DOI: 10.3897/folmed.68.e168322

Authors: Simona Kordeva, Konstantin Georgiev Tchernev Jr, Georgi Tchernev

Abstract: Abstract Surgical reconstructive techniques continue to evolve as dermatosurgeons combine clinical expertise, technical skill, and innovation. In some cases, such innovation can result in better outcomes in terms of tension management, vascular supply preservation, and esthetic appearance. The double-opposing rotation advancement flap, also known as the Ying-Yang flap due to its yin-yang mode of action, is often applied in the scalp region, where it provides excellent results with minimal complications. However, data supporting its application in less conventional anatomical sites remains limited. We present two independent cases involving primary defects resulting from skin tumor excisions, successfully reconstructed with the Ying-Yang flap in atypical locations: the medial foot ankle and preauricular regions. Tension-free closure was achieved in both cases, and follow-up at two months demonstrated great wound healing. While surgical excision remains the gold standard for treating skin cancer, these cases highlight the double-opposing rotation advancement flap as a versatile and effective reconstructive option beyond its standard indications.

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DOI: 10.3897/folmed.67.e155274

Authors: Velizar Hadzhiminev, Georgi Markov, Aleksandar Sarpanov, Lyubomir Paunov, Stanislav Karamitev, Aleksandrina Topalova-Shishmanova, Krasi Kalacheva, Atanas Batashki

Abstract: Abstract Introduction: Fournier’s gangrene (FG) is a rare and potentially life-threatening infection that leads to necrosis of soft tissue. This condition constitutes a medical emergency, necessitating prompt surgical intervention to mitigate the potential consequences. Aim: To analyze the demographic and clinical characteristics of a small cohort of patients with FG. Patients and methods: The present retrospective study included 31 patients with Fournier’s gangrene who were hospitalized in the Department of General Surgery from January 2020 to December 2023. A comprehensive examination of the patients’ demographic characteristics, comorbidities, presence of diabetes mellitus, microbial agents involved, and methods used for wound management was conducted. Results: The study found that men, particularly those over the age of 55, were more commonly affected than women. Escherichia coli was identified as the predominant microbial agent. The prevalence of diabetes mellitus was found to be higher among female patients. All patients received prompt surgery according to established protocols. Enzyme proteolysis was our method of choice for wound management. Ten patients underwent adjunctive surgery while seven patients had reconstructive procedures. The mortality rate registered was 25.8%. The mean length of hospital stay was 12.8 days. Conclusion: Fournier’s gangrene has a high mortality and complication rate despite the current treatment options. Wound management with enzyme proteolysis yielded promising results.

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DOI: 10.3897/folmed.67.e145385

Authors: Michela Saracco, Maria Grazia Cerrone, Gianmarco Vavalle, Raffaele Vitiello, Omar El Ezzo, Giulio Maccauro, Elisabetta Pataia

Abstract: Extremities are a very common site for the development of malignant tumors. A multidisciplinary approach is essential for the proper management of extremity tumors, ensuring complete surgical resection with clear margins, proper management of tissue loss, and optimal functional recovery following reconstruction. Up to 95% of patients undergo successful limb-sparing treatments, avoiding amputation. We will discuss the advantages and disadvantages of using various flaps to reconstruct upper and lower extremities. We will also explore the applications of microvascular surgery and free flaps in this context and conclude with a reflection on the timing of reconstructions.

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DOI: 10.3897/folmed.66.e114573

Authors: Anna Sukhotko, Serghei Covantsev, Anna Bumbu, Maria Kovaleva, Evgenii Zakurdaev

Abstract: Polyacrylamide hydrogel mammoplasty is a simple and relatively affordable surgery. However, this procedure is associated with a significant frequency of late complications, prompting its suspension in 2006. Despite this, patients continue facing long-term consequences. These include hydrogel migration, changes in breast shape and volume, granulomas, fistulas, and abscess formation. The clinical case described here presents the surgical treatment after augmentation mammoplasty with polyacrylamide hydrogel performed 35 years ago.

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DOI: 10.3897/folmed.66.e123678

Authors: Georgi Balchev

Abstract: Introduction: Eyelid tumors in children are rare and, fortunately, mostly benign. Reconstruction after excision of these tumors is an extremely responsible procedure, considering the early age of the patient. Aim: To analyze the incidence and location of malignant and benign tumors in children up to 18 years of age over a period of 10 years. Materials and methods: We conducted a retrospective study of 29 eyes from a cohort of 450 eyes with tumors operated on in our clinic between 2010 and 2019. Of all tumors of the eye and adnexa, only tumors of the eyelids were considered. All tumors were histopathologically examined after their surgical removal. Results: Eyelid tumors in children account for 6.4% of the tumors studied in all age groups, and 0.2% of them are malignant. The ratio of women to men is 62% to 38%, with most of them residing in cities. The most common eyelid tumors in children are cysts (47%), followed by papillomas (17%) and nevi (10%). The distribution on the eyelid is as follows: medially located 31%, centrally 45% and temporally 24%. Conclusion: Eyelid tumors in children prefer the female sex. Malignant tumors of the eyelids are rare. The average size of tumors is about 4-6 mm. The duration of the disease directly correlates with the size of the tumor. For tumors of the lower eyelid, a doctor is consulted earlier than for tumors of the upper eyelid. Inflammatory reaction around the tumor is more common in the right eye.

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DOI: 10.3897/folmed.66.e102981

Authors: Georgi Yankov, Magdalena Alexieva, Evgeni Mekov, Rosen Petkov

Abstract: Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed.

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