Search Results (8)

Background and Objectives: Penile tissue loss, which can be an acquired condition due to trauma or infection, but is also seen in congenital anomalies, is a rare condition in children. A standard surgical approach is often not possible due to the different degrees and etiologies of penile tissue loss. The continuing growth and the presence of various congenital anomalies in children require a different penile reconstruction approach than in adults. We aimed to share our experience and surgical results with children in whom we performed penile reconstruction with different techniques due to penile tissue loss. Materials and Methods: Ten cases that underwent penile reconstruction between 2018 and 2023 were evaluated retrospectively. Age at initial operation, associated anomalies, surgical technique, and other related surgical attempts, as well as functional and cosmetic results, were recorded. Results: Ten boys aged between 6 months and 17 years underwent phalloplasty due to penile tissue absence. In six cases, penile tissue loss was due to acquired causes, and in four cases, congenital anomalies were the reason. The most common cause of penile tissue loss was circumcision complications. In four cases, penile reconstruction was achieved by mobilization of the remaining corpus cavernosum tissues, in two cases, the cavernous tissue was adequate and repaired with glansplasty and penile skin graft. Phalloplasty was performed by tubularization of a skin and subcutaneous fat flap, removed from the pubic region and scrotal region, in two cases. A microvascular radial forearm flap was performed in a 17-year-old patient with penile tissue loss because of trauma, and a free skin flap taken from the forearm was used for penile reconstruction. Thirty percent of patients required a second surgery. Urinary continence was present in eight of the cases. Although four cases were classified as cosmetically unsatisfactory in our evaluation, all patients and their families reported being satisfied with the cosmetic results. Conclusions: Penile reconstruction for penile tissue loss in children should be performed in clinics where different scenarios can be applied. With maximum preservation and mobilization of existing cavernous tissues, temporary penile reconstruction with local flaps should be performed in young children at an early stage to minimize the psychological effects of penile absence. Although an esthetically perfect result cannot be guaranteed, patients and families are generally satisfied with the outcome. Full article

Background/Objectives: In the setting of breast surgery, indocyanine green angiography (ICGA) allows estimating the perfusion of cutaneous tissues during surgical interventions, in order to reduce vascularization-related complications. This study has a dual objective: to evaluate the correlation between preoperative factors and the level of skin vascularization, measured by ICGA, in patients undergoing subcutaneous mastectomy for breast cancer; and to establish any relationship between low intraoperative vascularization and the onset of postoperative complications. Methods: This is a preliminary, non-randomized, prospective clinical study that includes 46 female patients undergoing subcutaneous mastectomy with reconstruction for breast cancer between February 2022 and July 2024. The relationship between vascularization and the following preoperative variables was assessed: smoking, previous breast surgeries, prior radiotherapy, neoadjuvant or prior chemotherapy/anti-Her2 therapy, and the thickness of breast subcutaneous tissue evaluated through mammography. For the analysis, three ICGA procedures were performed, using 0.125 mg/kg of indocyanine green (ICG) for each procedure before the surgical incision (V1), at the end of the demolition phase (V2), and at the end of the reconstruction phase (V3). The results of this analysis were finally correlated with the occurrence of any postoperative complications. Results: Vascularization was conventionally classified as “low” and “good” using a cutoff of 33%. Previous surgeries on the ipsilateral breast and neoadjuvant or prior chemotherapy/anti-Her2 therapy were found to be predictive factors of “low” vascularization (p = 0.031). Patients with “low” vascularization at time V3 showed a significantly higher risk of developing complications (p = 0.038). Incision length emerged as an independent predictor of complications, with a 23% increase in risk per additional centimeter (p = 0.006), independent of perfusion level. Conclusions: This study supports the use of ICGA as a useful tool to improve outcomes in patients undergoing subcutaneous mastectomy with prosthetic reconstruction for breast cancer. The results of this preliminary work are encouraging, and recruiting a larger number of patients could provide more significant data. Full article

Background: Human myiasis, the infestation of tissues by dipterous larvae, commonly manifests as painful, raised skin lesions, particularly in tropical regions such as Latin America, where Dermatobia hominis (the human botfly) is a frequent cause. With increased international travel, cases of travel-related myiasis have become more prevalent, necessitating awareness among healthcare providers in non-endemic regions. Methods: We present a case of cutaneous myiasis in a 69-year-old male who returned to the United States from Belize. The patient exhibited a painful skin lesion on his right knee, initially suspected to be an insect bite. The diagnosis was confirmed through ultrasound imaging, which revealed the presence of a subcutaneous larva. Conservative larva removal efforts failed, leading to surgical extraction of the larva. Results: The surgical intervention successfully removed the larva in its entirety, with the wound healing well after the procedure. Pathological examination confirmed the larva as Dermatobia hominis. The patient experienced a satisfactory recovery, with no complications observed during follow-up. Conclusions: This case underscores the importance of considering myiasis in the differential diagnosis of patients presenting with painful skin lesions following travel to tropical regions. As globalization increases, healthcare providers should be vigilant in recognizing and appropriately treating travel-related diseases such as myiasis to ensure prompt and effective care. Full article

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder primarily targeting joints, significantly impacting patients’ quality of life. The introduction of tumor necrosis factor-alpha (TNF-α) inhibitors has markedly improved RA management by reducing inflammation. However, these medications are associated with adverse skin reactions, which can vary greatly among patients due to genetic differences. Objectives: This study aimed to identify risk factors associated with skin adverse events by TNF-α in RA patients. Methods: A cohort study was conducted, encompassing patients with RA who were prescribed TNF-α inhibitors. This study utilized machine learning algorithms to analyze genetic data and identify markers associated with skin-related adverse events. Various machine learning algorithms were employed to predict skin and subcutaneous tissue-related outcomes, leading to the development of a risk-scoring system. Multivariable logistic regression analysis identified independent risk factors for skin and subcutaneous tissue-related complications. Results: After adjusting for covariates, individuals with the TT genotype of rs12551103, A allele carriers of rs13265933, and C allele carriers of rs73210737 exhibited approximately 20-, 14-, and 10-fold higher incidences of skin adverse events, respectively, compared to those with the C allele, GG genotype, and TT genotype. The machine learning algorithms used for risk prediction showed excellent performance. The risk of skin adverse events among patients receiving TNF-α inhibitors varied based on the risk score: 0 points, 0.6%; 2 points, 3.6%; 3 points, 8.5%; 4 points, 18.9%; 5 points, 36.7%; 6 points, 59.2%; 8 points, 90.0%; 9 points, 95.7%; and 10 points, 98.2%. Conclusions: These findings, emerging from this preliminary study, lay the groundwork for personalized intervention strategies to prevent TNF-α inhibitor-associated skin adverse events. This approach has the potential to improve patient outcomes by minimizing the risk of adverse effects while optimizing therapeutic efficacy. Full article

Musculocontractural Ehlers-Danlos syndrome (mcEDS) is a subtype of EDS caused by mutations in the gene for carbohydrate sulfotransferase 14 (CHST14) (mcEDS-CHST14) or dermatan sulfate epimerase (DSE) (mcEDS-DSE). These mutations induce loss of enzymatic activity in D4ST1 or DSE and disrupt dermatan sulfate (DS) biosynthesis. The depletion of DS causes the symptoms of mcEDS, such as multiple congenital malformations (e.g., adducted thumbs, clubfeet, and craniofacial characteristics) and progressive connective tissue fragility-related manifestations (e.g., recurrent dislocations, progressive talipes or spinal deformities, pneumothorax or pneumohemothorax, large subcutaneous hematomas, and/or diverticular perforation). Careful observations of patients and model animals are important to investigate pathophysiological mechanisms and therapies for the disorder. Some independent groups have investigated Chst14 gene-deleted (Chst14^-/-) and Dse^-/- mice as models of mcEDS-CHST14 and mcEDS-DSE, respectively. These mouse models exhibit similar phenotypes to patients with mcEDS, such as suppressed growth and skin fragility with deformation of the collagen fibrils. Mouse models of mcEDS-CHST14 also show thoracic kyphosis, hypotonia, and myopathy, which are typical complications of mcEDS. These findings suggest that the mouse models can be useful for research uncovering the pathophysiology of mcEDS and developing etiology-based therapy. In this review, we organize and compare the data of patients and model mice. Full article

Objectives: To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. Methods: Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00–L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. Results: Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26–532.20) in 1999 to 827.92 (95% CI 825.62–830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin’s appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32–543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76–868.44) in 2020. From 520.75 (95% CI 518.02–523.48) in 1999 to 791.03 (95% CI 787.86–794.19) in 2020, the hospital admission rate for females grew by 51.9%. Conclusion: Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions. Full article

Subcutaneous facial emphysema related to dental treatments is a well-known clinical complication due to incidental or iatrogenic air or gas penetration into the subcutaneous tissues and fascial planes, leading to distension of the overlying skin. To the best of our knowledge, from 1960 to the current date, only six cases have been reported arising from peri-implant cleaning or non-surgical peri-implantitis treatment. Therefore, the present case of subcutaneous facial emphysema following open-flap air-powder abrasive debridement was the first report during surgical peri-implantitis therapy. Swelling on the left cheek and periorbital space suddenly arose in a 65-year-old woman during open-flap debridement with sodium bicarbonate air-powder abrasion (PROPHYflex™ 3 with periotip, KaVo, Biberach, Germany) of the infected implant surface. The etiology, clinical manifestations, diagnosis, potential complications, and management of subcutaneous emphysema are also briefly reviewed. The present case report draws the attention of dental practitioners, periodontists, oral surgeons, and dental hygienists to the potential iatrogenic risk of subcutaneous emphysema in using air-powder devices in implant surface debridement. Full article

(1) Background: Wounds with damages to the subcutaneous are difficult to regenerate because of the tissue damages and complications such as bacterial infection. (2) Methods: In this study, we created burn wounds on pigs and investigated the efficacy of three biomaterials: polycaprolactone-gelatin-silver membrane (PCLGelAg) and two commercial burn dressings, Aquacel^® Ag and UrgoTul^TM silver sulfadiazine. In vitro long-term antibacterial property and in vivo wound healing performance were investigated. Agar diffusion assays were employed to evaluate bacterial inhibition at different time intervals. Minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and time-kill assays were used to compare antibacterial strength among samples. Second-degree burn wounds in the pig model were designed to evaluate the efficiency of all dressings in supporting the wound healing process. (3) Results: The results showed that PCLGelAg membrane was the most effective in killing both Gram-positive and Gram-negative bacteria bacteria with the lowest MBC value. All three dressings (PCLGelAg, Aquacel, and UrgoTul) exhibited bactericidal effect during the first 24 h, supported wound healing as well as prevented infection and inflammation. (4) Conclusions: The results suggest that the PCLGelAg membrane is a practical solution for the treatment of severe burn injury and other infection-related skin complications. Full article