Matrix Metalloproteinase 28-Bearing Microcystic Adnexal Carcinoma on the Back

Although microcystic adnexal carcinoma (MAC) recurs and expands locally without metastases to the lymph nodes and other organs, its biological behavior remains unknown. In this report, a case of a giant MAC on the back treated with radical excision and curative radiation therapy and its characteristic dermoscopic findings are presented. In addition, immunohistochemical staining showed the expression of matrix metalloproteinase (MMP) 28 on the tumor cells and MMP12 and periostin in the stroma. The present case suggests the possible biological behaviors of MAC and might provide a possible target for the treatment of MAC in the future.

EXPERIMENTAL STUDY OF CLINICAL INDICATORS OF INTRATISSUE PRESSURE IN DEEP CIRCULAR BURNS AND ITS DYNAMICS DEPENDING ON THE NATURE AND VOLUME OF SURGERY

The purpose of research. To improve in the experiment the optimal variants of surgical tactics to eliminate the phenomena of compartment syndrome in circular deep burns on the basis of studying the dynamics of intratissue pressure. Materials and methods. An experiment to study the effectiveness of treatment of deep circular burns of III degree, accompanied by compartment-syndrome with objectification of intra-tissue pressure was performed on 18 male WAG rats weighing 190.0-200.0 g, which were divided into three groups depending from the nature and scope of surgery. Research results and their discussion. Based on the assessment of the dependence of the level of intratissue pressure in the tissues on the timing of modeling of deep circular burns in the experiment and tactics and volume of surgical treatment, a clear dependence of indicators in all groups of experimental animals. The primary necrectomy performed in the III main group due to the radical surgical intervention allowed to completely normalize the intratissue pressure within 24 hours. Conclusions. 1. Clinical indicators of intratissue pressure at deep circular burns depending on time of modeling of a thermal trauma and character and volume of surgical intervention are defined in experiment. 2. It is established that primary necrectomy due to radical excision of necrotized tissues and rapid decompression contributes to the nor malization of intratissue pressure.

Radical Resection and Reconstruction in Patients With Adenoid Cystic Carcinoma in the Minor Salivary Glands of the Palate

Background: This study evaluated the clinical outcomes of the patients with adenoid cystic carcinoma (ACC) of the minor salivary glands of the palate. Methods: Forty-four patients with stage I–II disease and 14 patients with stage III–IV disease underwent radical excision and reconstruction with a facial-submental artery island flap (FSAIF) and titanium mesh plus a free anterolateral thigh flap (ALTF) and radiotherapy respectively. Patients with stage III–IV disease subsequently received cobalt Co 60 adjuvant radiotherapy. Ki-67 expression was determined semiquantitatively in 52 patients with ACC by based on the cytoplasm staining intensity and percentage of positively stained tumor cells.Results: The median (range) follow-up was 32.9 (14–58) months. Forty-one (71.7%) patients survived without disease recurrence. Nine patients (15.5%) survived with recurrent tumors (four with local recurrence, three with regional recurrence requiring salvage surgery, and two with distant metastasis); among these patients, five had overlapping recurrence. Eight patients (13.8%) died of regional, distant, or multiorgan metastasis (range: 22–42 months). The overall median (95% CI) survival time was 32.5 (25.0–39.5) months, and the median (95% CI) progression-free survival time was 32.9 (28.5–36.9) months. Rates of survival and recurrence differed significantly between patients with low- and high-grade tumors, patients with clinical stage I–II disease and those with stage III–IV disease, patients with and without lymph node metastasis, patients who underwent radical excision with versus without radiotherapy, and patients with low and high Ki-67 expression. Conclusion: Radical resection and reconstruction with FSAIF is the most suitable treatment for stage I–II ACC of the minor salivary glands of the palate. Stage III–IV tumors require radical resection, reconstruction with titanium mesh and free ALTF, and radiotherapy.

Minimally Invasive Two-Staged Surgery in the Treatment of Large Cystic Lesions of the Jaw

Background: Cystic lesions of the jaw are commonly found in clinical practice. Large, expansive cysts raise challenges for the clinician from both diagnostic and surgical perspectives. The aim of our work is to present a combined, two-staged surgical approach in histologically confirmed non-aggressive cystic lesions of the jaw. Methods and Results: We report the case of an extensive mandibular cyst, associating a high risk of bone fracture, that is treated in the initial stage by cystic decompression through marsupialization with concomitant histological diagnostic confirmation, followed in the second stage by radical excision and mandibular reconstruction with titanium mesh, with the purpose of prevention for oro-cystic chronic fistula formation. Conclusions: Large odontogenic mandibular cysts imply a meticulously conducted assessment and treatment. Marsupialization should be taken into consideration for the treatment of large cystic lesions, followed by secondary enucleation, with minimal risks for the patient. The soft tissue healing process can be optimized with the use of titanium meshes, as an alternative for other reconstructive techniques, in the management of large cystic lesions.

Surgical Prevention of Breast Cancer-Related Lymphedema: Delayed Distal Lymphaticovenicular Anastomosis– An Alternative to the Classic LYMPHA Technique

Breast cancer-related lymphedema (BCRL) is a devastating potential complication of axillary lymphadenectomy and radiotherapy. Several effective surgical treatment measures now exist, including lymphaticovenicular anastomosis (LVA), vascularized lymph node transplant (VLNT), and vascularized lymph vessel transplant (VLVT) for fluid-predominant disease, and liposuction and radical excision for solid-predominant disease. Super-microsurgical LVA is of particular interest, owing to its minimally invasive nature and highly favorable outcomes in the hands of experienced supermicrosurgeons. As LVA techniques are refined and improved, interest is rising in utilizing it to prevent the manifestation of disease in the first place. Lymphatic microsurgical preventive healing approach (LYMPHA), also known as immediate lymphatic reconstruction (ILR), is the most widely used approach. It involves performing axillary LVA immediately following axillary lymphadenectomy. While preliminary results are favorable, the high-pressure proximal axillary venous branches used in ILR and the site’s vulnerability to damage from radiotherapy endanger the long-term patency of these anastomoses. Moreover, a theoretical oncologic concern exists regarding creating a direct conduit for the remaining malignant cells in the axilla into the circulation. Finally, coordinating ILR with axillary lymphadenectomy creates significant logistical challenges. Delayed, distally-based LVA (DD-LVA) has emerged as an alternative method that avoids these issues. This article presents an overview of the development of preemptive lymphatic reconstruction, and the senior author’s approach to the novel technique of DD-LVA.