Citations

BACKGROUND Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE To evaluate hidradenitis surgical patients. METHODS Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7–0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1–2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2–10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.

The resection of large pelvic tumors is challenging due to their infiltrative nature into multiple structures and organ systems. In this report, we describe the use of multiple vascularized and nonvascularized spare parts to reconstruct a pelvic defect in a patient with a uniquely large pelvic sarcoma invading the spinal canal. A 39‐year‐old Caucasian female who presented with a large retroperitoneal sarcoma where the tumor encased the left ureter, kidney, colon, and external iliac vessels and invaded the L3‐S1 vertebral bodies. An extensive hemipelvectomy and reconstruction was performed over two days. A free thigh and leg fillet flap together with ipsilateral fibula flap, based on the superficial femoral artery and venae comitantes, was used for spinal reinforcement as well as abdominal and pelvic wall reconstruction. The postoperative course was uneventful without complications, no flap compromise or wound healing problems. After a follow‐up period of 4 months, the patient had no complications and returned to activities of daily living with mild limitations. The success of this flap procedure shows the practicality and usefulness of using the full spectrum of tissue transfer for the purposes of a large pelvic reconstruction. © 2014 Wiley Periodicals, Inc. Microsurgery 35:320–323, 2015.

Anterolateral thigh (ALT) free flaps can result in donor site wounds that cannot be closed directly, requiring immediate or delayed split‐thickness skin grafting. The use of skin grafts for such wounds can impose postoperative activity restrictions and additional wound morbidity. The purpose of the study was to investigate the efficacy of continuous external tissue expander (CETE) in achieving staged direct closure of these wounds. Outcomes of 20 ALT free flap cases with flap widths up to 15 cm treated with CETE were retrospectively reviewed. Closure of the thigh wounds was achieved in 19 cases with an average expansion time of 9.6 days. The use of a CETE device was effective in achieving staged direct (tertiary) closure and avoiding skin grafting, which further decreased donor site morbidity of large ALT free flap reconstructions. © 2014 Wiley Periodicals, Inc. Microsurgery 35:290–294, 2015.

ABSTRACTBackgroundA radial forearm free flap (RFFF) is used frequently in oral and pharyngeal reconstruction. Pseudoaneurysms within RFFFs and their management have not been previously reported.Methods and ResultsIn the present case, a patient with chemoradiation failure of the right base of the tongue clear cell carcinoma underwent salvage resection and failed reconstruction with pectoralis major muscle flap. He subsequently underwent RFFF reconstruction with delayed development of a radial artery pseudoaneurysm at the site of a previous arterial line within the RFFF, which was not present perioperatively. A rupture of this pseudoaneurysm manifested with recurrent bleeding. Angiography with embolization successfully arrested the bleeding without compromising the flap.ConclusionRuptured pseudoaneurysm of the radial artery within the RFFF is a rare and life‐threatening complication, which in the posterior oral cavity and pharynx can be effectively managed with angioembolization. © 2014 Wiley Periodicals, Inc. Head Neck 37: E12‐E14, 2015

Microvascular replantation, when possible, is the treatment of choice for total ear amputations. Both arterial and venous reconstruction should be attempted. The present case report describes a successful total ear replantation in a 45‐year‐old woman whose ear was amputated due to a horse accident. Venous thrombosis subsequently occurred and was managed with anticoagulation and leech therapy. Eighty hours after the replantation, arterial thrombosis took place. The posterior auricular artery thrombosed anastomosis was resected and reconstructed with an interposition vein graft. This report illustrates the feasibility of the successful microvascular salvage of a thrombosed total ear replant. It suggests the need for close clinical monitoring of the replanted ear and prompt microvascular reexploration in an event of the loss of arterial flow. © 2013 Wiley Periodicals, Inc. Microsurgery 33:396–400, 2013.

AbstractDT388–GM-CSF, a targeted fusion toxin constructed by conjugation of human granulocyte-macrophage colony-stimulating factor (GM-CSF) with the catalytic and translocation domains of diphtheria toxin, is presently in phase I trials for patients with resistant acute myeloid leukemia. HL-60/VCR, a multidrug-resistant human myeloid leukemia cell line, and wild-type HL-60 cells were used to study the impact of DT388–GM-CSF on metabolism of ceramide, a modulator of apoptosis. After 48 hours with DT388–GM-CSF (10 nM), ceramide levels in HL-60/VCR cells rose 6-fold and viability fell to 10%, whereas GM-CSF alone was without influence. Similar results were obtained in HL-60 cells. Examination of the time course revealed that protein synthesis decreased by about 50% and cellular ceramide levels increased by about 80% between 4 and 6 hours after addition of DT388–GM-CSF. By 6 hours this was accompanied by activation of caspase-9, followed by activation of caspase-3, cleavage of caspase substrates, and chromatin fragmentation. Hygromycin B and emetine failed to elevate ceramide levels or induce apoptosis at concentrations that inhibited protein synthesis by 50%. Exposure to C6-ceramide inhibited protein synthesis (EC50∼5 μM) and decreased viability (EC50 ∼6 μM). Sphingomyelinase treatment depleted sphingomyelin by about 10%, while increasing ceramide levels and inhibiting protein synthesis. Diphtheria toxin increased ceramide and decreased sphingomyelin in U-937 cells, a cell line extremely sensitive to diphtheria toxin; exposure to DT388–GM-CSF showed sensitivity at less than 1.0 pM. Diphtheria toxin and conjugate trigger ceramide formation that contributes to apoptosis in human leukemia cells through caspase activation and inhibition of protein synthesis.