F ibroepithelial polyps or acrochordons are benign tumors of mesenchymal and ectodermal origin. They frequently occur in places where skin folds are present. Generally, their size does not exceed 5 millimeters. However, a case with a 42 centimeters long FEP has been reported in the literature. [1] There are different opinions about how FEPs reach these sizes and what triggers the growth. It is stated that the sensitivity of epithelium to hormones and hormonal changes may be the cause of the growth of FEPs, which are located in the genital tract and reached huge sizes. [2] It is also remarkable that FEPs located in this area are seen more frequently in women and in reproductive age. [3] It is not known exactly what triggered the growth of the FEPs that are located in other locations and reached huge sizes. However, a positive correlation between obesity, insulin resistance and FEP growth has been proposed. [4][5][6] Our case was unique concerning the FEP location. We did not find a similar case in terms of location and size in the literature. Our patient also had a ventriculoperitoneal shunt for six years due to idiopathic hydrocephalus. The shunt was 2 centimeters away from FEP. It may be thought that the foreign body reaction in this area may be an effect on FEP growth. In this report, we aimed to present our approach to a giant FEP and to examine the factors that cause FEP growth.

Necrotizing fasciitis is a rare complication of herpes zoster. Because of its rarity, it may be overlooked in the differential diagnosis of patients with bacterial superinfection on herpes zoster lesions. We present the case of a 59-year-old woman with diabetes mellitus receiving oral antibiotic therapy with the diagnosis of bacterial superinfection due to herpes zoster involving the C7-T8 dermatomes bilaterally. She presented at our emergency department with a deteriorated general condition and signs of sepsis. Her Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was 10. Necrotizing fasciitis can arise from herpes zoster lesions. However, its rarity can lead to delayed treatment which can further result in significant morbidity, and even mortality, and should be considered among patients presenting with bacterial superinfections. The LRINEC score is very effective and practical for differentiating necrotizing fasciitis from bacterial superinfections. In case of suspicion, follow-up must be conducted on an inpatient basis.

Introduction: Perforator-based flaps can be planned in any anatomic location in the body when there is a detectable perforator. Although preoperative perforator mapping ensures safety and versatility of these flaps, there is no consensus yet about flap planning in different anatomical locations. Material and Method: 28 patients underwent perforator-based flap surgery for different anatomical locations as face (5), sternum (3), back (5), lomber (4), sacral (4) and scrotal (4) areas, leg (2) and foot (1). 19 of the patients were male while 9 were female. The mean age was 58.1±13.5 (22-80 years). Perforator-based flaps were planned as V-Y design in face, sacral and scrotal areas while as perforator plus transposition flaps for lomber area, leg and sternum. On the other hand, for foot the flap was planned as subcutaneous-pedicled turnover flap. Results: The mean follow-up time was 10 months (3-36 months). Partial flap necrosis is seen in all 3 patients who had underwent flap surgery on the lower extremity. There were no other complications seen in short- or long-term follow-ups. Comorbid diseases were not statistically significant on complications rates (P>0.05). Conclusion: V-Y flap for the face and the sacral area; and perforator plus transposition flap for back ,lomber area and sternum are suggested as the ideal flap modifications for these anatomical locations. On the other hand, perforator-based flaps should not be used as a first choice in reconstruction of lower extremity defects.

Figure 1 Ulceration surrounded by a reticulated or mottled erythematous skin at the inguinal region.

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