British journal of plastic surgery
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The option of sentinel lymph node biopsy for patients with a cutaneous malignant melanoma has allowed an alternative to the traditional approaches to lymph node basin surgery. Lymphatic mapping usually identifies the sentinel node(s) in a recognised lymphatic basin, however aberrant nodes may occasionally be identified outside these areas. ⋯ Failure to remove an aberrant sentinel lymph node harbouring metastatic melanoma may reduce significantly the chance of control or cure of the disease. In order to reduce this risk we advocate lymphatic mapping prior to surgical management of the draining lymph nodes of a cutaneous malignant melanoma.
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Case Reports
Pyoderma gangrenosum occurring in a lower limb fasciocutaneous flap--a lesson to learn.
Pyoderma gangrenosum is a destructive cutaneous disease characterised by progressive painful ulceration. The occurrence of pyoderma gangrenosum at a surgical site is rare (especially if there is no predisposing illness), but is well recognised. We present a case of a 63-year-old man who developed erythematous ulcerative lesions due to pyoderma gangrenosum in and around a lower limb fasciocutaneous flap used to cover an exposed total knee prosthesis. ⋯ No predisposing disorder, other than the rarely reported association with osteoarthritis, was found. The diagnosis is important because its rapid detection not only avoids unnecessary treatment but also allows for prompt intervention with oral steroids. This case is presented to alert surgeons to the presence of pyoderma gangrenosum and its diagnostic confusion with postoperative wound infection.
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Comparative Study
Evaluation of the donor site morbidity after lateral arm flap with skin paddle extending over the elbow joint.
The free lateral arm flap may be extended to include the skin over the lateral aspect of the elbow and the forearm. However, extending the flap beyond the lateral condyle has been thought to interfere with the elbow function. The aim of this study was to assess the donor site morbidity after placement of the skin paddle across the lateral aspect of the elbow joint. ⋯ However, an area of hypoaesthesia with a mean size of 45 cm(2)(range 20-75 cm(2)) was found on the posterolateral surface of the forearm. Patient satisfaction with the donor site was rated high. From this retrospective review it appears that elbow function was not significantly affected by extending or planning the lateral arm flap over the lateral condyle.