BACKGROUND:Malignant melanoma of the head and neck is a highly aggressive tumor with a significant risk of regional and distant metastases. Due to the complex anatomy and rich lymphatic drainage of this area, accurate and timely diagnosis and staging are essential for optimal treatment planning. The sentinel lymph node plays a key role in assessing tumor spread and staging. MATERIALS AND METHODS:A retrospective study was conducted on 26 patients with head and neck melanoma who underwent sentinel lymph node biopsy at our institution between 2017 and 2023. We evaluated the success rate of sentinel node localization, presence of metastases, and subsequent lymphadenectomy. RESULTS:Sentinel lymph nodes were successfully identified in 23 patients; 5 had positive findings (3 macrometastases, 1 micrometastasis, 1 isolated tumor cells). Lymphadenectomy was indicated in patients with macrometastases, while follow up monitoring was preferred for micrometastases and isolated tumor cells. One patient experienced a complication after lymphadenectomy. Most patients with negative sentinel nodes remained disease-free during follow-up. CONCLUSION:Sentinel lymph node biopsy is a crucial tool for staging and treatment decision-making in head and neck malignant melanoma. The procedure's success depends on surgical expertise. Lymphadenectomy is indicated in cases of macrometastases, whereas micrometastases and isolated tumor cells warrant regular follow up. An individualized, multidisciplinary approach is essential.
BACKGROUND:Trigger finger causes pain, catching, and locking of the finger, with corticosteroid injection being the first-line treatment. Injections with local anaesthetic may reduce immediate pain, but it has been suggested that added volume worsens pain. This systematic review aimed to evaluate studies investigating pain following corticosteroid injection for trigger finger, with or without local anaesthetic. Evaluation of the topic: We performed a prospectively registered systematic review (PROSPERO ID: CRD42024502361) following PRISMA guidelines. We searched PubMed, Cochrane Library, and Embase database for randomised trials or prospective cohort studies investigating pain following injection with corticosteroid with or without local anaesthetic. Patient demographic data, injection details and outcomes including visual analogue scale (VAS) pain scores were collected and summarised. Two articles including 98 patients (135 injections) were included. One article compared steroid injection with local anaesthetic and adrenaline to steroid injection with placebo (0.9% saline), and found that omitting local anaesthetic had a lower immediate VAS pain score (2.0 vs. 3.5; P < 0.01) however all injections contained the same volume. The second study measured VAS pain scores at multiple time points, and a recollection score for patients injected with either corticosteroid alone (1mL), corticosteroid and 1% xylocaine (2 mL), or corticosteroid and 0.9% saline (2 mL). VAS pain scores were similar in the steroid alone and steroid and local anaesthetic group at 1 minute post-injection and highest in the steroid and saline group. The local anaesthetic group had the lowest pain score 10 minutes post-injection. Meta-analysis of outcomes in these heterogeneously reported studies was not possible. CONCLUSION:Corticosteroid injection for trigger finger varies considerably and outcomes are reported inconsistently. The evidence suggests that the addition of local anaesthetic may increase immediate pain due to volume effect or lowered pH but reduce early post-injection pain. Further well-designed randomised studies are needed to guide treatment decisions.
INTRODUCTION:A wound is defined as damage or loss of continuity to the skin or body tissue which can cause disruption to the body's anatomical structure. Wounds can be caused by several things, such as post-operative wounds, trauma, contact with heat sources, chemicals, and accidents. One of the potential complications from wounds and maxillofacial surgery is dehiscence. The combination of guava leaf ethanol extract (Psidium guajava Linn) and polyvinylpyrrolidone (PVP) hydrogel is expected to help the healing process of traumatic wounds on the oral mucosa by increasing the number of fibroblasts, epithelialization, vascular endothelial growth factor (VEGF) levels, and decreasing interleukin-16 (IL-16) levels. METHODS:This research was an experimental test, using 28 rabbits as experimental animals. A traumatic wound is an incision made 2 cm laterally from the left central incisor and along the curve of the tooth. The wound reaches the gum line from the incision on the facial aspect to the midline of the papilla. The animals were divided into four treatment groups.: group 1 - the intervention group with wounds healed and given a combination gel; group 2 - the intervention group with wounds not healed and given a combination gel; group 3 - the observed group with wound healed and given placebo gel; group 4 - the observed group with wounds not healed and given placebo gel. There was an increase in the number of fibroblasts, epithelialization, VEGF levels, and a decrease in IL-16 levels between the treatment and control groups. RESULTS:This study showed an increase in fibroblast levels in the treatment group (64.50 ± 4.43) which was higher than the control group (55.67 ± 4.04), with P = 0.041 as well as an increase in epithelialization in the treatment group. The results of the analysis in this study support the superiority of this gel combination in accelerating wound healing through a positive influence on VEGF levels and angiogenesis. In this study, IL-6 levels on day 3 showed a decrease of 25% in the treatment group. CONCLUSION:The combination of guava leaf ethanol gel and PVP hydrogel is an innovative therapy with high potential to accelerate wound healing, especially in chronic or difficult-to-heal wounds, with minimal risk of excessive inflammation and scar tissue formation.
BACKGROUND:Brachioplasty in the post-bariatric patient deserves special attention since a not negligible number of wound complications is reported in the literature. In this study, the authors present unique risk factors for wound dehiscence and delayed wound healing based on retrospective data in post-bariatric patients who underwent brachioplasty alone or with other procedures. METHODS:A total 31 patients who underwent brachioplasty alone or combined with other procedures between 2017-2022 were included. Data analyzed encompassed demographic information, biometric data, type of brachioplasty if performed alone or in combination with other procedures, days to epithelization/closure, and its management. RESULTS:A total of 15 patients (48.38%) experienced surgical wound dehiscence, the majority (66%) being minor wound dehiscence. Subjects who underwent concomitant arm liposuction with brachioplasty showed a higher degree of dehiscence (P = 0.021) and more days to epithelialization/closure (P = 0.10). Fifty-seven percent of patients who underwent a combined procedure showed some degree of dehiscence, as well as more days to epithelialization/closure (41 vs 15.75 days). Brachioplasty and mastopexy as combined procedures demonstrated more days to epithelialization/closure (P = 0.05). CONCLUSIONS:Brachioplasty in the post-bariatric population is deemed safe and effective; nevertheless, it carries an increased risk of wound dehiscence and delayed wound healing when combined with liposuction and other procedures. The plastic surgeon needs to become familiar with variables that increase the risk of this complication, all of which can be anticipated in preoperative planning.
