A Case of Pulmonary Adenocarcinoma with Large Skin Metastasis That Showed a Remarkable Response to Nivolumab Therapy

Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length ( W/ L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables ( P < .05 Kruskal–Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A ( W/ L ＞ 0.5) were more difficult to close than in group B ( W/ L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.

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Duodenal adenocarcinoma with skin metastasis as initial manifestation: A case report

Open Life Sciences ◽

10.1515/biol-2021-0029 ◽

2021 ◽

Vol 16 (1) ◽

pp. 395-398

Author(s):

Yixiao Fu ◽

Cuiping Zheng ◽

Jian Huang ◽

Shenghao Wu ◽

Yanyan Dai

Keyword(s):

Oral Treatment ◽

Duodenal Biopsy ◽

Skin Metastasis ◽

Metastatic Adenocarcinoma ◽

Duodenal Adenocarcinoma ◽

Initial Manifestation ◽

Case Presentation ◽

Replacement Treatment ◽

Lost To Follow Up

Abstract Background Duodenal adenocarcinoma (DA) with skin metastasis as initial manifestation is clinically rare. In this study, we report a rare case of skin metastasis of DA. Case presentation An 84-year-old male patient developed multiple ecchymoses on the trunk and lower extremities. Physical examination showed that the ecchymosis was dark red and had a hard texture, but showed no bulging, rupture, or tenderness. The skin biopsy implied skin metastatic adenocarcinoma. After an endoscopic duodenal biopsy, the patient was finally diagnosed with DA with skin metastasis. The patient received two courses of oral treatment of Tegafur (40 mg, bid d1–d14). However, the patient stopped taking Tegafur because of its poor effect and received Chinese medicine as a replacement treatment. Unfortunately, he was lost to follow-up. Conclusions Early diagnosis of DA metastasis is of significant importance as prognosis of these patients is poor.

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Reconstruction of Extensive Soft Tissue Defects of Lower Extremity With the Extended Anterolateral Thigh Flap

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620982238 ◽

2021 ◽

pp. 153473462098223

Author(s):

Jong-Ho Kim ◽

Hyokyung Yoo ◽

Seokchan Eun

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Distal Portion ◽

Outcome Data ◽

Anterolateral Thigh Flap ◽

Soft Tissue Defects ◽

Flap Viability ◽

Anterolateral Thigh ◽

Large Skin ◽

Tissue Defects

The anterolateral thigh flap is a classic flap used for various reconstruction defects. However, the flap viability of extended large skin paddles (ie, 240 cm2) was doubted by many surgeons. This study reports successful experience of reconstructing extensive soft tissue defects of lower extremity using extended large skin paddles. Twelve consecutive patients who had undergone reconstruction of defects using an extended anterolateral thigh flap were identified. Patient characteristics (age, sex, defect location, injured structures, and type of flap) and outcome data were analyzed retrospectively. One artery and 2 accompanying veins were anastomosed to vascularize each flap. Follow-up periods ranged from 10 to 91 months postoperatively. The average size of the flaps was 268.75 cm2 (range = 220-391 cm2). All flaps were perforator flaps with one perforator except that 2 perforators were used in 3 patients. Two patients suffered partial flap necrosis of the distal portion with delayed healing. In conclusion, the extended anterolateral thigh flap is a considerable option for massive defects requiring composite tissue coverage. This flap is advantageous for reconstructing various complex defects in the lower extremities, providing a pliable and vascularized tissue to cover exposed extensive defects including tendons, nerves, and bones.

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