Use of the O-Z Flap to Repair Scalp Defects After Cancer Tumor Resection

Abstract Objective and Importance: Carcinoma of the adnexal structures of the skin is a rare malignancy, and is even more unusual in the scalp. We report an unusual case of scalp adnexal carcinoma of eccrine origin that went untreated for years, resulting in a giant tumor with extension through the cranium. The tumor resection and reconstruction of the cranium and scalp defects posed unique challenges. Clinical Presentation: A 54-year-old woman experienced a large recurrence of her scalp adnexal carcinoma after an incomplete wide local excision, which invaded through the cranium. Intervention: The entire vertex of the scalp and cranium were removed en bloc. After cranioplasty, a free vascularized muscle flap was used for soft tissue coverage, but failed owing to poor vascular inflow. A large area of dura was left open, using a vacuum-assisted wound closure device to generate granulation tissue by secondary intention. Another split thickness skin graft was used to provide a cosmetically acceptable outcome. Conclusion: Scalp adnexal tumors of eccrine origin rarely metastasize and can be resected for cure with complete removal. Reconstruction options for large scalp and cranial tumors may be limited, and allowing the dura to granulate by secondary intention has been very rarely described. The novel use of a vacuum-assisted wound closure device was a very useful adjunct in this situation, and may be beneficial in the reconstruction of other patients with large scalp and cranial defects after neurosurgical procedures. It should be used with caution, since it may risk injury to a major venous sinus, especially when used in the midline, or cerebrospinal fluid leakage.

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Reconstruction Scalp Defects After Malignant Tumor Resection With Anterolateral Thigh Flaps

Journal of Craniofacial Surgery ◽

10.1097/scs.0b013e318231fdb2 ◽

2011 ◽

Vol 22 (6) ◽

pp. 2208-2211 ◽

Cited By ~ 9

Author(s):

Bi Bo ◽

Yang Qun ◽

Pu Zheming ◽

Xiao Haitao ◽

Liu Tianyi

Keyword(s):

Malignant Tumor ◽

Tumor Resection ◽

Scalp Defects ◽

Anterolateral Thigh ◽

Anterolateral Thigh Flaps

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Can we put a simplified algorithm for reconstruction of large scalp defects following tumor resection?

World Journal of Surgical Oncology ◽

10.1186/1477-7819-9-129 ◽

2011 ◽

Vol 9 (1) ◽

Cited By ~ 11

Author(s):

Adel Denewer ◽

Ashraf Khater ◽

Omar Farouk ◽

Mohammad Hegazy ◽

Mahmoud Mosbah ◽

...

Keyword(s):

Tumor Resection ◽

Scalp Defects ◽

Simplified Algorithm

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Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1683371 ◽

2019 ◽

Vol 81 (02) ◽

pp. 149-157

Author(s):

Denis Ehrl ◽

Alexandra Brueggemann ◽

P. Niclas Broer ◽

Konstantin Koban ◽

Riccardo Giunta ◽

...

Keyword(s):

Average Length ◽

Donor Site ◽

Tumor Resection ◽

Donor Site Morbidity ◽

Muscle Flaps ◽

Scalp Defects ◽

Oncologic Patients ◽

Deep Infiltration ◽

Malignant Skin ◽

Aesthetic Results

Abstract Background An oncologic tumor resection of the scalp can result in complex wounds that result in challenging scalp reconstructions. This study aimed to evaluate the outcomes of microvascular-based scalp reconstructions (MSR) in oncologic patients and to propose an algorithmic treatment approach. Methods Within a 5-year period, 38 patients having undergone 41 MSR (15 anterolateral thigh (ALT), 15 gracilis muscle (GM), and 11 latissimus dorsi muscle (LDM) flaps) after extensive scalp tumor resections fulfilled inclusion criteria for this study. Results Malignant skin disease included superficial and/or deep infiltration of the calvarium in 26 and combined intracranial infiltration in 12 patients. In case of bone replacement (24 patients), MSR was done concomitant, otherwise MSR was performed after pathological confirmation of tumor-free margins. LDM flaps were used in cases with defect sizes of 400 to 1250cm2, whereas ALT- and GM flaps were chosen for defects ranging from 40 to 350cm2. The average length of the pedicle was comparable in ALT- and LDM flaps and longer than in GM flaps. Total flap loss with need for revision surgery and minor donor site morbidity occurred in four and three patients, respectively. Conclusion Microsurgical reconstruction of moderate-to-extensive scalp defects remains a reliable method with overall low risks and satisfactory aesthetic results, while, according to our experience, muscle flaps show the best functional and aesthetic results. However, in cases of central scalp defects and in situations when a long vascular pedicle of the flap is important, the ALT flap seems to be the best solution.

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Key Biomarkers Within the Colorectal Cancer Related Inflammatory Microenvironment

10.21203/rs.3.rs-118868/v1 ◽

2020 ◽

Author(s):

Valentin Calu ◽

Adriana Ionescu ◽

Loredana Stanca ◽

Ovidiu Geicu ◽

Florin Iordache ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Tumor Resection ◽

Surgical Care ◽

Magnetic Bead ◽

Inflammatory Factors ◽

Tissue Samples ◽

Inflammatory Microenvironment ◽

Starting Point ◽

Cancer Tumor

Abstract The necessity of therapeutic approaches focused on the inflammatory microenvironment of colorectal cancer (CRC) is becoming more and more apparent, both in order to improve post-surgical care and subsequent therapeutic strategies, and also for better quality of life for the patients. We have investigated a panel of 39 inflammatory factors using a multiplex magnetic bead-based immunoassay, in relation with CEA and CA19-9, classical tumor markers and the expression levels of pErk, occludin, and STAT1 and STAT3 transcriptional factors. Within the tumor and paired normal tissue samples collected during tumor resection surgery, we have identified 32 biomarkers displaying statistically significant differences. Several relevant correlations have been observed in a combined multi-type correlation matrix. Chitinase 3-like 1 seems to be a trigger for activation pathways for tumor growth and metastasis. Through IL-22 and IL1β, IL-8 correlates indirectly with CA19-9 and CEA, respectively. We also emphasize the diminished APRIL and high BAFF levels in colon cancer tumor tissue, which is quite unique. The strong correlation between APRIL, BAFF, IL-8 and MMP2 recommends these as combined targets in immunotherapies for colon cancer treatment, and indicates the marker quartet may serve as a starting point in colon cancer screening.

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Ultrastructural modification of cellular interactions in cancer tumor

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100082455 ◽

1978 ◽

Vol 36 (2) ◽

pp. 318-319

Author(s):

N. P. Dmitrieva

Keyword(s):

Cancer Cells ◽

Human Thyroid ◽

Adjacent Cell ◽

Main Role ◽

Cellular Interactions ◽

Electron Microscopic ◽

Cancer Tumor ◽

Normal Human ◽

Characteristic Features

One of the most characteristic features of cancer cells is their ability to metastasia. It is suggested that the modifications of the structure and properties of cancer cells surfaces play the main role in this process. The present work was aimed at finding out what ultrastructural features apear in tumor in vivo which removal of individual cancer cells from the cell population can provide. For this purpose the cellular interactions in the normal human thyroid and cancer tumor of this gland electron microscopic were studied. The tissues were fixed in osmium tetroxide and were embedded in Araldite-Epon.In normal human thyroid the most common type of intercellular contacts was represented by simple junction formed by the parallelalignment of adjacent cell membranees leaving in between an intermembranes space 15-20 nm filled with electronlucid material (Fig. 1a). Sometimes in the basal part of cells dilatations of the intercellular space 40-50 nm wide were found (Fig. 1a). Here the cell surfaces may form single short microvilli.

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Decellularized bone extracellular matrix in skeletal tissue engineering

Biochemical Society Transactions ◽

10.1042/bst20190079 ◽

2020 ◽

Vol 48 (3) ◽

pp. 755-764

Author(s):

Benjamin B. Rothrauff ◽

Rocky S. Tuan

Keyword(s):

Tissue Engineering ◽

Bone Regeneration ◽

Tissue Regeneration ◽

Animal Studies ◽

Tumor Resection ◽

Regenerative Capacity ◽

Skeletal Tissue ◽

Large Bone

Bone possesses an intrinsic regenerative capacity, which can be compromised by aging, disease, trauma, and iatrogenesis (e.g. tumor resection, pharmacological). At present, autografts and allografts are the principal biological treatments available to replace large bone segments, but both entail several limitations that reduce wider use and consistent success. The use of decellularized extracellular matrices (ECM), often derived from xenogeneic sources, has been shown to favorably influence the immune response to injury and promote site-appropriate tissue regeneration. Decellularized bone ECM (dbECM), utilized in several forms — whole organ, particles, hydrogels — has shown promise in both in vitro and in vivo animal studies to promote osteogenic differentiation of stem/progenitor cells and enhance bone regeneration. However, dbECM has yet to be investigated in clinical studies, which are needed to determine the relative efficacy of this emerging biomaterial as compared with established treatments. This mini-review highlights the recent exploration of dbECM as a biomaterial for skeletal tissue engineering and considers modifications on its future use to more consistently promote bone regeneration.

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