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We describe here the first dorsal metacarpal artery propeller perforator flap, used to cover a full thickness, radiopalmar defect of the index finger after tumour excision. By associating a propeller design to the dissection of the first metacarpal pedicle, this flap can be effective in coverage of proximal index and web space defects, with primary closure and pleasant aesthetic outcomes. Harvested together with a superficial sensory branch from the radial nerve, this flap can provide effective coverage and sensory recovery.

Laissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1-80 months) for LFS and 30 months (range 6-60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

Haemangiopericytoma (HPC) is a rare soft tissue tumour of fibroblastic origin and is part of the solitary fibrous tumour spectrum. The tumour is generally considered to be benign, but can behave clinically as if sarcomatous -- with relentless infiltrative local growth. HPC generally presents in adulthood (median age 45 years for orbital disease) and is equally frequent in both sexes. HPC can arise in any site in the body and presents as a slowly growing, painless mass. We report a case of a 20 year old African male seen at Kikuyu Eye Unit, Kenya, with a 12 year history of a gradually enlarging, painless orbital mass. The patient underwent skin-sparing orbital exenteration with complete tumour excision; histology confirmed diagnosis of HPC.

Objective and importance. Trochlear nerve schwannomas without neurofibromatosis are very rare. No more than 33 cases have been pathologically verified. None of the reported cases showed postoperative improvement of trochlear palsy. The authors present a case of trochlear palsy due to a trochlear nerve schwannoma with subsequent improvement of trochlear palsy after subtotal excision of the tumour. Clinical presentation. A 65-year-old woman presented with diplopia, vertigo and left arm weakness. There was no history of neurofibromatosis. MR imaging demonstrated a tumour in the right perimesencephalic/ambient cistern. Intervention. The tumour was operated by a pterional approach, and subtotal excision was achieved preserving the tumour capsule with the trochlear nerve. The tumour was pathologically diagnosed as a schwannoma. Conclusion. At 2-year follow-up, there was no double vision and MR imaging showed a small, stable tumour remnant. To our knowledge, this is the first reported case of a trochlear...

We report on a patient who developed winged scapula on the contralateral side to the approach for a cerebellopontine tumour excision, an unreported complication following this procedure. We think this was due to damage of the long thoracic nerve in the dependant side, while in the park bench position.

Some degree of hydrocephalus is present in almost all cases of medium to large posterior fossa tumours. The initial symptoms in such cases are usually due to the hydrocephalus and the consequent increased supratentorial pressure, and more often precede the symptoms primarily due to the local invasion and compression of the brain stem and cerebellum by a significant length of time. In our experience, based on 62 posterior fossa tumour operations, insertion of a cerebrospinal fluid (CSF) diverting shunt because of hydrocephalus makes the subsequent tumour excision more difficult and hazardous. The various problems presumed to be related to preoperative shunt surgery are discussed in this report. It is concluded that preoperative shunts for posterior fossa tumours are rarely indicated.

This paper reviews the current status of conservative treatment for early breast cancer. While the first patients were treated with such techniques more than 60 years ago, it is during the last decade that randomized trials have confirmed that such treatment is comparable to mastectomy in preventing breast cancer death. Radiotherapy to the breast after local tumour excision is important to prevent local breast relapse, but it is not clear whether it has any influence on the risk of distant metastases. Several questions remain to be answered. While most investigators agree that the breast should receive a radiation dose of about 50 Gy in 5 weeks, there is no general agreement about the need for a tumour bed booster dose. Considering patients with tumour infiltration at the surgical resection line for whom it is not possible for cosmetic reasons to perform re-resection, it is not clear whether an acceptable local control rate can be achieved through application of a high booster dose in the tumour bed. More trials are needed to show whether certain patients with small invasive carcinomas should be treated with wide local excision without radiotherapy. The need for radiotherapy after local excision for small intraductal (ductal carcinoma in situ) cancers is being addressed in ongoing trials.

Surgical management of malignant tumours aims at disease eradication coupled with preservation of adjacent normal tissue. This premise is particularly true with peri-ocular basal cell epitheliomas. The functional and cosmetic sequelae of removal of excessive normal tissue in this region may have far reaching consequences. The fresh tissue technique of micrographic surgery, an adaptation of the fixed tissue technique as described by Mohs, was developed to overcome just such problems.All patients presenting with peri-ocular basal cell epitheliomas since December 1987 have been considered for micrographic surgery. The results of a prospective study of 41 of these patients with particular emphasis upon the two major advantages of the technique, namely surety of tumour excision allied to tissue preservation, are presented. The authors conclude that micrographic surgery has a definite role to play in the management of certain peri-ocular basal cell epitheliomas.

Lid malignancies necessitate ample lid excision. If the tumour is near the medial canthal region of the lower lid, the lower puncta may have to be sacrificed. The patient may suffer from a long-lasting epiphora. The author had a case in which lower puncta and part of the canaliculus were removed on tumour excision, and still the tear draining mechanism was preserved. This case may add some ideas to lacrimal reconstructive surgery.

This review comprises an analysis of the treatment alternatives for pancreatic tumours of the MEN 1 syndrome presently in use at the Surgical Endocrine Unit of Sahlgrenska Hospital, GoUteborg, Sweden. Patients with pancreatic tumours localized by imaging studies are offered surgical excision. Otherwise the therapy is individualized. Some patients with Zollinger-Ellison syndromes are managed with medical antiulcer treatment, others are treated with total gastrectomy. MEN 1 patients with other syndromes, e.g. insulinomas, glucagonomas and VIPomas, are offered surgery with the aim of tumour excision. Even noncurative excision might benefit the management of these cases and possibly prolong life. Asymptomatic patients with raised hormonal tumour markers in whom imaging studies have failed to reveal any tumours, are continuously followed without treatment. The malignant behaviour of the pancreatic tumours varies between different MEN 1 families. MEN 1 patients are considered for total pancreatectomy if they ha...