The scalp has a key role in maintaining the integrity of the osseous structure that protects the central nervous system. Its restoration, especially keeping the aesthetic appearance and shape following lesions, is challenging. The present study describes the case of a child with extensive slough and bone exposure in the scalp following a necrotising cellulitis-type infection, which was treated with debridement, microperforation of the calvaria, and application of a gauze bandage with vaseline. Granulation tissue formed after 10 days. A partial skin graft was later carried out with satisfactory results.

Keywords: BACTERIAL INFECTIONS, SCALP, RECONSTRUCTION

This study describes a technique for correcting entropion based on the case of a female patient who had that alteration in the left lower eyelid, in addition to sagging and fat pseudo-herniation in the left and right eyelid areas. Bilateral upper and lower blepharoplasty was performed, with wedge resection of the orbicularis muscle and tarsus in both lower eyelids, followed by reconstruction. The patient presented good functional and aesthetic results, with no complications.

Keywords: BLEPHAROPLASTY; ENTROPION; RECONSTRUCTION.

Lip tumors account for 15% of head and neck neoplasias. When the defect is greater than one third of the lip, the Camille Bernard’s flap is suitable for the reconstruction of the lower lip. The present study describes a case with a satisfactory outcome, where functional, aesthetic, and sensory preservation of the lower lip was obtained by using this technique in its surgical reconstruction, following excision of a locally advanced tumor.

Keywords: CARCINOMA, BASAL CELL, RECONSTRUCTIVE SURGICAL PROCEDURES, LIP NEOPLASMS

The ear is a complex anatomical structure in which each subunit has unique characteristics. No single reconstruction technique could work in all situations; therefore, knowing different ways to reconstruct surgical defects in each one of these subunits is essential to achieving the best cosmetic results. We report here a detailed explanation of a superior helical advancement flap designated to repairs of the upper helical rim.

Keywords: MOHS SURGERY, RECONSTRUCTION, EAR NEOPLASMS, EAR, SURGICAL FLAPS

Basal cell carcinoma is the most common skin cancer and can result in significant morbidity if not completely excised. The present article describes a case of nasal reconstruction using the Rieger flap, after the excision of a basal cell carcinoma, which yielded good aesthetic results. The authors have chosen this flap due to the fact that the donor area contains an abundant supply of tissue to cover surgical wounds, which is of a good color and texture for the upper region of the nose.

Keywords: CARCINOMA, BASAL CELL; RECONSTRUCTIVE SURGICAL PROCEDURES; NOSE NEOPLASMS; SURGICAL FLAPS.

Eccrine spiradenoma is a rare benign adnexal epithelial neoplasm characterized by a bluish-pink, slow-growing solitary nodule, coursing with paroxysmal pain, mainly in young adults. It is most commonly located in the trunk and extremities. Bleeding and/or ulceration are common in the giant vascular variant, which is characterized by a size greater than 2 cm in diameter and a high degree of vascularization seen on histology. Its clinical characteristics are unspecific and require biopsy with histological analysis for diagnosis. Its histology presents one or more basophilic intradermal lobules enveloped in a fibrous capsule without connection to the epidermis. It presents two types of cells: small cells with dark nuclei in the periphery and large cells with light nuclei in the center. An accurate diagnosis is important due to the fact that it can develop into a potentially fatal malignancy - which is a rare phenomenon and occurs most often in the multiple variant. A rare case of eccrine spiradenoma in the abdomen with bleeding associated is described in the present paper, as well as a discussion on possible treatments.

Keywords: ECCRINE SPIROADENOMA, BENIGN EPITHELIAL NEOPLASIA, SEBACEOUS GLANDS

The lips are a preferred site for carcinomas. Roughly 95% of tumors in the lips involve the lower lip, with 90% being squamous cell carcinomas. Surgery is the treatment of choice and has a good prognosis when diagnosis is performed early. Defects involving less than half of the lower lip can be closed using the edge-to-edge technique, whereas larger defects require greater technical complexity of methods and have increased risk of complications. The present article describes a straightforward technique for reconstructing these defects, using edge-to-edge suture, without necessity ofV or W shaped excisions, and with good aesthetic and functional outcomes.

Keywords: CARCINOMA, SQUAMOUS CELL; LIP NEOPLASMS; RECONSTRUCTIVE SURGICAL PROCEDURES

Having the mastery of surgical techniques, ability to deal with complications and the capacity to train residents in those skills are crucial to the good practice of a dermatologic surgeon. Furthermore, the transmission of clear and objective guidelines to patients has a direct impact on the outcomes of skin surgeries. The present article describes the case of the exeresis of a basal-squamous carcinoma in the scalp with the proposed closure by second intention that developed with infection and necrosis, requiring the team's knowledge and skills to work around the situation. The result of the combination of techniques was satisfactory, showing that proper training is key for a good surgical practice.

Keywords: SKIN NEOPLASMS; RECONSTRUCTIVE SURGICAL PROCEDURES; BLOODLESS MEDICAL AND SURGICAL PROCEDURES; INTERNSHIP AND RESIDENCY

Introduction: The use of a median-frontal flap for nasal reconstruction was first described in 600 B.C., and it is still widely used for the reconstruction of nasal tumoral lesions.
Objective: To report the experience of a medical school's plastic surgery service in the use of this flap type.
Methods: A retrospective descriptive study was carried out with a series of 35 cases surgically treated from January 2005 to June 2015.
Results: The patients' mean age was 68.6 (± 10.8) years, with a predominance of the male gender (68.6%). The median-frontal flap was used for reconstruction after resection of tumors, with basal cell carcinoma being the most frequent.
Conclusions: The median-frontal flap is the ideal reconstructive choice for many patients, with good aesthetic and functional outcomes.

Keywords: SURGICAL FLAPS; RECONSTRUCTION; NOSE; NOSE NEOPLASMS

Lower lip squamous cell carcinomas (SCC) correspond to 20-30% of all oral cavity cancers. It mainly affects men over 50 years of age who have previous history of smoking, alcoholism and exposure to the sunlight. The diagnosis is clinical, confirmed by histological analysis. The present paper describes a case of a patient with a SCC affecting more than 1/3 of the lower lip, who underwent resection of the primary lesion and a conservative reconstruction of the lesion’s region, due to the great local mobility, aimed at preserving the functionality without compromising the aesthetic outcome.

Keywords: Carcinoma, squamous cell; Mouth neoplasms; Reconstruction

Eyelid defects resulting from skin cancer excision are common in the daily practice of dermatologic surgeons. The aim of this review is to summarize the most relevant methods for eyelid repair, proposing reconstructive algorithms for both lower and upper eyelids. Both algorithms were designed according with dichotomic decisions based on the thickness (partial- versus full-thickness) and the size of the eyelid defect (less than 1/3, less than 2/3 or larger than 2/3 of the eyelid length).

Keywords: Eyelids; Reconstruction; Eyelid Neoplasms; Eyelid Neoplasms/surgery; Cornea

The reconstruction of defects involving up to 2/3 of the lip extension is challenging, considering the functional and aesthetic importance of this structure. There are several surgical techniques described for this purpose, highlighting the Abbé-Estlander flap, the Karapandzic flap, and the Bernard-Burrow- Webster flap. The choice of the best approach should consider the size and location of the defect as well as the comorbidities of the patient. The reverse Yu flap is an alternative to be considered in relation to other methods, allowing obtaining excellent cosmetic-functional results in general.

Keywords: Surgical flaps; Reconstruction; Lip

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

Sarcomas são neoplasias mesenquimais malignas, raras, que acometem, principalmente, crianças e adolescentes. O rabdomiossarcoma, subtipo oriundo da musculatura esquelética, é condição incomum em adultos, acometendo sítios de localização não habitual, crescimento rápido e de difícil tratamento. Apresenta-se caso de adulto jovem com nodulação em lóbulo auricular esquerdo, cuja análise histopatológica e imuno-histoquímica confirmou tratar-se de rabdomiossarcoma alveolar, o qual foi conduzido em conjunto com a Oncologia.

Keywords: Rabdomiossarcoma Alveolar; Miogenina; Desmina; Excisão de Linfonodo

The cheek is the largest anatomical unit of the face. In this area, surgical skin cancer treatment must aim for its complete eradication and the best aesthetic-functional result. A 69-year-old woman presented with a 3.5 cm tumor in the left cheek for three years. Biopsy showed moderately differentiated squamous cell carcinoma. We performed an A-T flap, where the surgical defect corresponded to the “A” and the junction of the inferior orbital, nasofacial, and nasolabial grooves, to the top of the “T”. The patient evolved without recurrence and had an excellent aesthetic-functional aspect.

Keywords: Skin neoplasms; Carcinoma, Squamous cell; Zygoma; Surgical flaps; Reconstructive surgical procedures.