Search Results (44)

Background/Objectives: Fibroproliferative disorders (FPDs), such as Dupuytren’s contracture, scleroderma, capsular contracture, rhinophyma, and keloid scars, are characterised by excessive fibroblast activity and collagen deposition. These conditions are frequently encountered in plastic and reconstructive surgery and remain therapeutically challenging. Cyclooxygenase (COX) inhibitors have emerged as a potential adjunct therapy to modulate fibrotic pathways and improve clinical outcomes. This systematic review aims to evaluate the efficacy and safety profile of COX inhibitors in the management of plastic-surgery-related FPDs. In doing so, it explores how phenotype-guided and route-specific COX-inhibitor use may contribute to precision, patient-centred care. Methods: To identify eligible studies, a comprehensive search was conducted in MEDLINE, Embase, and the Cochrane Library. Data were synthesised using both tabular summaries and narrative analysis. The certainty of evidence was appraised according to the GRADE guidelines. Results: Thirteen studies from 1984 to 2024 met inclusion criteria, addressing FPDs such as hypertrophic scarring, Dupuytren’s contracture, and desmoid tumours, representing 491 patients. Of those, five studies were related to Dupuytren contracture, three studies were related to hypertrophic scar, and one study each was on topics related to scleroderma, keloid scar, osteogenesis imperfecta, actinic keloidalis nuchae/dissecting cellulitis of the scalp, and desmoid tumours. Nine studies reported clinical improvements (four demonstrating statistically significant outcomes), three showed no difference, and one did not assess outcomes. The thirteen studies show minor side effects from oral and topical COX inhibitors. The overall certainty of evidence was graded as “low.” Conclusions: COX inhibitors demonstrate promising efficacy with minimal adverse effects in the management of plastic-surgery-related FPDs. Their accessibility, safety, and potential to reduce fibrosis underscore the need for future high-quality, large-scale studies to establish definitive clinical recommendations. Full article

Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients. Full article

Transcranial electrical stimulation, as a means of neural modulation, is increasingly favored by researchers. The distribution and magnitude of the electric field generated within the brain may directly affect the results of neural modulation. Therefore, it is important to clarify the change trend of the cortical electric field and the determinants of the induced electric field in the endodermis at different ages during the adult life cycle. In this study, we used SimNIBS software to perform MR image segmentation and realistic head model reconstruction on 476 individuals (aged 18 to 88 years old) and calculated the cortical electric field of four electrode montages commonly used in cognitive tasks. We divided all participants into groups by age with a span of 10 years for each group and compared the electric field distribution patterns, electric field intensities, and focalities of the cortexes and regions of interest related to cognitive tasks within groups. The degree of influence of global and local anatomical parameters on the electric field was analyzed using a stepwise regression model. The results showed that, in the cortexes and regions of interest, the variability of electric field distribution patterns was highest in adolescents (<20 years old) and elderly individuals (>80 years old). Moreover, throughout the adult lifespan, the electric field induced by transcranial electrical stimulation did not decrease linearly with age but rather presented a U-shaped pattern. In terms of the entire adult life cycle, compared with global anatomical parameters (intracranial brain tissue volume), local anatomical parameters (such as scalp or skull thickness below the electrode) have a greater impact on the amplitude of the intracranial electric field. Our research results indicated that it is necessary to consider the effects caused by different brain tissues when using transcranial electrical stimulation to modulate or treat individuals of different ages. Full article

Background/Objectives: Scalp defect reconstruction often poses a challenge due to the distinct anatomy and limited skin elasticity of the region. Rotational flaps, when properly planned, offer a superior and creative solution for effectively covering most scalp defects. The aim of this study is to present the indications, and versatile use of rotational flaps in scalp reconstructive surgery, guided by an algorithmic approach and exemplified by numerous clinical applications. Methods: An observational cohort study was conducted between 2019 and 2024. The study protocol adhered to the ethical guidelines of the Declaration of Helsinki, was approved by the local ethics committee, and followed the STROBE statement for cohort studies. Results: A total of 152 rotational flaps were performed in 138 patients to reconstruct scalp defects, mostly following skin cancer excision. The defect size ranged from 30 to 96 mm in largest diameter (mean diameter, 52.8 ± 8.8 mm). Postoperative complications occurred in 13 cases (9.4%), and 5 cases (3.6%) required further surgical treatment, due to wound healing problems and/or necrosis. Based on high VAS scores (9.4 + 0.3), the cosmetic outcomes were deemed satisfactory, with excellent color and texture matching. Conclusions: This study underscores the critical role of meticulous surgical planning and technique in achieving optimal outcomes in scalp reconstruction. By combining the principles of tissue biomechanics with the versatility of rotational flaps, surgeons can effectively address a wide range of defects, achieving both functional and esthetic excellence. Full article

The reconstruction of large full-thickness scalp injuries represents a great challenge in pediatric plastic surgery. Epidermal–dermal substitutes come to the rescue when traditional surgical strategies are not suitable. Recently, the new Integra MicroMatrix UBM particulate has arisen on the market. This is an extracellular matrix derived from the porcine urinary bladder matrix (UBM) in which the particulate structure provides close contact to the wound bed. We present the concomitant application of Integra DRT and MicroMatrix for the reconstruction of a full-thickness subtotal scalp defect in a child mauled by a dog. Full article

Electrical burn injuries to the scalp are at risk of extensive tissue damage and neurological complications. We present the case of a patient who came into contact with a high-voltage power line while cherry picking, resulting in a large full-thickness scalp defect. Early on in his presentation, he developed progressive global weakness which remained relatively static during his admission. An incidental finding of an extradural abscess complicated his management, requiring urgent surgical intervention with definitive tissue coverage. The scalp was reconstructed using a free myocutaneous anterolateral thigh flap. There were no postoperative complications. Following rehabilitation, the patient was discharged home with limited functional recovery. He mobilises independently with a wheelchair and requires full-time carers. Full article

Angiosarcomas are malignant vascular tumors that commonly occur on the skin of the head and neck, breast, or scalp. Oral angiosarcoma is a rare tumor (0.0077% of all cancers in Europe), and regarding this atypical localization, no formal treatment trials have been conducted yet. We present a case of a 58-year-old female patient with a diagnosis of oral angiosarcoma. After tumor excision was performed by transoral surgical approach, immediate reconstruction of the intraoral surgical defects was made using Integra^® bilayer wound collagen matrix. A skin regeneration technique has previously been reported to provide good healing for defects of buccal resection, preventing postoperative cicatricial fibrosis. Full article

Background: Skin substitutes play a crucial role in wound care by actively modulating the wound healing process, promoting angiogenesis, and protecting the integrity of the native extracellular matrix. Consequently, surgeons have increasingly recognized these resources as excellent complements to improve reconstructive outcomes. This review focuses on the author’s experience using these biomaterials in complex cases, highlighting the benefits they bring to patient care. Methods: A literature review was conducted to evaluate the regenerative properties of skin substitutes and their applicability in head and neck, upper and lower extremities, and trunk reconstruction. Results: The reviewed literature, along with the authors’ experience, supports the adjunct use of skin substitutes in various reconstructive situations. Combining them with skin grafts improves resulting skin quality and may also enhance donor site healing. They have proven to be effective in addressing chronic venous ulcers, traumatic wounds with limited donor tissues for coverage, extensive burns, diabetic foot ulcers, and oncological resections in the face and scalp. Furthermore, combining them with autologous tissue shows promising results in achieving stable closure. Conclusions: Incorporating skin substitutes in complex reconstructive scenarios offers multiple benefits. Their regenerative properties and ability to modulate the healing process contribute to enhanced outcomes and reduced overall costs. Full article

Background: Scalp-associated cutaneous squamous cell carcinoma (cSCC) presents formidable treatment challenges, especially when it leads to full-thickness defects involving bone. Aggressive or recurring cases often demand a multidisciplinary approach. Leveraging our surgical experience and a literature review, we introduce a therapeutic algorithm to guide the selection of reconstruction methods, particularly for locally advanced lesions, furthermore showing the synergy between surgery and other therapies for comprehensive, multidisciplinary disease management. Methods: Our algorithm stems from a retrospective analysis of 202 patients undergoing scalp cSCC resection and reconstruction over a 7-year period, encompassing 243 malignancies. After rigorous risk assessment and documentation of surgical procedures, reconstruction methods were therefore related to malignancy extent, depth, and individual clinical status. Results: The documented reconstructions included 76 primary closures, 115 skin grafts, 7 dermal substitute reconstructions, 33 local flaps, 1 locoregional flap, and 1 microsurgical free flap. Patients unsuitable for surgery received radiotherapy or immunotherapy after histological confirmation. Precise analysis of tumor characteristics in terms of infiltration extent and depth guided the selection of appropriate reconstruction and treatment strategies Combining these insights with an extensive literature review enabled us to formulate our algorithm for managing scalp cSCCs. Conclusions: Effectively addressing scalp cSCC, especially in locally advanced or recurrent cases, demands a systematic approach integrating surgery, radiotherapy, and immunotherapy. Our multidisciplinary team’s decision-making algorithm improved patient outcomes by offering a broader spectrum of therapeutic options that can synergistically achieve optimal results. Full article

Meibomian gland dysfunction (MGD) is one of the main causes of dry eye disease. To better understand the physiological functions of human meibomian glands (MGs), the present study compared MGs with free sebaceous glands (SGs) and hair-associated SGs of humans using morphological, immunohistochemical, and liquid chromatography—mass spectrometry (LCMS)-based lipidomic approaches. Eyelids with MGs, nostrils, lips, and external auditory canals with free SGs, and scalp with hair-associated SGs of body donors were probed with antibodies against cytokeratins (CK) 1, 8, 10, and 14, stem cell markers keratin 15 and N-cadherin, cell–cell contact markers desmoglein 1 (Dsg1), desmocollin 3 (Dsc3), desmoplakin (Dp), plakoglobin (Pg), and E-cadherin, and the tight junction protein claudin 5. In addition, Oil Red O staining (ORO) was performed in cryosections. Secretions of MGs as well as of SGs of nostrils, external auditory canals, and scalps were collected from healthy volunteers, analyzed by LCMS, and the data were processed using various multivariate statistical analysis approaches. Serial sections of MGs, free SGs, and hair-associated SGs were 3D reconstructed and compared. CK1 was expressed differently in hair-associated SGs than in MGs and other free SGs. The expression levels of CK8, CK10, and CK14 in MGs were different from those in hair-associated SGs and other free SGs. KRT15 was expressed differently in hair-associated SGs, whereas N-cadherin was expressed equally in all types of glands. The cell–cell contact markers Dsg1, Dp, Dsc3, Pg, and E-cadherin revealed no differences. ORO staining showed that lipids in MGs were more highly dispersed and had larger lipid droplets than lipids in other free SGs. Hair-associated SGs had a smaller number of lipid droplets. LCMS revealed that the lipid composition of meibum was distinctively different from that of the sebum of the nostrils, external auditory canals, and scalp. The 3D reconstructions of the different glands revealed different morphologies of the SGs compared with MGs which are by far the largest type of glands. In humans, MGs differ in their morphology and secretory composition and show major differences from free and hair-associated SGs. The composition of meibum differs significantly from that of sebum from free SGs and from hair-associated SGs. Therefore, the MG can be considered as a highly specialized type of holocrine gland that exhibits all the histological characteristics of SGs, but is significantly different from them in terms of morphology and lipid composition. Full article

Background/Objectives: The need for surgical reconstruction of scalp defects following the excision of cutaneous skin cancers is an increasingly common procedure. Particular challenges arise when considering options for reconstruction of large defects not amenable to local skin flap coverage. The use of skin grafts poses the risk of donor site morbidity. This paper investigates the emerging use of Integra^®, a synthetic acellular dermal regeneration template, as an alternative or adjunct to skin grafting in scalp reconstruction. Methods: The study presents a retrospective analysis of 101 patients who underwent Integra^®-based reconstruction of scalp defects. Demographics, procedure details, complications, need for further surgery, and time to healing were evaluated. Results: The overall success rate of the one-stage Integra^®-only procedure was 95%, with a minor complication rate of 30.7%. Anticoagulation medication was identified as an independent risk factor for post-operative infection, while previous head and neck radiotherapy and increased defect depth were associated with the requirement for a second-stage skin graft. Conclusions: These findings support the consideration of Integra^® as a safe and viable alternative for both partial and full thickness scalp defects in a select cohort of complex highly co-morbid patients, reducing complications and the need for additional procedures. Full article

The goal of this study was to test a novel approach (iCanClean) to remove non-brain sources from scalp EEG data recorded in mobile conditions. We created an electrically conductive phantom head with 10 brain sources, 10 contaminating sources, scalp, and hair. We tested the ability of iCanClean to remove artifacts while preserving brain activity under six conditions: Brain, Brain + Eyes, Brain + Neck Muscles, Brain + Facial Muscles, Brain + Walking Motion, and Brain + All Artifacts. We compared iCanClean to three other methods: Artifact Subspace Reconstruction (ASR), Auto-CCA, and Adaptive Filtering. Before and after cleaning, we calculated a Data Quality Score (0–100%), based on the average correlation between brain sources and EEG channels. iCanClean consistently outperformed the other three methods, regardless of the type or number of artifacts present. The most striking result was for the condition with all artifacts simultaneously present. Starting from a Data Quality Score of 15.7% (before cleaning), the Brain + All Artifacts condition improved to 55.9% after iCanClean. Meanwhile, it only improved to 27.6%, 27.2%, and 32.9% after ASR, Auto-CCA, and Adaptive Filtering. For context, the Brain condition scored 57.2% without cleaning (reasonable target). We conclude that iCanClean offers the ability to clear multiple artifact sources in real time and could facilitate human mobile brain-imaging studies with EEG. Full article

Free flap reconstruction is the standard of care for extensive defects of the head and neck area. In this study, two types of free flaps, the antero-lateral thigh flap (ALT) and the vastus lateralis muscle flap, were compared. The primary endpoint was flap success, secondary endpoints were complication rates, hospitalization and surgery time. Cases with defect situations of the scalp and consecutive microvascular free flap reconstructions using either ALT flaps or vastus lateralis muscle flaps between 2014 and 2022 were retrospectively analyzed. Indications, perioperative handling and outcomes were compared. Twenty patients were included in the analysis. Ten patients (50%) received a free flap reconstruction using an ALT flap and ten patients (50%) received a vastus lateralis flap. A simultaneous two-team approach was possible in each case and the flap success rate was 100% with the need for one successful anastomosis revision. The mean defect size in our cohort was 147 ± 46 cm². There were no significant differences in surgery time, duration of hospitalization or complication rate between both cohorts. Both free flaps, the ALT and the vastus lateralis flap, are suitable for the closure of large scalp defects. They provide high success rates, short surgery times without the need for patient repositioning and low donor-site morbidity. The vastus lateralis muscle flap bares the advantage of being perforator-independent and allows for the preparation of long vessels for anastomosis if needed while baring the disadvantage of a prolonged period of healing via granulation or the need for secondary surgery in terms of covering by split-thickness skin grafts which may interfere with necessary adjuvant treatment in oncological patients. Full article

Background and Objectives: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. Materials and Methods: This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients’ characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. Results: Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities (p = 0.001), aseptic bone necrosis (p = 0.001), as well as skin atrophy in frontal, occipital, and parietal region (p = 0.001, p = 0.042 and p = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region (p = 0.026). Conclusions: Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors’ experience in managing these patients. Full article

The forehead and temporal region are frequent areas of skin cancer development. After tumor removal, reconstruction must be performed, maintaining the frontal–temporal line of the scalp and symmetry of the eyebrows in an attempt to hide the scars within these marks or natural folds and wrinkles. Second wound healing and skin grafts generally do not produce an acceptable cosmetic result. When direct closure is not possible, the technique of choice is skin flaps. In the midfrontal line continuation of the glabella, there is a remnant of skin to be used as a donor area for local flaps; similarly, it occurs in the preauricular cheek, which can move toward the temple. In addition to the classic advancement and rotation flaps, the frontalis myocutaneous transposition flap is an excellent technique for closing defects which are wider than higher on the forehead. Its design is very versatile and can be performed between the two pupil lines at different heights depending on the location of the defect. On the other hand, the preauricular skin advancement flap with an infralobular Burow’s triangle is also an excellent option for reconstructing tumors in the temporal area. Full article