There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

There are various methods for reconstructing defects caused by Mohs micrographic surgery (MMS). However, there are limits to the reconstruction methods that can be used if the defect is large. An 85-year-old woman presented with a 2.4×2.2 cm hyperkeratotic plaque on her right temple for 2 years. A skin biopsy was performed for a diagnosis. Histopathology confirmed squamous cell carcinoma, and MMS was performed to completely remove the tumor. A total of three MMS stages were performed intraoperatively to confirm margin clear, resulting in a skin defect measuring 5.0×4.5 cm. To reconstruct the large defect, a splitted full thickness skin graft was performed, taking into account the site, size, and function of the defect. Each skin graft was harvested from the submental area and a tie-over bolster dressing was applied to the recipient site. To date, the surgical site has remained free of surgical complications or tumor recurrence.

Cutaneous squamous cell carcinoma is the second most common tumor in humans, and its incidence is increasing. In cutaneous squamous cell carcinoma, lymph node and distant metastases are rare, and bone invasion in the lower limbs is uncommon. A 67-year-old male presented with a solitary erythematous plaque on the fifth toe, accompanied by swelling. A shave biopsy was performed. The diagnosis of bone-invaded squamous cell carcinoma with aggressive behavior was made by combining the histopathological, immunohistochemical staining, and magnetic resonance imaging results. Mohs micrographic surgery was performed to remove the skin lesion and tumor-invaded bone. However, 2 months later, squamous cell carcinoma relapsed in the same area. After confirming the absence of lymph node metastasis, additional treatment, including ray amputation, was performed. Adjuvant radiotherapy was not administered. We present a rare case of squamous cell carcinoma that relapsed after Mohs surgery and was subsequently treated with ray amputation.

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Chronic osteomyelitis is one of the various causes of subsequent pathologic mandibular fractures; however, it is rare, and there have been few reports using free flaps in osteomyelitis of the mandible. We share our experience with a 76-year-old patient who presented with a pathologic fracture following osteomyelitis of the mandible that was reconstructed using a fibula osteocutaneous flap after wide segmental resection.

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, low grade neoplasm which usually occurs in subcutaneous soft tissue. Histologically, it features ectatic blood filled vessels surrounded by hyalinized stroma and pleomorphic spindle cells. Clinically and histologically, PHAT could be misdiagnosed as such tumor as neurogenic tumor, malignant fibrous histiocytoma. About 100 cases of PHAT have been reported so far, and it is even rarer in head and neck area. We experienced a case of PHAT in 41-year-old male with several months of history of gradually enlarging neck mass which was surgically removed by wide excision.

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, low grade neoplasm which usually occurs in subcutaneous soft tissue. Histologically, it features ectatic blood filled vessels surrounded by hyalinized stroma and pleomorphic spindle cells. Clinically and histologically, PHAT could be misdiagnosed as such tumor as neurogenic tumor, malignant fibrous histiocytoma. About 100 cases of PHAT have been reported so far, and it is even rarer in head and neck area. We experienced a case of PHAT in 41-year-old male with several months of history of gradually enlarging neck mass which was surgically removed by wide excision.

BACKGROUND AND OBJECTIVES: Impaired recovery from left ventricular (LV) dysfunction is a major prognostic factor after myocardial infarction (MI). Because P2Y12 receptor blockade inhibits myocardial injury, ticagrelor with off-target properties may have myocardial protection over clopidogrel. In animal models, ticagrelor vs. clopidogrel protects myocardium against reperfusion injury and improves remodeling after MI. We aimed to investigate the effect of ticagrelor on sequential myocardial remodeling process after MI. METHODS: High platelet inhibition with ticagrelor to improve LV remodeling in patients with ST-segment elevation MI (HEALING-AMI) is an investigator-initiated, randomized, open-label, assessor-blinded, multi-center trial done at 10 sites in Korea. Patients will be enrolled if they have ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention and a planned duration of dual antiplatelet treatment of at least 6 months. Screened patients will be randomly assigned (1:1) using an internet-based randomization with a computer-generated blocking with stratification across study sites to either ticagrelor or clopidogrel treatment. The co-primary primary endpoints are LV remodeling index with three-dimensional echocardiography and the level of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) at 6 months representing post-MI remodeling processes. Changes of LV end-systolic/diastolic volume indices and LV ejection fraction between baseline and 6-month follow-up will be also evaluated. Analysis is per protocol. CONCLUSIONS: HEALING-AMI is testing the effect of ticagrelor in reducing adverse LV remodeling following STEMI. Our trial would show the benefit of ticagrelor vs. clopidogrel related to the recovery of post-MI LV dysfunction beyond potent platelet inhibition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02224534
Blood Platelets ; Echocardiography, Three-Dimensional ; Follow-Up Studies ; Humans ; Korea ; Models, Animal ; Myocardial Infarction ; Myocardium ; Natriuretic Peptide, Brain ; Percutaneous Coronary Intervention ; Random Allocation ; Reperfusion Injury ; Ventricular Remodeling