Malignant transformation of a non-healing traumatic wound on the lower extremity: A case report

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It is important to exclude malignancy in chronic wounds.

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Change in wound characteristic should be investigated with a biopsy.

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Marjolin’s ulcer refers most commonly to squamous cell carcinoma arising in scar tissue.

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Basal cell carcinoma, sarcoma and melanoma are also described in Marjolin’s ulcers.

Objective: Malignant transformation of chronic non-healing wounds is often overlooked. If a chronic wound fails to heal, or if there are changes in the characteristics of a wound, a biopsy should be performed.

Methods: This case is presented in line with SCARE guidelines.

Presentation of case: We present a case of a man with a non-healing traumatic wound over two years in which a basal cell carcinoma was diagnosed by biopsy. The basal cell carcinoma was radically excised and the defect was closed using a split thickness skin transplant.

Discussion: The term Marjolin’s ulcer, pathophysiology and recommended treatment.

Conclusion: Delayed diagnosis of malignancy in chronic wounds can lead to a worsened prognosis and therefore it is important to exclude a malignant aetiology. Malignant transformation of chronic wounds is not common but Marjolin's ulcer should be considered.

[Diagnostics, treatment and prognosis in breast cancer during pregnancy]

Breast cancer is the second most common form of cancer diagnosed during pregnancy. The diagnosis and treatment of breast cancer during pregnancy requires multidisciplinary efforts to treat the cancer while protecting the foetus. Pregnancy-related changes in the breast make the diagnosis particularly challenging. Surgery is possible during all three trimesters. Chemotherapy can be administered in the second and third trimesters without increased risk of foetal malformations. Radiation, endocrine and biological therapies however, must be postponed until after delivery.

Incidental Treatment of a Subclinical Chronic Tension-Type Headache by Cosmetic Use of Botulinum Toxin A: A Case Report

Background

Headache is a common disorder of the nervous system; chronic headache in particular may affect quality of life negatively. The pathophysiology is multifactorial and not completely elucidated. Studies have demonstrated the beneficial effects of botulinum toxin A on chronic migraine headaches, but failed to show the same effect on chronic tension-type headaches.

Methods

We present the case of a 32-year-old woman who after receiving cosmetic injections with botulinum toxin A for fine lines of the forehead experienced relief of subclinical tension-type headaches.

Conclusions

Although the effect of botulinum toxin A on chronic tension-type headaches is limited, several studies demonstrate its pain-modulating effects, and as such it is worth paying attention to this potential beneficial effect when performing cosmetic injections with botulinum toxin A.

[Evaluation and treatment of nipple secretion]

Nipple secretion is a common condition; it can occur in men and women, and be uni- or bilateral. It is related to hormonal changes, physical stimulation, intracerebral processes and certain drugs, and it is divided into three types: galactorrhoea, clear/bloody or viscous. Only the clear/bloody type is an indication of breast malignancy. Malignancy should always be ruled out in the presence of breast tumours. Treatment is determined by aetiology, and can vary from patient education, medications to surgery.

[Lipoatrophy after insulin injections can be treated with lipofilling]

Lipoatrophy is a known, albeit rare, side effect of insulin injections. We describe a case concerning a 17-year-old woman with insulin-dependent diabetes, who was treated with an insulin pump. In the areas surrounding the injection point subcutaneous lipoatrophy occurred. Such lipoatrophy is of cosmetic importance, and it may incur glycaemic imbalance due to altered and unpredictable absorption of insulin in the atrophied areas. With no spontaneous regeneration of the atrophied areas observed the patient was successfully treated with lipofilling in the atrophied areas.

Deep venous thrombosis as the single sign of unexpected metastatic urinary tract cancer in a patient with a history of cutaneous melanoma: A case report

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Spontaneous deep venous thrombosis in a patient with no known risk factors.

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History of melanoma prompting PET/CT revealing occult metastatic urinary tract cancer.

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Recognizing occult metastatic cancer as a risk factor of VTE is important.

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Keep an open mind towards routine screening for occult malignancy in unprovoked VTE.

Introduction

Cancer is a recognized risk factor of venous thromboembolism (VTE) as it induces a prothrombotic state through various mechanisms of activation of coagulation. Recognizing occult cancer as a risk factor is equally important. In patients with no known thromboembolic risk factors, utilizing PET/CT as a screening tool may be considered in order to reveal occult malignancy associated with otherwise unexplainable VTE.

Methods

This case report has been reported in line with the SCARE criteria.

Presentation of case

We describe a case of deep venous thrombosis of the lower leg as the single sign of metastatic urinary tract cancer. The patient had a history of cutaneous melanoma but no thromboembolic risk factors. Following treatment for deep venous thrombosis, the patient was referred directly to the plastic surgery department for further examination including PET/CT due to suspicion of metastatic melanoma.

Discussion

Screening for occult cancer in patients with unprovoked VTE has so far not been shown to benefit survival. As new treatments emerge, significant improvement in prognosis might be expected with early diagnosis of occult cancer and initiation of treatment. Thus an open mind should be kept towards utilizing advanced diagnostic tools such as PET/CT to screen for occult cancer in patients presenting with unprovoked VTE.

Conclusion

This case highlights the importance of considering all possible causes and utilizing targeted diagnostic tools when assessing a patient with seemingly unprovoked deep venous thrombosis. A whole-body PET/CT scan ultimately proved significant in revealing occult metastatic cancer of a completely different origin than expected.

[Inverted nipples]

Inverted nipples is an anatomical variation which can be uni- or bilateral, congenital or acquired. The degree of inversion can vary from slight to severe. Treatment can be surgical or non-surgical and should depend on the degree of functional problems. Non-surgical treatment can be beneficial, does not risk affecting sensibility, spares the lactiferous ducts, and therefore does not risk any interference with breast-feeding. Surgical options should only be considered when non-surgical treatment is insufficient.

Post-bariatric abdominoplasty resulting in wound infection and dehiscence-Conservative treatment with medical grade honey: A case report and review of literature

INTRODUCTION

Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times.

METHODS

This case report has been reported in line with the CARE criteria.

PRESENTATION OF CASE

A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction.

DISCUSSION

Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey.

CONCLUSION

Although more research is needed for definitive conclusions of honey's efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment.

[Breast implant-associated anaplastic large-cell lymphoma]

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare entity. Due to the lack of awareness of BIA-ALCL, patients with prior history of breast implants who present with non-specific implant-related complications might experience a delay in diagnosis and appropriate treatment of this distinct condition. There are still no evidence-based guidelines on how this condition should be diagnosed, treated or followed because of the rarity of available data. We review current literature in order to raise awareness and discuss management options of this unique clinical entity.

[Merkel cell carcinoma is a rare, aggressive neuroendocrine skin cancer]

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a poor survival rate. The low incidence and lack of characteristic manifestation of MCC often cause an incorrect diagnosis. A 92-year-old male presented with an asymptomatic, smooth lesion on the right cheek, which was initially diagnosed as a basal cell carcinoma. After histological diagnosis of MCC the patient underwent radical surgery, but developed metastases later. Attention to the diagnosis of this condition, patient history and initial presentation can provide clues in order to offer the right treatment with minimal delay.

[Limited evidence for negative pressure wound treatment of skin transplants and closed surgical wounds]

The indications for negative pressure wound treatment (NPWT) are increasing, e.g. for fixation of skin transplant and primary closed surgical wounds. The evidence for indications and positive effects are limited. NPWT should exclusively be used for fixation of split thickness skin transplants when immobilisation is otherwise difficult and for primary closed surgical wounds in selected patients at risk. Future high-quality investigations are necessary to pinpoint indications for topical negative pressure therapy, the effect of the different NPWT-modalities, and the overall economy compared to conventional bandages.

Increased morbidity in patients undergoing abdominoplasty after laparoscopic gastric bypass

INTRODUCTION

30-40% of the adult population in Denmark are overweight and 10-13% are obese. The number of bariatric operations reached 3,000 in 2009, and it is expected that a third or more of the patients need corrective plastic surgery.

MATERIAL AND METHODS

Medical charts of all patients who had abdominoplasty performed during a 2.5-year period. We included 72 patients of whom 21 had lost weight after bariatric surgery and 51 patients had lost weight through diet and exercise or had not been overweight.

RESULTS

The overall complication rate was 21% (43% of the post-bariatric patients and 12% of the non-post-bariatric patients, p < 0.01). When adjusted for the maximum body mass index (BMI) and BMI at the time of abdominoplasty, post-bariatric patients still had a higher complication rate than non post-bariatric patients (OR = 4.8; 95% CI: 0.92-25.04). Post-bariatric patients had a significantly higher maximum weight, weight at the time of abdominoplasty and had lost more BMI units.

CONCLUSION

Our data show that post-bariatric patients who have an abdominoplasty performed suffer a high complication rate which appears to be higher than that of patients who do not have bariatric surgery. We have also shown a tendency towards increased costs of abdominoplasty in post-bariatric patients due to a slightly longer operating time and more postoperative office visits.

[Paraffin oil injection in bodybuilders calls for preventive action]

Injection of paraffin oil to change physical configuration is an obsolete procedure from 1899, revived by bodybuilders as an alternative to intramuscular injections of steroids. Paraffin oil has destructive consequences: skin inflammation, hard oedema, sterile abscesses, diffuse lymphangitis and paraffinomas. We report a case of a 24-year-old male bodybuilder who self-injected one litre of paraffin oil in each arm. Hazard notice and advice to bodybuilders with potential risk attitude or "reverse anorexia" are warranted.

Neovaginal construction in vaginal aplasia and sex-reassignment surgery

During the period 1984-1994 33 patients were admitted to the department of plastic surgery for the purpose of neovaginal construction. They comprised 22 patients with vaginal agenesis or aplasia and 11 transsexual men. In most cases neovaginal construction was done by blunt dissection and lining with a split thickness skin graft from the thigh, and in the cases of sex-reassignment surgery genital skin was also used. The two groups differed as the patients with vaginal agenesis or aplasia had remarkably few complications compared with the transsexual group. The most common complications were defects in the skin grafts and vaginal stenosis. The transsexuals therefore had an extended recovery period including several admissions and visits to the outpatient clinic. The difference in genotype does not explain the high complication rate in the transsexual group as eight in the vaginal agenesis or aplasia group had Morris syndrome (testicular feminisation (XY)). However, the phenotype may be of importance in vaginal construction as the male (transsexual) pelvis is narrow and the levator muscles are stronger than those in the female pelvis.

[Incidence and treatment of urinary calculi in patients in Frederiksborg County]

The case records of all patients admitted to one of the hospitals in the County of Frederiksborg with radiologically demonstrated first episodes of urinary calculi during a period of one year in 1983/1984 and 1988/1989 respectively were reviewed retrospectively. Uniform frequencies of calculus incidence and sex distribution were encountered mutually and as compared with the remainder of Denmark during the two periods. In 30% of the cases the calculi were localized to the kidneys and in 58% to the ureter. In approximately 65% of the patients, the greatest diameter of the stones was 100 mm or less. Spontaneous passage of the stones occurred in approximately 40%. Development in the treatment of urinary tract stones has followed the development in the county as a whole. The number of operative interventions during the five year period was reduced by 30% and extracorporeal shock wave treatment was employed in 22% during the second period.

[Idiopathic aortoduodenal fistula]

A case of primary aortoduodenal fistula of unknown origin in a 72 year old female is presented. The fistula was successfully treated by excision from the duodenum and direct suture of the aortic wall.