73
Letters to the Editor However, in our institute we have seen two children from the same family with XP, both with multiple premalignant and malignant Iesions over the scalp as well as lesions on the face. The illustrations show the scalps. All these lesions were mobile over the cranium, hence wide excision and split skin grafting was done. After six months both the children presented with small lesions over the adjacent areas of scalp, which were again excised. These lesions were histologically malignant melanoma, squamous cell carcinoma or pseudoepitheliomatous hyperplasia. The occurrence of scalp tumours was as frequent as over the face in these two children. This could be because the scalp is not well protected from exposure to the sun in our country, in particular because of the popular custom of
repeated head shaving for religious purposes in this part of the country. It could even be a genetic trait, as it has been observed in two siblings. Hence, contrary to the popular view, we do not recommend scalp as a preferred site for harvesting split skin grafts in these patients until further studies prove otherwise. Yours faithfully, K. Agrawai Associate Professor and Head Department of Plastic Surgery Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry 605 006 India
References AsbaJl, G., Quaba, A. A. and Hackett, M. E. J. (1987). Facial resurfacing in Xeroderma Pigmentosum : are we spoiling the ship for a ha’p’orth of tar? British Journalof Plastic Surgery, 40,610. Mouly, R., Dufounnentel, C., Ban&, P. and PapadopowIos, 0. (1980).Xeroderma Pigmentosum. Annales de Chirurgie Plastiqrre, 25,117.
The dartos
myockltaneous filap-reply
Sir, In relation to our article “The dartos myocutaneous flap” (British JournalofPlastic Surgery, 44,33), it has been brought to our attention by Dr Mendez Fernandez that a scrotal flap has been used by him in two cases : one, a paraplegic, with a recurrent ischioperineal decubitus ulcer and another with an ulcer of the penis with exposed dacron graft previously placed to treat Peyronie’s disease. He also refers to articles by Kapian (1972), Lanier and Neale (1974) and Taube et al. (1977). A scrotal flap to repair an ischial decubitus ulcer was described by Kaplan (1972). Lanier and Neale (1974) have used it in sores of the ischium and penis. Taube et al. (1977) have used a rotation flap of the scrotum to cover a sore in the right groin region, bringing the testicle into the defect to fill the dead space. We apologise that we failed to acknowledge these previous reports and publications related to the topic. Our failure to ,refer to these articles is obviously an oversight. However, the flap described by us is certainly different from that described by the above mentioned authors. The pedicle of the flap described by us is composed of muscle only and a skin island of the desired size is taken over the distal part of the muscle. The flap described by us may be useful for reconstructing the proximal part of the urethra in one stage. Yours faithfully, QPPramod Kumaa, MS, MCh, Assistant Professor, Department of Plastic Surgery and Burns, Kasturba Hospital, Manipal - 576 119, Karnataka, South India.
References XapBaa, II. (1972). The scrotal flap in ischial decubitus. British Journal of Plastic Surgery, 25,22. Eanier, V. C. Jr and Neale, H. W. (1974). Necrosis of penis with
decubitus ulcer: debridement and closure with scrotal flap. Case report. Plastic and Reconstructive Surgery, 54,609. M&de%-Femandez,M. A., Hollan, CL,Frank, D. H, and Fisher, 9. C. (1986). The scrotal myocutaneous flap. Plastic and Reconstructive Surgery, 78,676.
Taalae,,E., Labandter, H. and Kapllan,I. (1977). Decubitus ulcer in the groin : repair using a testiculo-scrotal flap. British Journal of Plffstic Surgery, LW, 86.
Letters to the Editor However, in our institute we have seen two children from the same family with XP, both with multiple premalignant and malignant Iesions over the scalp as well as lesions on the face. The illustrations show the scalps. All these lesions were mobile over the cranium, hence wide excision and split skin grafting was done. After six months both the children presented with small lesions over the adjacent areas of scalp, which were again excised. These lesions were histologically malignant melanoma, squamous cell carcinoma or pseudoepitheliomatous hyperplasia. The occurrence of scalp tumours was as frequent as over the face in these two children. This could be because the scalp is not well protected from exposure to the sun in our country, in particular because of the popular custom of
repeated head shaving for religious purposes in this part of the country. It could even be a genetic trait, as it has been observed in two siblings. Hence, contrary to the popular view, we do not recommend scalp as a preferred site for harvesting split skin grafts in these patients until further studies prove otherwise. Yours faithfully, K. Agrawai Associate Professor and Head Department of Plastic Surgery Jawaharlal Institute of Post-graduate Medical Education and Research Pondicherry 605 006 India
References AsbaJl, G., Quaba, A. A. and Hackett, M. E. J. (1987). Facial resurfacing in Xeroderma Pigmentosum : are we spoiling the ship for a ha’p’orth of tar? British Journalof Plastic Surgery, 40,610. Mouly, R., Dufounnentel, C., Ban&, P. and PapadopowIos, 0. (1980).Xeroderma Pigmentosum. Annales de Chirurgie Plastiqrre, 25,117.
The dartos
myockltaneous filap-reply
Sir, In relation to our article “The dartos myocutaneous flap” (British JournalofPlastic Surgery, 44,33), it has been brought to our attention by Dr Mendez Fernandez that a scrotal flap has been used by him in two cases : one, a paraplegic, with a recurrent ischioperineal decubitus ulcer and another with an ulcer of the penis with exposed dacron graft previously placed to treat Peyronie’s disease. He also refers to articles by Kapian (1972), Lanier and Neale (1974) and Taube et al. (1977). A scrotal flap to repair an ischial decubitus ulcer was described by Kaplan (1972). Lanier and Neale (1974) have used it in sores of the ischium and penis. Taube et al. (1977) have used a rotation flap of the scrotum to cover a sore in the right groin region, bringing the testicle into the defect to fill the dead space. We apologise that we failed to acknowledge these previous reports and publications related to the topic. Our failure to ,refer to these articles is obviously an oversight. However, the flap described by us is certainly different from that described by the above mentioned authors. The pedicle of the flap described by us is composed of muscle only and a skin island of the desired size is taken over the distal part of the muscle. The flap described by us may be useful for reconstructing the proximal part of the urethra in one stage. Yours faithfully, QPPramod Kumaa, MS, MCh, Assistant Professor, Department of Plastic Surgery and Burns, Kasturba Hospital, Manipal - 576 119, Karnataka, South India.
References XapBaa, II. (1972). The scrotal flap in ischial decubitus. British Journal of Plastic Surgery, 25,22. Eanier, V. C. Jr and Neale, H. W. (1974). Necrosis of penis with
decubitus ulcer: debridement and closure with scrotal flap. Case report. Plastic and Reconstructive Surgery, 54,609. M&de%-Femandez,M. A., Hollan, CL,Frank, D. H, and Fisher, 9. C. (1986). The scrotal myocutaneous flap. Plastic and Reconstructive Surgery, 78,676.
Taalae,,E., Labandter, H. and Kapllan,I. (1977). Decubitus ulcer in the groin : repair using a testiculo-scrotal flap. British Journal of Plffstic Surgery, LW, 86.
