Contenuto

Un lavoro pubblicato nel primo numero di gennaio della rivista internazionale più autorevole nel campo della chirurgia plastica è stato considerato come "viewpoint" sul trattamento innovativo utilizzato ai limiti delle possibilità chirurgiche sia oncologiche che ricostruttive

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Articolo

Riggio, Egidio M.D.; Catanuto, Giuseppe M.D.; Nava, Maurizio B. M.D.

Silicone Barrier Sheath as an "Oncologic Vallum" in Two-Stage Reconstruction with Expanders for Large, Recurrent, Soft-Tissue Cancer.

Plastic & Reconstructive Surgery. 119(1):445-446, January 2007.

Commento

Sir: Creative solutions are basic parts of the plastic surgery specialty. The case reported here demonstrates how a plastic surgeon can solve an extreme case when oncologic surgeons are unable to find the right surgical approach and reconstructive options are challenging.
A 47-year-old woman with systemic lupus erythematosus and herpes zoster was being treated for type II diabetes. She presented in 1998 with a lump in the back that was treated with local excision. A pathologic analysis demonstrated schwannoma infiltrating the dermis.
In 2000, the disease recurred for the first time and the patient underwent excision and radiotherapy. Local relapse was observed in 2001, 2002, and 2003, requiring multiple resections. After the last excision, extensive local disease at pathology required admission for large demolition of the back, including the spinous process of the dorsal vertebrae. The defect was repaired with a latissimus dorsi myocutaneous flap and skin grafts. In April of 2004, skin advancement flaps and grafts were used to repair a new area of malignancy. Eight months later, disease recurred in the interscapular region. Lack of covering tissue forced the surgeon to leave the wound open after resection and insert a 500-cc expander underneath the flap. Once pathology reported locoregional dissemination, new tissue expansion was required. No regional or distant flaps were wide enough to cover the tissue loss. Four expanders were inserted, and a silicone lamina was used to mechanically protect the latissimus dorsi from local involvement. The implants were placed under the flap, in the left lower back, in the left deltoid region, and in the posterior neck; the last one was extruded postoperatively, but the others worked well. In April of 2005, large excision was carried out with full skin coverage using the expanded tissue flaps.

Ultimo aggiornamento: lunedì 12 febbraio 2007