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Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive soft tissue sarcoma. The local recurrence rate is high, in some studies upwards of 60%, likely reflecting a failure to remove occult extensions of tumor. Surgical excision has been the treatment of choice for the resection of DFSP. Any pitfall on management therapy of DFSP not only increase the recurrence rate but also add new problems to patients with DFSP. 58-year-old male patient, came with a local recurrent of DFSP on his right leg. Then performed excision with margin one centimetre, and closing defect using pedicle sural flap, durante surgery turned pedicle on the flap is too short and because of poor soft tissue handling pedicle was injured. It consulted into the vascular division for evaluated and treatment pedicle. Postoperative evaluation, the flap experiences bluish due to vascularization compromised. It was decided to expose the flap and the defect was covered with skin graft. 2 months postoperative evaluation found local recurrent on skin graft area. Excision margins between 2 to 5 cm can reduce the recurrence rate. Proper planning in designing flaps to cover defects and the ability of good soft tissue handling is required to avoid new problems on management DFSP.

25% of basal cell carcinoma (BCC) occurs in nose. The recently accepted treatment includes wide excision with safety margin of 4 mm of clinically normal skin. 3 major points in the treatments are clearance, cosmetic and functional value. Often, due to its central location and delicacy of the surrounding tissue makes it hard to achieve standard surgical margin for lesions located in nose. The size and the depth of the lesion may complicate therapy. These 3 cases reporting large lesion BCC treated with multiple wide excisions before underwent reconstruction. Case 1 and 2 had 3 and 4 time excisions due to failure of gaining negative margin in the previous surgeries. Multiple surgeries were preferred for although it delayed reconstruction, from oncologic point of view it is principle to accomplish perfect clearance of the tumor. Recurrences do not happen on big percentage of cases with positive margin, but may lead to even more complicated reconstruction that compromises patient health. The 2 cases gave satisfactory results with no recurrence within 3 years after surgery.

Chronic kidney disease (CKD) is a chronic disease with a high prevalence worldwide. In 2017, an estimated 1.2 million people died from CKD globally. There are 713,783 CKD sufferers (0.38%) in Indonesia aged 15 years who have been registered nationally. Hemodialysis (HD) is one of three renal replacement therapies for managing CKD. Adequate vascular access is required in patients undergoing HD. Vascular access is ideal if it causes minor complications when used for hemodialysis. Arteriovenous fistula (AVF) is a common vascular access used during HD. The main options for AVF are radiocephalic (RC) and brachiocephalic (BC) fistula, with their respective advantages and disadvantages. This cross-sectional study compares QB in patients with RC and BC fistula and with hematological parameters pre and post-HD. There were 18 RC subjects and 18 BC subjects involved in this study. Subjects were then examined for hematological parameters and QB before and after HD. The results of this study showed that QB in the RC group was not significantly different from the BC group (p=0.126). The mean comparative test showed that the levels of Hb, BUN, and SC were significantly different before and after HD both in the RC group (p=0.005; p=<0.001; p=<0.001) and BC (p=0.001; p =<0.001; p=<0.001). The correlation test results showed that QB only correlated with SC pre-HD levels (p=0.030; r=0.361). Multivariate tests showed that the decrease in BUN levels with AV fistula BC was higher than with RC (p=0.015). This study proves that QB is unrelated to the type of AV fistula used, but QB is positively correlated with serum creatinine levels in patients undergoing HD. BC fistula were also found to lower BUN levels better than RC fistula.