Search Results (578)

Intraosseous hemangiomas (IH) are rare intrabony lesions that represent less than 1% of intraosseous tumors. IH are mostly seen in the axial skeleton and skull. Most commonly, the frontal bone, zygomatic, sphenoid, maxilla, ethmoid, and lacrimal bone can manifest IH. Currently, IH is classified as a developmental condition of endothelial origin. According to WHO, the five histological types of IH are cavernous, capillary, epithelioid, histiocytoid, and sclerosing. IH of the zygoma is an extremely rare condition with female predominance. A systematic review recently estimated that there were 78 cases published in the literature until 2023. The lesion is usually asymptomatic and presents with a gradually deteriorating deformity of the malar area, and the patient might be able to recall a history of trauma. Numbness due to involvement of the infraorbital nerve might also be present; however, atypical skin and bone sensations might also occur. Other symptoms include painful swelling, bone asymmetry, skin irritation, sinus pressure, paresthesia, diplopia, enophthalmos, or atypical neuralgia. A bony lesion with a trabecular pattern in a radiating formation (sunburst pattern) or a multilocal lytic lesion pattern created by the multiple cavernous spaces (honeycomb pattern) is commonly observed during radiologic evaluation. We present a rare case of IH of the zygoma in a 65-year-old generally healthy woman. A cyst-like bone tumor was revealed from the CT scan, which made preoperative biopsy of the lesion problematic. A careful radiological diagnostic differentiation of the lesion should always be conducted in such cases to outline a safe surgical plan and possible alternatives if needed. The patient underwent total tumor resection in the operating room, and the defect was reconstructed with the use of a titanium mesh and a synthetic hydroxyapatite bone graft based on a 3D surgical guide printed model. Full article

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients, evaluate the short-term and long-term results, including complications and functional outcomes, as well as to share some unique observations regarding the use of BTM in paediatric population. Patients and Methods: Patients undergoing reconstructive surgery and BTM application during the last three years were included. Data collected included patient demographics, primary diagnosis, previous surgical management, post-operative complications and final outcomes. BTM was used in 32 patients. The indications varied including epidermolysis bullosa (n = 6), burns (n = 4), trauma (n = 7), infection (n = 4), ischemia or necrosis (n = 11). Results: The results were satisfying with acceptable aesthetic and functional outcomes. Complications included haematoma underneath the BTM leading to BTM removal and re-application (n = 1), BTM infection (n = 1) and split-thickness skin graft failure on top of BTM requiring re-grafting (n = 2). Conclusions: BTM can be a good alternative to large skin grafts, locoregional flaps or even free flaps. The big advantages over other dermal substitutes or skin grafts are that BTM is less prone to infection and offers excellent scarring by preserving the normal skin architecture. Specifically in children, BTM might not require grafting, resulting in spontaneous healing with good scarring. In critically ill patients, BTM reduces the operation time and there is no donor site morbidity. BTM should be considered in the reconstructive ladder when discussing defect coverage options in children and young people. Full article

Objectives: Nasal reconstructive surgery following skin cancer resection is challenging, with esthetic concerns impacting patients’ quality of life. Non-surgical rhinoplasty may be an alternative to repeated surgeries. This study aimed to evaluate non-surgical rhinoplasty esthetic benefits and subjective patient outcomes after skin cancer resection. Methods: We conducted a retrospective study on patients with post-operative esthetic dissatisfaction after nasal skin cancer surgery, who underwent non-surgical rhinoplasty with hyaluronic acid. Subjective benefits were evaluated with the FACE-Q Rhinoplasty self-questionnaire at three consultations: before injection (baseline), and at one and two months after. Two-dimensional and three-dimensional Vectra H2 photographs were used to assess subjective esthetic concerns and objective volumetric changes. Results: The study included six female patients with an average age of 58.3 years. They had undergone, on average, five nasal surgeries for cancer. The mean FACE-Q scores were 53.3 (±10.31), 77.5 (±4.18), and 79.7 (±6.76), respectively, at baseline, one month, and two months. Significant differences were observed between baseline and one month (p < 0.001) and between baseline and two months (p < 0.001), but not between one and two months. The was a mean volumetric gain of 1.13 mL at one month and 1.19 mL at two months. Conclusions: This preliminary study suggested that hyaluronic acid-based non-surgical rhinoplasty could improve esthetic outcomes and quality of life in patients who had undergone nasal skin cancer surgery. These findings highlight a potential role for this minimally invasive technique in selected post-reconstructive cases, although the small sample size limited the generalizability of the results and underlined the need for further prospective evaluation. Full article

Background/Objectives: Deep models have achieved remarkable progress in the diagnosis of skin lesions but face two significant drawbacks. First, they cannot effectively explain the basis of their predictions. Although attention visualization tools like Grad-CAM can create heatmaps using deep features, these features often have large receptive fields, resulting in poor spatial alignment with the input image. Second, the design of most deep models neglects interpretable traditional visual features inspired by clinical experience, such as color–texture and edge features. This study aims to propose a novel approach integrating deep learning with traditional visual features to handle these limitations. Methods: We introduce the edge- and color–texture-aware bag-of-local-features model (ECT-BoFM), which limits the receptive field of deep features to a small size and incorporates edge and color–texture information from traditional features. A non-rigid reconstruction strategy ensures that traditional features enhance rather than constrain the model’s performance. Results: Experiments on the ISIC 2018 and 2019 datasets demonstrated that ECT-BoFM yields precise heatmaps and achieves high diagnostic performance, outperforming state-of-the-art methods. Furthermore, training models using only a small number of the most predictive patches identified by ECT-BoFM achieved diagnostic performance comparable to that obtained using full images, demonstrating its efficiency in exploring key clues. Conclusions: ECT-BoFM successfully combines deep learning and traditional visual features, addressing the interpretability and diagnostic accuracy challenges of existing methods. ECT-BoFM provides an interpretable and accurate framework for skin lesion diagnosis, advancing the integration of AI in dermatological research and clinical applications. Full article

Background/Objectives: Obesity is associated with various skin complications, yet its impact on dermal elastic fibers—key components maintaining skin elasticity—remains unclear, particularly in cases of mild obesity prevalent in East Asian populations. The aim of this study was to investigate whether mild obesity is associated with the early structural deterioration of dermal elastic fibers and alterations in elastin-related gene expression in Japanese individuals. Methods: Abdominal skin samples from 31 Japanese women (the mean body mass index [BMI] 23.9 ± 3.2 kg/m², mean age 49.5 ± 4.8) undergoing breast reconstruction surgery were analyzed. Gene expression levels of elastin-regenerative and -degradative molecules were assessed by quantitative polymerase chain reaction in the epidermis, dermis, and subcutaneous fat. Dermal elastic fiber content was evaluated histologically using Elastica van Gieson staining. Results: No statistically significant correlations between the BMI and elastin-degrading gene expression (NE, MMP2, MMP9, and NEP) were observed. ELN expression in the dermis showed a significant positive correlation with the BMI (ρ = 0.517, p = 0.003), potentially reflecting a compensatory response. Histological analysis revealed a significant inverse correlation between dermal elastic fiber content and the BMI (r = −0.572, p = 0.001), independent of age or smoking history. Conclusions: Even mild obesity is associated with the early degradation of dermal elastic fibers despite limited transcriptional alterations. These findings underscore the need for early skin care interventions to mitigate obesity-related skin fragility, especially in populations with predominantly mild obesity. Full article

Background: Huriez syndrome is a rare hereditary skin disorder marked by early-onset sclerodactyly, hyperkeratosis of the palms and soles, and nail dysplasia. A key concern is the early and aggressive development of cutaneous squamous cell carcinoma (SCC), typically affecting the dorsal aspects of the hands. Methods: This narrative review summarizes clinical features, genetic aspects, and oncologic implications of Huriez syndrome. A systematic search was conducted in PubMed and Scopus, including English-language articles published up to May 2025. Relevant case reports and small case series were analyzed. Results: Seven patients (58.3%) underwent multiple surgeries due to recurrent or bilateral disease. Six patients (50%) required amputations, including finger, hand, and arm amputations, with no foot amputations reported. Reconstruction after oncological resection was performed in six patients (50%) using skin grafts (3), pedicled flaps (2), or free flaps (1). Amputation was mainly for advanced disease, with radial forearm flaps used for reconstruction. All flaps remained disease-free. Five cases (41.6%) had a history of local recurrence. Conclusions: The early diagnosis of Huriez syndrome is crucial to enable the surveillance and timely treatment of SCC. A multidisciplinary team including dermatologists, oncologists, plastic surgeons, and geneticists is recommended. Further research is needed to clarify genetic mechanisms and develop early detection strategies to improve outcomes. Full article

Tissue engineering enables autologous reconstruction of human tissues, addressing limitations in tissue availability and immune compatibility. Several tissue engineering techniques, such as self-assembly, rely on or benefit from extracellular matrix (ECM) secretion by fibroblasts to produce biomimetic scaffolds. Models have been developed for use in humans, such as skin and corneas. Ascorbic acid (vitamin C, AA) is essential for collagen biosynthesis. However, AA is chemically unstable in culture, with a half-life of 24 h, requiring freshly prepared AA with each change of medium. This study aims to demonstrate the functional equivalence of 2-phospho-L-ascorbate (2PAA), a stable form of AA, for tissue reconstruction. Dermal, vaginal, and bladder stroma were reconstructed by self-assembly using tissue-specific protocols. The tissues were cultured in a medium supplemented with either freshly prepared or frozen AA, or with 2PAA. Biochemical analyses were performed on the tissues to evaluate cell density and tissue composition, including collagen secretion and deposition. Histology and quantitative polarized light microscopy were used to evaluate tissue architecture, and mechanical evaluation was performed both by tensiometry and atomic force microscopy (AFM) to evaluate its macroscopic and cell-scale mechanical properties. The tissues produced by the three ascorbate conditions had similar collagen deposition, architecture, and mechanical properties in each organ-specific stroma. Mechanical characterization revealed tissue-specific differences, with tensile modulus values ranging from 1–5 MPa and AFM-derived apparent stiffness in the 1–2 kPa range, reflecting the nonlinear and scale-dependent behavior of the engineered stroma. The results demonstrate the possibility of substituting AA with 2PAA for tissue engineering. This protocol could significantly reduce the costs associated with tissue production by reducing preparation time and use of materials. This is a crucial factor for any scale-up activity. Full article

Background/Objectives: The gold standard of treatment for both melanoma and non-melanoma skin cancers is wide surgical resection to obtain oncological radicality, which occasionally results in functional or aesthetic impairment, potentially affecting quality of life. Despite the increased complexity of the technique, extended duration of hospitalization, and prolonged surgical operative times, microsurgery can facilitate the reconstruction of locally invasive skin cancers following ablative surgery and may yield superior functional and aesthetic outcomes. Consequently, microsurgical reconstruction is more likely to be necessary if a large skin tumor requires excision. However, the impact of this extensive and complex procedure on patients with skin cancer has not yet been fully elucidated. The objective of this research was to critically analyze the utilization of free flap reconstruction subsequent to skin cancer therapy. Through a comprehensive examination of published data, this study aimed to assess the potential benefits and drawbacks associated with this reconstructive approach. Methods: A systematic review of studies that were published from January 2004 to May 2024 was conducted using the MEDLINE online database search. To present an evidence summary and provide a systematic approach and quality assessment, the GRADE^® rating was applied to the results. Results: This review summarizes the oncological and clinical data, including previous interventions, adjuvant and neoadjuvant therapies, nodal status, distant metastasis, and follow-up time. Surgical outcome parameters such as healing time, flap survival, revision rate success, and minor and major complications were documented. Along with the findings, a quality assessment of the studies was also provided. Conclusions: This systematic review underscores the extensive use and efficacy of microsurgery for reconstruction after skin cancer excision; however, the literature remains limited by inconsistent reporting of oncological outcomes and the lack of a standardized approach to evaluate the impact of free flap reconstruction on both immediate and long-term cancer-specific results. Full article

Background: Mycobacterium ulcerans causes Buruli ulcer (BU), a necrotizing skin disease endemic in over 30 countries. Its toxin, mycolactone, drives tissue destruction, and the infection is transmitted via environmental reservoirs or vectors. Disease patterns vary globally, and an improved understanding of their pathogenesis may enhance current antimicrobial and surgical treatments. Methods: A comprehensive literature search from 1901 to 2025 was conducted across major databases to explore antimicrobial and reconstructive surgical strategies for Mycobacterium ulcerans. Search terms included BU, key antibiotics, and surgical interventions. Relevant English-language studies on treatment outcomes were reviewed to summarize evolving management trends and emerging therapeutic approaches. Results and Discussion: This review highlights the importance of early diagnosis and timely antimicrobial therapy in preventing disease progression and limb loss. It reviews WHO-recommended antibiotic regimens and discusses the theoretical risk of drug resistance, although clinical resistance remains rare and unreported in Australia. Surgical interventions in select cases are crucial, with timing being a significant factor in functional outcomes. The review also covers pediatric-specific challenges, including growth preservation and psychosocial support for young patients. Reconstructive options focus on limb salvage and staged reconstructions, with multidisciplinary care essential for optimal outcomes. The paper advocates for RCTs to refine treatment protocols, surgical guidelines, and explore emerging antibiotic therapies such as telacebec. Conclusions: BU remains a global health challenge, requiring early diagnosis, timely antimicrobial therapy, and surgery in selected cases. Future research will refine treatment and reduce long-term impacts. Full article

Laminosioptes cysticola (Vizioli, 1870), a tissue-dwelling mite responsible for nodular acariasis in birds, was identified from two hens reared in a rural backyard flock in Umbria, Italy. Adult mites were found in the subcutaneous tissue and on the serosal surface of various internal organs. Larval and first- and second-stage nymphal forms were observed beneath the skin and near the trachea and esophageal serosa. By comparing the existing literature with that reported in the present study, we propose a hypothetical reconstruction of the parasite’s life cycle. It is postulated that the entry of L. cysticola occurs through the cervical skin, where adults mate and larviparous females give birth to larvae. These larvae migrate into the loose connective tissues surrounding the trachea and esophagus, where they develop into nymphs. The immature forms then progress along the esophagus and trachea to reach the thoracic and abdominal cavities, colonizing the serosal surfaces of visceral organs. It remains unclear whether, or how, the mites return to the subcutaneous tissues to complete their maturation. Senescent specimens degenerate within the subcutis, where they are encased by a granulomatous inflammatory reaction that leads to the formation of characteristic calcified nodules. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Cockpit noise, as a critical environmental factor affecting flight safety, may impair pilots’ cognitive functions, leading to a decreased operational performance and decision-making errors, thereby posing potential threats to aviation safety. In order to reveal the relationship between the cockpit noise sound pressure level and pilot physiological indicators, and provide a scientific basis for cockpit noise airworthiness standards, this experiment takes pilot trainees as the research subject. Based on the principle of multimodal data synchronization, a sound field reconstruction system is used to reconstruct the cockpit sound field. Electroencephalogram (EEG), electrocardiogram (ECG), and electrodermal activity (EDA) measurements are carried out in different sound pressure level noise operating environments. The results show that with the increase in the sound pressure level, the significant suppression of α-wave activity in the occipital and parietal regions suggests that the cortical resting state is lifted and visual attention is enhanced; the enhancement of the β-wave in the frontal regions reflects the enhancement of alertness and prefrontal executive control, and the suppression of θ-wave activity in the frontal and temporal regions may indicate that cognitive tuning is suppressed, which reflects the brain’s rapid adaptive response to external noise stimuli in a high-noise environment; noise exposure triggers sustained sympathetic nerve hyperactivity, which is manifested by a significant acceleration of the heart rate and a significant increase in the mean value of skin conductance when the noise sound pressure level exceeds 70 dB(A). The correlation analysis between physiological indicators shows that cockpit noise has a multi-system synergistic effect on human physiological indicators. The experimental results indicate that noise has a significant impact on EEG, ECG, and EDA indicators. Full article

Soft tissue reconstruction in patients with upper extremity necrotizing soft tissue infections (NSTIs) can be challenging; these defects can be large with exposed critical structures. Following appropriate source control and debridement, soft tissue reconstruction is based on size, exposed structures, medical co-morbidities and the physiologic status of the patient. There are multiple options for soft tissue coverage from local wound care to free tissue transfer. Dermal substitutes can help prepare a healthy wound bed that can later accept a skin graft. Local rotational flaps, distant pedicled flaps and free flaps are also options depending on the patient and the defect. Patients can have good functional outcomes after soft tissue reconstruction after upper extremity NSTI. Full article

Background/Objectives: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and aggressive cutaneous lymphoma, often misdiagnosed due to nonspecific clinical features. Early diagnosis and treatment remain challenging. Methods: We report the case of a 31-year-old female with a chronic non-healing gluteal wound initially treated as an abscess. The lack of improvement prompted repeated investigations, culminating in the diagnosis of SPTCL with an alpha–beta T-cell phenotype. Results: Management involved combined chemotherapy and surgical wound reconstruction. Six cycles of CHOEP-21 chemotherapy led to complete clinical remission. A soft tissue defect superinfected with multidrug-resistant organisms was successfully reconstructed using Integra Dermal Regeneration Template followed by split-thickness skin grafting. Conclusions: This case highlights the diagnostic complexity of SPTCL and the therapeutic potential of dermal matrix application in complex wound management, especially in immuno-compromised patients. Full article

Background: Intercostal artery perforator (ICAP) flaps are a reliable option for volume replacement in breast-conserving surgery (BCS), particularly for lower pole defects. However, limited flap volume may reduce their applicability in selected patients. Autologous fat grafting has been proposed to enhance both volume and aesthetic outcomes. Methods: This retrospective study evaluated 10 patients undergoing BCS with immediate reconstruction using fat-graft-augmented ICAP flaps. Nine anterior ICAP (AICAP) flaps and one lateral ICAP (LICAP) flap were employed. The outcomes included flap viability, complications, and aesthetic results over a 6-month follow-up. Results: Partial flap resorption occurred in 2 patients (20%), both of whom were active smokers. No cases of skin necrosis were observed. Fat grafting volumes ranged from 20 to 60 cc. Aesthetic outcomes were satisfactory, with good restoration of the breast contour and stable integration of the flap and grafted fat. Conclusions: The combined use of ICAP flaps and autologous fat grafting is a feasible and effective technique for immediate reconstruction after BCS. It allows volume enhancement, maintains natural contour, and shows low complication rates in properly selected patients. Smoking remains a significant risk factor. Full article