Perforator flaps have revolutionized reconstructive surgery by enabling reliable tissue coverage while significantly reducing donor site morbidity. Based on the use of small-caliber perforating vessels, these flaps allow the transfer of cutaneous and subcutaneous tissues without sacrificing muscle. Advances in the understanding of vascular anatomy and the use of preoperative imaging—particularly Doppler ultrasound and CT angiography—have enabled precise planning and safe dissection. Numerous variants have been developed, including deep inferior epigastric perforator (DIEP) flaps, anterolateral thigh (ALT) flaps, gluteal perforator flaps, and freestyle flaps, each with specific indications and advantages. The emergence of supermicrosurgical techniques, particularly perforator-to-perforator anastomoses, has expanded reconstructive options, especially for distal or complex tissue defects. This article provides a review of the principles, technical aspects, and clinical applications of perforator flaps, highlighting their central role in modern reconstructive surgery.

Eccrine porcarcinoma is an extremely rare malignancy of the skin with few well documented cases reported in literature. It is a malignant cutaneous adnexal neoplasm originating from the intraepidermal ductal portion of eccrine sweat glands. This tumor predominantly affects elderly patients, with a high potential for locoregional metastasis, significant morbidity, and mortality. We present a rare case of porocarcinoma affecting a 22-year-old patient on the lower limb, without extension. The initial tumor was biopsied, excised and diagnosed as an eccrine porocarcinoma. Reconstruction of the heel was achieved with a medial plantar flap.

Acral melanoma is a rare but aggressive form of skin cancer, typically located on the palms, soles, or periungual regions. It carries a poor prognosis, particularly in North Africa, where diagnosis is often delayed. Sentinel lymph node biopsy (SLNB) is currently recommended for staging high-risk or thick melanomas, yet its specific role in managing acral melanoma remains underreported in Morocco. This retrospective descriptive study was conducted at CHU Avicenne between January 2020 and June 2024 and included five patients with histologically confirmed acral melanoma who underwent SLNB according to international guidelines. Clinical and histological parameters, sentinel lymph node status, and patient outcomes were analyzed. The average age was 61.2 years, with a mean diagnostic delay of 7.2 months. The sentinel lymph node was positive in 40% of cases, all involving thick and ulcerated tumors. In all positive cases, management was modified to include lymph node dissection and adjuvant immunotherapy. No deaths were observed during a median follow-up of 24 months. This case series highlights the frequent nodal involvement in acral melanoma in Morocco and emphasizes the value of SLNB in improving patient management and prognosis.

Malignant gastrocolic fistula is a rare and challenging clinical entity characterized by nonspecific symptoms, often leading to delayed diagnosis and management. Imaging modalities such as barium studies, contrast-enhanced CT scans, and upper gastrointestinal endoscopy are crucial for diagnosis. We report the case of a 44-year-old man who presented with anorexia, significant weight loss, and nausea. Upper Gl endoscopy and colonoscopy revealed a gastrocolic fistula secondary to invasive adenocarcinoma involving the stomach extending into splenic flexure as a fistula. The patient underwent a D2 gastrectomy with Roux-en-Y gastrojejunostomy and left radical hemicolectomy. Histopathology confirmed moderately differentiated adenocarcinoma with lymph node involvement. This case highlights the importance of timely diagnosis and aggressive surgical management in improving outcomes in such rare malignancies.

Meckel’s diverticulum is a congenital gastrointestinal anomaly commonly seen in the pediatric age group. It can be divided into symptomatic and asymptomatic presentations, with the most common clinical presentation being gastrointestinal bleeding, intestinal obstruction, and perforation. The diagnosis uses imaging modalities like ultrasound or computerized tomography, with the technetium 99 scan and angiography reserved for complicated presentations. Meckel’s diverticulum is treated by performing a diverticulectomy or resection, which can be performed as an open or laparoscopic procedure. The treatment of incidental Meckel’s diverticulum is an area of controversy due to the absence of any guidelines on management.

Background: Full-thickness alar defects require complex reconstruction of the nasal lining, framework, and skin. While the forehead flap is the standard, it involves multiple stages. This study presents the nasolabial turnover flap as a single-stage alternative offering both functional and aesthetic advantages. Method: Over a two-year period, 16 patients with basal cell carcinoma underwent alar reconstruction using a folded nasolabial turnover flap with cartilage grafting. Candidates had thick nasal skin and adequate cheek laxity. Reconstruction followed the nasal subunit principle, and a nasal conformer was used postoperatively. Results: All flaps survived with no infections. Minor complications included two cases of venous congestion and one case of partial nasal obstruction requiring revision. Donor sites healed well with concealed scarring. At 12 months, outcomes were functionally and cosmetically satisfactory with high patient satisfaction and minimal need for secondary procedures. Conclusion: The nasolabial turnover flap is a reliable, single-stage solution for full-thickness alar reconstruction in select patients. It offers excellent color match, structural support, and minimal morbidity, making it a valuable alternative to multistage techniques.

Introduction: Medulloblastomas account for approximately 20% of pediatric brain tumors but are rare in adults. We present a case of adult medulloblastoma with radiological features suggestive of cerebellar metastases, along with a literature review focusing on immunohistochemical classification and management strategies. Case Report: A 37-year-old male patient, with a medical history of benzodiazepine use (discontinued six months prior), tobacco and cannabis consumption, was admitted following generalized seizures in a context of increased intracranial pressure and a static cerebellar syndrome. A brain CT scan revealed two cerebellar hemispheric lesions (right and left), associated with perilesional edema and mass effect on the fourth ventricle, resulting in upstream hydrocephalus. Further imaging with MRI demonstrated hypointense lesions on T1-weighted sequences, hyperintense on T2, with no contrast enhancement after gadolinium injection. The patient underwent urgent ventriculoperitoneal shunt (VPS) placement. After stabilization, a stereotactic biopsy was performed and histopathological analysis confirmed the diagnosis of a WHO grade IV medulloblastoma. Discussion: Recent advances in the molecular characterization of medulloblastomas have highlighted significant heterogeneity among subtypes, supporting their classification as distinct pathological entities with unique biological and clinical profiles. Immunohistochemistry plays a pivotal role in both therapeutic decision-making and prognosis, allowing assessment of metastatic and recurrence potential. Furthermore, the extent of residual tumor following surgical resection remains a critical determinant of recurrence and guides the indication for adjuvant radiotherapy. Conclusion: Medulloblastomas can present diagnostic challenges on neuroimaging, particularly on non-contrast-enhanced CT. Our literature review underscores the critical importance of immunohistochemical classification in the therapeutic management of medulloblastomas.