed to deliver local anesthetics by the surgeons. METHOD To prepare a comprehensive research report on anesthesia, we performed a structured literature search of bibliographic databases for peer-reviewed articles published recently. The studies of different articles were summarized and a deductive qualitative and quantitative data analysis was applied. Subsequently, a comprehensive summary of the analysis was used to frame this review article with ample examples. RESULTS A thorough analysis of the reports suggested that there have been tremendous developments of synthesizing nanoparticle-based local anesthesia drugs. The active targeting ability of nanoparticle-based drug delivery strategy can further help to deliver the desired anesthetic drug locally. It was also found that different local anesthetic drugs are developed into liposome form and show better efficacy in patients receiving anesthesia. CONCLUSION The findings of this review article endorse that safe delivery of anesthesia drugs are essential for the safety of patients. Further, nanotechnology-based strategies are extremely useful for targeted delivery of anesthetic drugs at the required dose without affecting the neighboring tissues.
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Affiliation(s)
- Guo-Liang Liu
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Wen-Chao Bian
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun 130041, China
| | - Peng Zhao
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
| | - Li-Hua Sun
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun 130041, China
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