a-case-series-successful-abdominal-closure-utilizing-novel-technique

A Case Series of Successful Abdominal Closure Utilizing a Novel Technique Combining a Mechanical Closure System with a Biologic Xenograft that Accelerates Wound Healing

In the acute setting, once intra-abdominal injuries have been addressed, the next great hurdle is restoring a functional and intact abdominal compartment. ...

Texas Tech University Health Sciences Center

The development of malignancies in graft donor sites is rare and may be caused by de novo malignancies as well as metastatic and iatrogenic spread. Malignancies in graft donor sites are distinguished from Marjolin ulcers by some investigators because they occur in healed surgical wounds rather than in chronic wounds or unstable scars and tend to occur sooner after injury. We present a unique case of Merkel cell carcinoma (MCC) developing in a vein graft donor site 18 years after vein harvesting. 

Merkel cell carcinoma in a vein graft donor site.

We present a case report on the successful healing of a Pseudomonas infection wound in a 52-year-old female with morbid obesity, noninsulin dependent diabetes mellitus and a history of tobacco use, who presented with Stage IIIA (T3, N2, Mo) infiltrating ductal carcinoma. The patient received neoadjuvant chemotherapy prior to her bilateral skin-sparing total mastectomies with right axillary sentinel lymphadenectomy. She also had staged reconstruction with temporary breast implants and plans for deep inferior epigastric perforator flaps. Two months after chest wall and regional nodal radiation therapy, she developed a marked soft tissue reaction to radiation. She underwent over 10 right chest wall open wound radical debridements resulting in a tissue defect of 25 cm in length, by 20 cm in width, by 10 cm in depth. Despite surgical debridement, intravenous antibiotics, hyperbaric oxygen therapy, colistin spray therapy, and heat lamp therapy, the infection failed to resolve and the wound failed to heal. She was left with an open wound that was extremely painful and required chronic pain management with opioids. The patient later was found to have developed a multidrug-resistant Pseudomonas infection in her wound. However, the experimental placement of a porcine bladder matrix (ACell©, Inc., Columbia, MD) on the wound resulted in the complete relief of pain just three days after the application of the product. After two weekly applications of ACell

Porcine Urinary Bladder Matrix for Management of Infected Radiation Mastectomy Wound.

Breast cancer rarely metastasizes to the uterus. Here, we report two breast cancer patients with synchronous metastases to the uterus. Case 1 highlights a 46-year-old female with invasive ductal carcinoma who presented with a breast mass and was found to have uterine enlargement on positron emission tomography (PET) scan. Biopsy revealed a metastatic 4 mm focus of breast cancer in the background of endometrial hyperplasia. Case 2 reports a 62-year-old postmenopausal female diagnosed with lobular carcinoma of the breast following an abnormal screening mammogram. A routine pap smear necessitated further workup, revealing simultaneous endometrial and cervical metastasis. Both patients did not have any gynecologic symptoms and presented a diagnostic challenge.

Synchronous Uterine Metastases from Breast Cancer: Case Study and Literature Review.

A horseshoe kidney (HSK) is a urological malformation that is typically found incidentally after a traumatic injury due to its asymptomatic nature. We present a 25-year-old male with multiorgan injuries secondary to blunt abdominal trauma caused by a gunshot wound. We report the courses of action taken that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical management. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an improving minimally invasive technique that was used to control hemorrhage in the early preoperative stages and during surgical repair of the injuries. Multiorgan injuries that involve an HSK are uncommon. Our interest in the case relies on the rarity and unique aspects of the injuries and the recovery of the patient following the use of REBOA.

Article	Year
Merkel cell carcinoma in a vein graft donor site. Cutis\| PubMed ID: 27274546	2016
Porcine Urinary Bladder Matrix for Management of Infected Radiation Mastectomy Wound. Cureus\| PubMed ID: 28929035	2017
Synchronous Uterine Metastases from Breast Cancer: Case Study and Literature Review. Cureus\| PubMed ID: 29344435	2017
Deployment of a Resuscitative Endovascular Balloon Occlusion of the Aorta Device in a Case of Gunshot Wound Injury to a Horseshoe Kidney. Cureus\| PubMed ID: 30533333	2018

Catherine A. Ronaghan

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