Which tumour focus should I use for the conference talk? · What should I prepare next?

cutaneous angiosarcoma wide local excision margin reconstruction keystone flap posterior trunk review

angiosarcoma AND surgery

keystone perforator island flap surgical schematic design and closure

posterior trunk back perforator anatomy flap reconstruction surgical diagram

keystone flap posterior trunk oncologic defect surgical technique review perforator flap

keystone flap AND trunk

~/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7700866

PMID: 35477115

PMID: 40961959

mkdir -p "/tmp/workspace/back-vascular-tumour-conference/src" "/tmp/workspace/back-vascular-tumour-conference/output" "/tmp/workspace/back-vascular-tumour-conference/assets"

python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.shapes import MSO_AUTO_SHAPE_TYPE from pptx.enum.text import MSO_AUTO_SIZE from pptx.oxml.xmlchemy import OxmlElement from pptx.oxml.ns import qn from pathlib import Path out=Path('/tmp/workspace/back-vascular-tumour-conference/output/Back_Vascular_Tumour_WLE_Keystone_Flap_Conference.pptx') prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # Palette NAVY=RGBColor(12,31,48); TEAL=RGBColor(0,137,144); AQUA=RGBColor(75,201,196); ORANGE=RGBColor(235,141,61); RED=RGBColor(184,65,65); BG=RGBColor(247,249,250); TEXT=RGBColor(29,42,53); MID=RGBColor(93,111,125); PALE=RGBColor(224,241,240); WHITE=RGBColor(255,255,255); GREY=RGBColor(226,231,234) def rect(slide,x,y,w,h,fill,line=None,r=False): s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if r else MSO_SHAPE.RECTANGLE,Inches(x),Inches(y),Inches(w),Inches(h)); s.fill.solid(); s.fill.fore_color.rgb=fill; s.line.color.rgb=line or fill if r: s.adjustments[0]=0.08 return s def text(slide,txt,x,y,w,h,size=18,color=TEXT,bold=False,align=PP_ALIGN.LEFT,font='Aptos',val=MSO_ANCHOR.TOP): tb=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=tb.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(.03); tf.margin_right=Inches(.03); tf.margin_top=Inches(.01); tf.margin_bottom=Inches(.01); tf.vertical_anchor=val for i,line in enumerate(txt.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align; p.space_after=Pt(4) for r in p.runs: r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def bullet(slide, items, x,y,w,h,size=18): tb=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=tb.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=Inches(.08);tf.margin_right=Inches(.02) for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph();p.text=item;p.level=0;p.font.size=Pt(size);p.font.name='Aptos';p.font.color.rgb=TEXT;p.space_after=Pt(8);p._p.get_or_add_pPr().insert(0, OxmlElement('a:buChar')) if False else None p.text='• '+item return tb def title(slide,ttl,sub=None,n=None): rect(slide,0,0,13.333,.2,TEAL);text(slide,ttl,.55,.35,11.8,.52,27,NAVY,True) if sub:text(slide,sub,.57,.91,11.6,.30,11,MID) if n:text(slide,f'{n:02}',12.15,.39,.55,.30,14,TEAL,True,align=PP_ALIGN.RIGHT) rect(slide,.55,7.1,12.22,.01,GREY) def footer(slide,s): text(slide,s,.57,7.16,12,.18,8,MID) def add_notes(slide, txt): # notes text placeholder exists in notes slide try: tf=slide.notes_slide.notes_text_frame tf.text=txt except Exception: pass def line(slide,x1,y1,x2,y2,color=TEAL,width=2): c=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));c.line.color.rgb=color;c.line.width=Pt(width);return c def circle(slide,x,y,d,fill,lab='',size=12): s=slide.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(d),Inches(d));s.fill.solid();s.fill.fore_color.rgb=fill;s.line.color.rgb=fill if lab:text(slide,lab,x,y+.1,d,d-.1,size,WHITE,True,align=PP_ALIGN.CENTER,val=MSO_ANCHOR.MIDDLE) return s # 1 s=prs.slides.add_slide(blank);rect(s,0,0,13.333,7.5,NAVY);rect(s,.72,.85,.12,5.65,TEAL);text(s,'Wide Local Excision and\nKeystone Flap Coverage\nfor a Back Vascular Tumour',1.12,1.05,9.5,2.2,31,WHITE,True);text(s,'Conference presentation | Oncologic principles, posterior trunk reconstruction, and operative workflow',1.15,3.6,8.8,.6,16,RGBColor(204,224,228)); # abstract geometric back panel rect(s,10.45,1.02,1.55,4.8,TEAL,r=True);rect(s,11.3,1.55,1.05,3.75,AQUA,r=True);circle(s,10.82,2.42,.55,ORANGE);text(s,'Suspected malignant\nvascular tumour\nBack / posterior trunk',1.15,5.35,6.5,.75,15,WHITE,False);footer(s,'Educational template: adapt diagnosis, dimensions, imaging and MDT plan to the individual patient.');add_notes(s,'Opening: This presentation assumes a suspected malignant vascular tumour of the posterior trunk. Histology must drive definitive margins and adjuvant treatment.') #2 objectives s=prs.slides.add_slide(blank);title(s,'Learning objectives','A practical, oncologically safe pathway',2);bullet(s,['Separate vascular tumours from vascular malformations before committing to oncologic resection.','Plan biopsy, imaging, margin strategy and reconstruction together in an MDT.','Perform a wide en bloc excision without compromising future flap perfusion.','Design and inset a keystone perforator island flap for a moderate posterior trunk defect.','Recognise when a keystone flap is inappropriate and escalate reconstruction.'],.75,1.45,7.2,4.8,20);rect(s,8.55,1.55,3.7,3.75,PALE,r=True);text(s,'Core rule',8.9,1.95,2.9,.4,18,TEAL,True);text(s,'Clear margins first.\nReconstruction must not constrain resection.',8.9,2.62,2.95,1.3,25,NAVY,True,align=PP_ALIGN.CENTER,val=MSO_ANCHOR.MIDDLE);footer(s,'Framework informed by Sabiston Textbook of Surgery, Angiosarcoma and Soft Tissue Management sections.') #3 diagnostic guardrail s=prs.slides.add_slide(blank);title(s,'Diagnostic guardrail: “vascular lesion” is not a diagnosis','Management diverges before the first incision',3) headers=['Benign vascular tumour','Vascular malformation','Malignant vascular tumour'] cols=[(TEAL,['Often circumscribed','Symptoms / bleeding / mass effect','Treatment: observe, laser, sclerotherapy or tailored excision']), (ORANGE,['Structural anomaly, often present early','May be extensive and infiltrative','MRI and multidisciplinary vascular-anomaly plan']), (RED,['Examples: cutaneous angiosarcoma, epithelioid hemangioendothelioma','May be infiltrative, multifocal or high-grade','Core/incisional biopsy, staging and sarcoma MDT'])] for i,(c,items) in enumerate(cols): x=.65+i*4.15;rect(s,x,1.5,3.65,4.7,WHITE,RGBColor(210,218,222),True);rect(s,x,1.5,3.65,.58,c, c,True);text(s,headers[i],x+.2,1.66,3.25,.25,15,WHITE,True,align=PP_ALIGN.CENTER);bullet(s,items,x+.28,2.35,3.1,3.4,16) text(s,'Do not label a lesion “haemangioma” clinically when imaging, growth pattern or pathology is discordant.',.75,6.45,11.5,.32,15,RED,True);footer(s,'Angiosarcoma is an endothelial malignancy that may arise at many sites. Sabiston Textbook of Surgery, Angiosarcoma section.') #4 workup s=prs.slides.add_slide(blank);title(s,'Preoperative work-up: make the resection reconstructible',None,4) steps=[('1','Clinical mapping','Photograph; measure visible lesion; palpate fixation; document prior scars, radiation and bleeding history.'),('2','Tissue diagnosis','Image-guided core or representative incisional biopsy. Place tract where it can be excised en bloc.'),('3','Local extent','Contrast MRI for soft tissue plane, muscle/fascia and neurovascular relation. Consider CTA/MRA if hypervascular or anatomy uncertain.'),('4','Stage and plan','CT chest ± other staging directed by histology; review in sarcoma/vascular anomaly/oncoplastic MDT.')] for i,(num,h,b) in enumerate(steps): y=1.35+i*1.32;circle(s,.75,y,.5,TEAL,num,15);text(s,h,1.42,y-.02,2.25,.28,18,NAVY,True);text(s,b,3.67,y-.02,8.75,.6,15,TEXT) footer(s,'Biopsy route and imaging should be agreed with the definitive surgical team. General sarcoma practice: image before definitive excision.') #5 strategy s=prs.slides.add_slide(blank);title(s,'Oncologic resection strategy','The resection specimen, not the flap, determines the oncologic result',5) rect(s,.7,1.35,5.75,4.95,WHITE,RGBColor(210,218,222),True);text(s,'Wide local excision: operative goals',1.0,1.68,4.8,.32,20,NAVY,True);bullet(s,['Mark clinical tumour and planned margin before infiltration or distortion.','Excise skin, subcutis and any involved deep fascia or muscle en bloc.','Orient specimen with sutures/ink and communicate close planes to pathology.','Avoid piecemeal resection and avoid traversing tumour with undermining.','If gross or frozen-section concern persists, extend resection when feasible.'],1.0,2.18,4.9,3.65,16) rect(s,6.9,1.35,5.7,4.95,PALE,PALE,True);text(s,'Margin language',7.25,1.68,4.4,.32,20,TEAL,True);text(s,'R0 = microscopically negative margin',7.25,2.25,4.55,.35,22,NAVY,True);text(s,'A numeric margin is histology-, site- and barrier-dependent. Deep fascia can be a meaningful anatomic barrier; “one rule for all vascular tumours” is unsafe.',7.25,2.95,4.45,1.25,17,TEXT);text(s,'For angiosarcoma: surgery is the only potentially curative modality without metastasis, and negative skin margins are central to outcome.',7.25,4.65,4.45,.85,15,RED,True);footer(s,'Sabiston Textbook of Surgery, Angiosarcoma section; STS trunk review: negative margins with planned en bloc resection. Do not apply a fixed 3-cm margin to every posterior trunk lesion.') #6 reconstructive ladder s=prs.slides.add_slide(blank);title(s,'Reconstruction begins before excision','Choose coverage based on defect, recipient bed, prior treatment and required adjuvant therapy',6) ladder=[('Primary closure','Small, low-tension defects'),('Skin graft','Well-vascularised bed; surveillance priority; no exposed critical structures'),('Keystone / local perforator flap','Moderate defect; adjacent non-irradiated lax tissue; perforators preserved'),('Regional muscle / myocutaneous flap','Dead space, exposed bone/hardware, need for bulk'),('Free flap','Large, irradiated, recurrent or composite defects; failed local options')] for i,(a,b) in enumerate(ladder): y=1.35+i*.95;rect(s,.85,y,2.35,.64,TEAL if i==2 else RGBColor(215,226,229),r=True);text(s,a,1.02,y+.15,2.0,.24,14,WHITE if i==2 else NAVY,True,align=PP_ALIGN.CENTER);line(s,3.25,y+.32,3.65,y+.32,TEAL,2);text(s,b,3.9,y+.12,6.4,.3,16,TEXT) rect(s,10.25,1.5,2.0,3.8,PALE,PALE,True);text(s,'Keystone is\nnot “free tissue”',10.52,1.9,1.48,.7,18,NAVY,True,align=PP_ALIGN.CENTER);text(s,'It needs a healthy adjacent donor field and preserved perforators.',10.52,3.05,1.45,1.05,15,TEAL,True,align=PP_ALIGN.CENTER);footer(s,'Sabiston Textbook of Surgery, Soft Tissue Management: local options include rotation, V-Y and keystone flaps; scars and radiation may limit them.') #7 anatomy s=prs.slides.add_slide(blank);title(s,'Why the posterior trunk is suitable for perforator-based reconstruction','Abundant segmental perforators and broad adjacent tissue reservoirs',7) # body schematic rect(s,5.25,1.42,2.75,4.9,RGBColor(225,234,232),RGBColor(190,205,203),True);circle(s,5.95,1.05,1.3,RGBColor(225,234,232));line(s,6.62,1.6,6.62,6.1,MID,1) for y in [2.2,3.0,3.8,4.6,5.4]: line(s,6.62,y,5.55,y-.32,ORANGE,2);line(s,6.62,y,7.68,y-.32,ORANGE,2);circle(s,5.45,y-.4,.18,ORANGE);circle(s,7.6,y-.4,.18,ORANGE) text(s,'Segmental dorsal perforators',.8,1.65,3.6,.3,19,TEAL,True);bullet(s,['Intercostal perforators: upper and mid back','Lumbar perforators: lower back','Thoracodorsal and circumflex scapular systems: lateral upper back','Paraspinal perforators: medial back'],.85,2.15,3.7,3.2,17) text(s,'Planning implications',8.6,1.65,3.3,.3,19,TEAL,True);bullet(s,['Doppler can guide design but is not a substitute for safe dissection.','Do not place the flap over prior radiation, scar or a resection field likely to sacrifice its perforators.','Align advancement with available laxity and avoid midline tension when possible.'],8.6,2.15,3.75,3.2,17);footer(s,'Posterior trunk reconstruction review: local and perforator flaps are enabled by abundant perforators; surrounding tissue quality is decisive.') #8 keystone design s=prs.slides.add_slide(blank);title(s,'Keystone perforator island flap: concept and design','A curvilinear trapezoidal, islanded fasciocutaneous advancement flap',8) # diagram rect(s,.85,1.45,5.35,4.8,WHITE,RGBColor(210,218,222),True);text(s,'Schematic marking',1.15,1.75,4.3,.28,18,NAVY,True) # defect rect(s,2.75,3.2,1.5,.9,RED,RED,True);text(s,'DEFECT',2.85,3.5,1.3,.2,13,WHITE,True,align=PP_ALIGN.CENTER) # curved-ish trapezoid via chevrons rectangles / lines line(s,1.55,2.7,2.75,3.2,TEAL,4);line(s,1.55,4.6,2.75,4.1,TEAL,4);line(s,4.25,3.2,5.45,2.7,TEAL,4);line(s,4.25,4.1,5.45,4.6,TEAL,4);line(s,1.55,2.7,1.15,3.65,TEAL,4);line(s,1.15,3.65,1.55,4.6,TEAL,4);line(s,5.45,2.7,5.85,3.65,TEAL,4);line(s,5.85,3.65,5.45,4.6,TEAL,4) text(s,'Flap width approximately equals defect width; ends advance as paired V-Y closures.',1.15,5.35,4.8,.55,14,MID,align=PP_ALIGN.CENTER) rect(s,6.75,1.45,5.7,4.8,PALE,PALE,True);text(s,'Mechanics',7.1,1.78,3,.3,19,TEAL,True);bullet(s,['Islanded flap supplied by multiple small fasciocutaneous / musculocutaneous perforators.','Deep fascial release increases mobility.','Two V-Y movements at the ends reduce tension.','Blunt dissection protects perforators, veins and sensory branches.','Variants: Type I, IIa/IIb, III double keystone, IV rotational.'],7.1,2.3,4.8,3.25,16);footer(s,'Behan 2003; PMID 12608972. The flap relies on randomly located perforators and paired V-Y advancement.') #9 decision s=prs.slides.add_slide(blank);title(s,'Is a keystone flap appropriate?',None,9) left=[('Favourable','Moderate cutaneous/subcutaneous defect','Healthy, mobile adjacent skin','No major perforator sacrifice in donor area','No significant dead space','Defect can close with acceptable tension')] right=[('Avoid or escalate','Heavily irradiated, scarred or infected field','Large three-dimensional defect / exposed hardware','Need for bulk or dead-space obliteration','Recipient tissue or perforators removed with tumour','Closure still under high tension after appropriate release')] for x,(hd,*items),c in [(.85,left,TEAL),(6.85,right,RED)]: rect(s,x,1.45,5.5,4.95,WHITE,RGBColor(210,218,222),True);rect(s,x,1.45,5.5,.62,c,c,True);text(s,hd,x+.25,1.63,4.9,.24,18,WHITE,True,align=PP_ALIGN.CENTER);bullet(s,items,x+.35,2.35,4.7,3.55,17) footer(s,'If perfusion, reach or tension is doubtful, choose a safer reconstructive rung rather than forcing a local flap.') #10 operative sequence s=prs.slides.add_slide(blank);title(s,'Operative sequence: wide local excision then keystone coverage','A reproducible posterior trunk workflow',10) ops=[('A','Mark lesion, planned margin and flap with patient positioned as for surgery.'),('B','Prepare wide field; anticipate bleeding. Infiltrate only away from lesion margins if required.'),('C','Excise tumour en bloc to planned deep plane. Orient specimen and send margins per pathology protocol.'),('D','Reassess defect: size, fascia/muscle exposure, tension vector and donor-field integrity.'),('E','Incise flap, divide deep fascia selectively and elevate by blunt dissection, preserving visible perforators.'),('F','Advance flap centrally; close V-Y ends; inset without torsion or tension. Drain selectively.')] for i,(letter,desc) in enumerate(ops): col=i%2;row=i//2;x=.75+col*6.2;y=1.35+row*1.65;circle(s,x,y,.46,TEAL,letter,14);text(s,desc,x+.68,y-.02,5.15,.62,16,TEXT) footer(s,'Technique must be tailored to tumour biology, defect geometry and local tissue quality. This slide is an operative checklist, not a substitute for training.') #11 key technical s=prs.slides.add_slide(blank);title(s,'Technical points that prevent failure',None,11) items=[('Haemostasis','Vascular tumours may bleed substantially. Use deliberate bipolar control, clips/ligatures where needed, and avoid prolonged thermal injury to flap edges.'),('Perfusion','Preserve perforators by blunt dissection. Do not skeletonise routinely. Check colour, capillary refill and bleeding at inset.'),('Tension','If closure blanches or requires force, increase release, use a double keystone or change the plan. Do not “win” with tight sutures.'),('Dead space','Quilt/anchor where appropriate; use closed suction drainage selectively. Consider muscle flap if the cavity is substantial.'),('Margins','Do not narrow resection to save skin. Reconstruct after margin strategy is secured; record any planned close margin for MDT/pathology.')] for i,(h,b) in enumerate(items): y=1.25+i*.98;rect(s,.75,y,.16,.62,ORANGE,r=True);text(s,h,1.15,y,2.1,.25,17,NAVY,True);text(s,b,3.05,y,9.0,.56,15,TEXT) footer(s,'Clinical judgement and local protocols govern blood-loss planning, drains, antibiotics and wound management.') #12 postop s=prs.slides.add_slide(blank);title(s,'Postoperative management and surveillance','Wound success supports timely adjuvant therapy, but does not replace oncologic follow-up',12) for i,(h,its) in enumerate([('First 72 h',['Assess flap colour, temperature, capillary refill and haematoma','Avoid pressure and shear across the back','Analgesia; mobilisation and positioning plan']),('Pathology review',['Margin status, grade, size, depth and lymphovascular pattern','Discuss re-excision if positive margins when feasible','Document pathology-MDT recommendations']),('MDT treatment and surveillance',['Consider radiotherapy/systemic therapy by final histology, stage and resectability','Clinical examination plus site- and histology-appropriate imaging','Teach patient early signs of recurrence and wound complication'])]): x=.7+i*4.18;rect(s,x,1.48,3.7,4.85,WHITE,RGBColor(210,218,222),True);rect(s,x,1.48,3.7,.63,[TEAL,ORANGE,RED][i],[TEAL,ORANGE,RED][i],True);text(s,h,x+.22,1.66,3.25,.25,16,WHITE,True,align=PP_ALIGN.CENTER);bullet(s,its,x+.3,2.48,3.06,3.3,15) footer(s,'Angiosarcoma has substantial local-recurrence risk. Final treatment strategy must be discussed in a specialist MDT.') #13 evidence s=prs.slides.add_slide(blank);title(s,'What does the evidence say about keystone flaps?',None,13) rect(s,.75,1.38,3.65,4.9,NAVY,NAVY,True);text(s,'Systematic review\nof keystone flaps',1.15,1.85,2.85,.7,20,WHITE,True,align=PP_ALIGN.CENTER);text(s,'98%',1.45,3.05,2.25,.72,42,AQUA,True,align=PP_ALIGN.CENTER);text(s,'overall flap success\nacross included series',1.2,3.92,2.75,.6,15,WHITE,align=PP_ALIGN.CENTER) rect(s,4.85,1.38,3.65,4.9,PALE,PALE,True);text(s,'Trunk-specific\nsystematic review',5.25,1.85,2.85,.7,20,NAVY,True,align=PP_ALIGN.CENTER);text(s,'54',5.55,3.05,2.25,.72,42,TEAL,True,align=PP_ALIGN.CENTER);text(s,'flaps across 8 studies\n64.4% after oncologic resection',5.25,3.92,2.85,.6,15,TEXT,align=PP_ALIGN.CENTER) rect(s,8.95,1.38,3.65,4.9,RGBColor(252,237,224),RGBColor(252,237,224),True);text(s,'Interpret with care',9.35,1.85,2.85,.35,20,RED,True,align=PP_ALIGN.CENTER);text(s,'35.2%',9.55,3.05,2.25,.72,42,RED,True,align=PP_ALIGN.CENTER);text(s,'reported trunk complication rate\nmostly infection, dehiscence or delayed healing; partial loss 1.9%',9.2,3.92,3.15,.9,15,TEXT,align=PP_ALIGN.CENTER);footer(s,'Weinberg et al. 2022, PMID 35477115. Trunk systematic review, PMCID PMC7700866. Small, heterogeneous observational evidence.') #14 complications s=prs.slides.add_slide(blank);title(s,'Complications: recognise early, respond proportionately',None,14) comp=[('Haematoma / bleeding','Evacuate if compromising flap or wound. Correct coagulopathy; reassess bleeding source.'),('Venous congestion','Remove constriction, offload pressure, assess haematoma/twist. Early return to theatre if progressive.'),('Edge necrosis / delayed healing','Debride conservatively when demarcated; dressings/NPWT; revise or graft if needed.'),('Infection / dehiscence','Culture when appropriate, antibiotics plus source control. Review tension and dead space.'),('Positive margin / recurrence','Do not treat as a wound issue alone. Return to MDT for re-excision and adjuvant strategy.')] for i,(h,b) in enumerate(comp): y=1.25+i*.98;circle(s,.8,y,.38,RED,'!',14);text(s,h,1.42,y-.01,2.55,.25,17,NAVY,True);text(s,b,4.15,y-.02,7.85,.46,15,TEXT) footer(s,'Reported trunk KDPIF complications were commonly minor wound events, but complication classification and reporting varied across studies.') #15 case template s=prs.slides.add_slide(blank);title(s,'Case presentation template','Replace placeholders with the actual case. Do not fabricate patient-specific details.',15) boxes=[('Patient / lesion','Age, sex, symptoms, duration, prior radiotherapy/lymphoedema, clinical dimensions, photographs.'),('Investigations','Biopsy result and IHC; MRI local extent; CT chest or staging; vascular imaging if indicated.'),('MDT decision','Tumour type/grade; resection plane and margin intent; need for radiotherapy/systemic therapy; reconstructive plan.'),('Operation','Position, resection dimensions/deep plane, blood loss, specimen orientation, flap type and dimensions, drain.'),('Outcome','Final pathology/margins, complication status, time to healing, adjuvant treatment, surveillance status.')] for i,(h,b) in enumerate(boxes): x=.8+(i%2)*6.1;y=1.3+(i//2)*1.65;rect(s,x,y,5.55,1.18,WHITE,RGBColor(210,218,222),True);text(s,h,x+.25,y+.17,1.85,.24,16,TEAL,True);text(s,b,x+2.05,y+.14,3.13,.72,13,TEXT) footer(s,'Ethics: obtain consent for identifiable images; remove identifiers; state follow-up duration and limitations transparently.') #16 MDT s=prs.slides.add_slide(blank);title(s,'MDT discussion prompts',None,16) prompts=['Is the diagnosis secure and representative of the most aggressive area?','What is the true local extent and which deep plane must be removed?','What margin is appropriate for this histology and anatomic constraint?','Will planned resection sacrifice donor perforators or preclude a keystone flap?','Is radiotherapy planned, and how does that affect flap choice/timing?','What is the salvage plan if intraoperative margins expand the defect?'] for i,p in enumerate(prompts): y=1.2+i*.78;circle(s,.83,y,.35,TEAL,str(i+1),12);text(s,p,1.4,y-.02,10.75,.33,18,TEXT) footer(s,'A combined oncologic-reconstructive plan avoids compromise: pathology, radiology, anaesthesia, surgical oncology/plastics and radiation/medical oncology.') #17 take homes s=prs.slides.add_slide(blank);title(s,'Take-home messages',None,17) msgs=[('1','Name the lesion before choosing the operation.','A vascular malformation and a malignant vascular tumour do not share the same treatment pathway.'),('2','Plan the biopsy, resection and reconstruction as one pathway.','The definitive surgeon should be able to excise the biopsy tract and achieve planned margins.'),('3','For a suitable back defect, keystone flap coverage is a useful local option.','It offers like-for-like tissue and avoids microsurgery, but only when donor tissue and perforators are reliable.'),('4','Do not force the flap.','Oncologic clearance, tissue quality, tension and dead space determine whether to escalate coverage.')] for i,(n,h,b) in enumerate(msgs): y=1.22+i*1.3;circle(s,.8,y,.5,TEAL,n,16);text(s,h,1.55,y-.02,4.6,.3,18,NAVY,True);text(s,b,6.25,y-.02,5.85,.52,15,TEXT) footer(s,'Educational conclusion: final decisions require patient-specific pathology, imaging, operative judgement and MDT input.') #18 refs s=prs.slides.add_slide(blank);title(s,'Selected references',None,18) refs=['Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73:112-120. PMID: 12608972.','Weinberg M, et al. Outcomes of the Keystone Island Perforator Flap: A Systematic Review. J Reconstr Microsurg. 2022. PMID: 35477115.','A systematic review of the keystone design perforator island flap in reconstruction of trunk defects. Medicine (Baltimore). 2020. PMCID: PMC7700866.','Behr B, et al. Reconstructive Options for Oncologic Posterior Trunk Defects: A Review. Front Oncol. 2016;6:51. PMCID: PMC4782339.','Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Angiosarcoma; Soft Tissue Management sections.','Patel AB, et al. Survival Outcomes in Cutaneous Angiosarcoma: A Meta Analysis. Dermatol Surg. 2026. PMID: 40961959.'] bullet(s,refs,.8,1.35,11.6,4.8,16);text(s,'Evidence caveat: angiosarcoma and keystone-flap data are predominantly retrospective and heterogeneous. Use disease-specific guidelines and local MDT policy for patient care.',.85,6.15,11.4,.46,14,RED,True);footer(s,'Prepared as a conference teaching deck. No patient-specific recommendation is implied.') # set background each slide for slide in prs.slides: bg=slide.background.fill;bg.solid();bg.fore_color.rgb=BG # background overwritten title slide? fix title # restore title slide prs.slides[0].background.fill.solid();prs.slides[0].background.fill.fore_color.rgb=NAVY prs.save(out) print(out) PY

python - <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pathlib import Path out=Path('/tmp/workspace/back-vascular-tumour-conference/output/Back_Vascular_Tumour_WLE_Keystone_Flap_Conference.pptx') prs=Presentation();prs.slide_width=Inches(13.333);prs.slide_height=Inches(7.5); blank=prs.slide_layouts[6] N=RGBColor(12,31,48);T=RGBColor(0,137,144);A=RGBColor(75,201,196);O=RGBColor(235,141,61);R=RGBColor(184,65,65);B=RGBColor(247,249,250);X=RGBColor(29,42,53);M=RGBColor(93,111,125);P=RGBColor(224,241,240);W=RGBColor(255,255,255);G=RGBColor(215,226,229) def box(s,x,y,w,h,c,ln=None,round=False): q=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if round else MSO_SHAPE.RECTANGLE,Inches(x),Inches(y),Inches(w),Inches(h));q.fill.solid();q.fill.fore_color.rgb=c;q.line.color.rgb=ln or c return q def tx(s,a,x,y,w,h,sz=18,c=X,b=False,align=PP_ALIGN.LEFT): z=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h));f=z.text_frame;f.clear();f.word_wrap=True;f.margin_left=f.margin_right=Inches(.03);f.margin_top=Inches(.01) for j,v in enumerate(str(a).split('\n')): p=f.paragraphs[0] if j==0 else f.add_paragraph();p.text=v;p.alignment=align;p.space_after=Pt(4) for r in p.runs:r.font.name='Aptos';r.font.size=Pt(sz);r.font.bold=b;r.font.color.rgb=c return z def bl(s,arr,x,y,w,h,sz=16): tx(s,'\n'.join('• '+q for q in arr),x,y,w,h,sz) def tit(s,a,sub='',n=0): box(s,0,0,13.333,.18,T);tx(s,a,.55,.35,11.5,.5,27,N,True);tx(s,sub,.57,.9,11.4,.25,11,M);tx(s,f'{n:02}',12.15,.38,.5,.25,14,T,True,PP_ALIGN.RIGHT);box(s,.55,7.1,12.2,.01,G) def foot(s,a):tx(s,a,.57,7.15,12,.14,8,M) def notes(s,a): try:s.notes_slide.notes_text_frame.text=a except:pass def circ(s,x,y,d,c,l=''): q=s.shapes.add_shape(MSO_SHAPE.OVAL,Inches(x),Inches(y),Inches(d),Inches(d));q.fill.solid();q.fill.fore_color.rgb=c;q.line.color.rgb=c if l:tx(s,l,x,y+.08,d,d-.1,13,W,True,PP_ALIGN.CENTER) def ln(s,x1,y1,x2,y2,c=T,w=2): q=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));q.line.color.rgb=c;q.line.width=Pt(w) def slide(title,sub='',n=0): s=prs.slides.add_slide(blank);s.background.fill.solid();s.background.fill.fore_color.rgb=B;tit(s,title,sub,n);return s # 1 s=prs.slides.add_slide(blank);s.background.fill.solid();s.background.fill.fore_color.rgb=N;box(s,.72,.85,.12,5.65,T);tx(s,'Wide Local Excision and\nKeystone Flap Coverage\nfor a Back Vascular Tumour',1.12,1.05,9.4,2.2,31,W,True);tx(s,'Conference presentation | Oncologic principles, posterior trunk reconstruction, operative workflow',1.15,3.6,8.8,.6,16,RGBColor(204,224,228));box(s,10.45,1.02,1.55,4.8,T,round=True);box(s,11.3,1.55,1.05,3.75,A,round=True);circ(s,10.82,2.42,.55,O);tx(s,'Suspected malignant vascular tumour | Posterior trunk',1.15,5.35,6.8,.4,15,W);foot(s,'Educational template. Adapt histology, imaging, dimensions and MDT plan to the actual patient.');notes(s,'Frame as suspected malignant vascular tumour, with angiosarcoma as the principal malignant example. Histology determines treatment.') #2 s=slide('Learning objectives','A practical, oncologically safe pathway',2);bl(s,['Separate vascular tumour from vascular malformation before committing to wide excision.','Plan biopsy, imaging, margins and reconstruction together in MDT.','Perform en bloc resection without compromising potential flap perfusion.','Design and inset a keystone perforator island flap for a moderate posterior trunk defect.','Recognise when a keystone flap should be replaced by another option.'],.75,1.45,7.2,4.8,20);box(s,8.55,1.55,3.7,3.75,P,round=True);tx(s,'Core rule',8.9,1.95,2.9,.4,18,T,True,PP_ALIGN.CENTER);tx(s,'Clear margins first.\nReconstruction must not constrain resection.',8.9,2.62,2.95,1.3,24,N,True,PP_ALIGN.CENTER);foot(s,'Sources: Sabiston Textbook of Surgery, Angiosarcoma and Soft Tissue Management sections.') #3 s=slide('Diagnostic guardrail: “vascular lesion” is not a diagnosis','Management diverges before the first incision',3) for i,(h,c,ar) in enumerate([('Benign vascular tumour',T,['Often circumscribed','Symptoms, bleeding, mass effect','Observe, laser, sclerotherapy or tailored excision']),('Vascular malformation',O,['Structural anomaly, often extensive','MRI and vascular-anomaly MDT','Intervention tailored to flow type and symptoms']),('Malignant vascular tumour',R,['Examples: angiosarcoma, EHE','May be infiltrative or high-grade','Biopsy, staging and sarcoma MDT'])]): x=.65+i*4.15;box(s,x,1.5,3.65,4.7,W,G,True);box(s,x,1.5,3.65,.58,c,c,True);tx(s,h,x+.18,1.66,3.3,.25,15,W,True,PP_ALIGN.CENTER);bl(s,ar,x+.28,2.35,3.1,3.4,16) tx(s,'Do not label a discordant or growing lesion “haemangioma” on clinical appearance alone.',.75,6.45,11.5,.3,15,R,True);foot(s,'Angiosarcoma is an endothelial malignancy. Sabiston Textbook of Surgery, Angiosarcoma.') #4 s=slide('Preoperative work-up: make the resection reconstructible','Plan the biology and the geometry',4) for i,(h,b) in enumerate([('1 Clinical mapping','Photograph, measure, assess fixation, scars/radiation, bleeding history.'),('2 Tissue diagnosis','Image-guided core or representative incisional biopsy. Place tract so it can be excised.'),('3 Local extent','Contrast MRI for skin, subcutis, fascia, muscle and neurovascular relationship.'),('4 Stage and plan','CT chest or histology-directed staging; sarcoma/vascular anomaly/oncoplastic MDT.')]): y=1.35+i*1.32;circ(s,.75,y,.5,T,str(i+1));tx(s,h[3:],1.42,y-.02,2.25,.28,18,N,True);tx(s,b,3.67,y-.02,8.75,.6,15) foot(s,'Image before definitive excision. The definitive surgical team should agree the biopsy route.') #5 s=slide('Oncologic resection strategy','The specimen, not the flap, determines the oncologic result',5);box(s,.7,1.35,5.75,4.95,W,G,True);tx(s,'Wide local excision: goals',1,1.68,4.8,.32,20,N,True);bl(s,['Mark lesion and planned margin before distortion.','Excise skin, subcutis and involved fascia/muscle en bloc.','Avoid piecemeal resection and undermining through tumour.','Orient/ink specimen and communicate close planes to pathology.','Extend resection if margin concern remains feasible.'],1,2.18,4.9,3.65,16);box(s,6.9,1.35,5.7,4.95,P,P,True);tx(s,'Margin language',7.25,1.68,4.4,.32,20,T,True);tx(s,'R0 = microscopically negative margin',7.25,2.25,4.55,.35,22,N,True);tx(s,'Margin width is histology-, site- and barrier-dependent. Deep fascia can be a useful barrier; one numeric rule is unsafe.',7.25,2.95,4.45,1.25,17);tx(s,'For angiosarcoma without metastasis, surgery is the only potentially curative modality and negative skin margins matter.',7.25,4.65,4.45,.85,15,R,True);foot(s,'Sabiston Textbook of Surgery: Angiosarcoma; trunk soft-tissue sarcoma review. Do not apply a fixed 3-cm margin universally.') #6 s=slide('Reconstruction begins before excision','Choose coverage after defining the defect and recipient bed',6) for i,(a,b) in enumerate([('Primary closure','Small, low-tension defect'),('Skin graft','Vascular bed, simple surface coverage'),('Keystone/local perforator','Moderate defect, healthy adjacent tissue'),('Regional muscle flap','Dead space or need for vascularised bulk'),('Free flap','Large, irradiated, recurrent/composite defect')]): y=1.35+i*.95;box(s,.85,y,2.35,.64,T if i==2 else G,round=True);tx(s,a,1.02,y+.15,2,.24,14,W if i==2 else N,True,PP_ALIGN.CENTER);ln(s,3.25,y+.32,3.65,y+.32);tx(s,b,3.9,y+.12,6.4,.3,16) box(s,10.25,1.5,2,3.8,P,P,True);tx(s,'Keystone is\nnot “free tissue”',10.52,1.9,1.48,.7,18,N,True,PP_ALIGN.CENTER);tx(s,'Requires healthy adjacent donor field and preserved perforators.',10.52,3.05,1.45,1.05,15,T,True,PP_ALIGN.CENTER);foot(s,'Sabiston Textbook of Surgery, Soft Tissue Management: local rotation, V-Y and keystone options may be limited by scarring/radiation.') #7 s=slide('Why the posterior trunk suits perforator reconstruction','Abundant segmental perforators and broad tissue reservoirs',7);box(s,5.25,1.42,2.75,4.9,RGBColor(225,234,232),G,True);circ(s,5.95,1.05,1.3,RGBColor(225,234,232));ln(s,6.62,1.6,6.62,6.1,M,1) for y in [2.2,3,3.8,4.6,5.4]: ln(s,6.62,y,5.55,y-.32,O,2);ln(s,6.62,y,7.68,y-.32,O,2);circ(s,5.45,y-.4,.18,O);circ(s,7.6,y-.4,.18,O) tx(s,'Segmental dorsal perforators',.8,1.65,3.6,.3,19,T,True);bl(s,['Intercostal: upper/mid back','Lumbar: lower back','Thoracodorsal/circumflex scapular: lateral upper back','Paraspinal: medial back'],.85,2.15,3.7,3.2,17);tx(s,'Planning implications',8.6,1.65,3.3,.3,19,T,True);bl(s,['Doppler may guide design.','Avoid radiation, scar or donor area with sacrificed perforators.','Advance along the laxity vector; minimise midline tension.'],8.6,2.15,3.75,3.2,17);foot(s,'Behr et al. Reconstructive Options for Oncologic Posterior Trunk Defects. PMCID: PMC4782339.') #8 s=slide('Keystone perforator island flap: concept and design','Islanded fasciocutaneous advancement with paired V-Y closure',8);box(s,.85,1.45,5.35,4.8,W,G,True);tx(s,'Schematic marking',1.15,1.75,4.3,.28,18,N,True);box(s,2.75,3.2,1.5,.9,R,R,True);tx(s,'DEFECT',2.85,3.5,1.3,.2,13,W,True,PP_ALIGN.CENTER) for q in [(1.55,2.7,2.75,3.2),(1.55,4.6,2.75,4.1),(4.25,3.2,5.45,2.7),(4.25,4.1,5.45,4.6),(1.55,2.7,1.15,3.65),(1.15,3.65,1.55,4.6),(5.45,2.7,5.85,3.65),(5.85,3.65,5.45,4.6)]:ln(s,*q,T,4) tx(s,'Flap width approximates defect width; ends advance as V-Y closures.',1.15,5.35,4.8,.55,14,M,False,PP_ALIGN.CENTER);box(s,6.75,1.45,5.7,4.8,P,P,True);tx(s,'Mechanics',7.1,1.78,3,.3,19,T,True);bl(s,['Multiple small fascia-/musculocutaneous perforators supply the flap.','Selective deep fascial release increases mobility.','Blunt dissection protects perforators, veins and nerves.','Types I, IIa/IIb, III double keystone, IV rotational.'],7.1,2.3,4.8,3.25,16);foot(s,'Behan 2003, PMID: 12608972. Design requires an intact, well-perfused donor field.') #9 s=slide('Is a keystone flap appropriate?','Decision rule: tissue quality + perfusion + reach + tension',9) for x,h,c,ar in [(.85,'Favourable',T,['Moderate cutaneous/subcutaneous defect','Mobile adjacent skin','Perforators preserved in donor area','No major dead space','Low-tension closure after release']),(6.85,'Avoid or escalate',R,['Heavily irradiated, scarred or infected field','Large 3-D defect/exposed hardware','Need for bulk/dead-space fill','Donor perforators removed with tumour','Persistent closure tension'])]: box(s,x,1.45,5.5,4.95,W,G,True);box(s,x,1.45,5.5,.62,c,c,True);tx(s,h,x+.25,1.63,4.9,.24,18,W,True,PP_ALIGN.CENTER);bl(s,ar,x+.35,2.35,4.7,3.55,17) foot(s,'If perfusion, reach or tension is doubtful, escalate rather than forcing a local flap.') #10 s=slide('Operative sequence: WLE then keystone coverage','Posterior trunk workflow',10) ops=['Mark lesion, margin and flap in operative position.','Prepare wide field; anticipate bleeding.','Excise tumour en bloc to planned deep plane.','Orient specimen; send margins per pathology protocol.','Reassess defect, donor field and tension vector.','Elevate by blunt dissection, preserving perforators.','Advance centrally; close V-Y ends; inset without torsion.','Drain selectively and protect from pressure/shear.'] for i,z in enumerate(ops): x=.75+(i%2)*6.2;y=1.25+(i//2)*1.25;circ(s,x,y,.46,T,chr(65+i));tx(s,z,x+.68,y-.02,5.15,.55,16) foot(s,'This is an educational checklist, not a substitute for reconstructive training or local protocols.') #11 s=slide('Technical points that prevent failure','Perfusion, haemostasis, tension and dead space',11) for i,(h,b) in enumerate([('Haemostasis','Deliberate bipolar control and ligation. Avoid thermal injury at flap edge.'),('Perfusion','Blunt dissection, no routine skeletonisation. Check colour/refill/edge bleeding.'),('Tension','Release appropriately. If blanching or forceful closure persists, change plan.'),('Dead space','Anchor/quilting and use selective closed suction drainage. Add vascularised bulk if needed.'),('Margins','Never reduce oncologic resection to save skin. Record and discuss close/positive margins.')]): y=1.25+i*.98;box(s,.75,y,.16,.62,O,O,True);tx(s,h,1.15,y,2.1,.25,17,N,True);tx(s,b,3.05,y,9,.56,15) foot(s,'Final decisions must reflect pathology, anatomy and the individual patient.') #12 s=slide('Postoperative management and surveillance','Wound healing supports, but does not replace, oncologic care',12) for i,(h,ar,c) in enumerate([('First 72 h',['Flap colour, temperature, refill','Avoid pressure and shear','Positioning, analgesia, mobilise'],T),('Pathology review',['Margins, grade, size, depth','Re-excision discussion if positive','Document MDT recommendation'],O),('MDT and surveillance',['Adjuvant therapy by final histology','Clinical + indicated imaging','Teach recurrence/wound warning signs'],R)]): x=.7+i*4.18;box(s,x,1.48,3.7,4.85,W,G,True);box(s,x,1.48,3.7,.63,c,c,True);tx(s,h,x+.22,1.66,3.25,.25,16,W,True,PP_ALIGN.CENTER);bl(s,ar,x+.3,2.48,3.06,3.3,15) foot(s,'Angiosarcoma has significant local recurrence risk. Specialist MDT follow-up is required.') #13 s=slide('Evidence snapshot: keystone flaps','Useful evidence, with limits',13) for x,c,top,big,bot in [(.75,N,'Systematic review','98%','overall flap success'),(4.85,P,'Trunk review','54','flaps in 8 studies'),(8.95,RGBColor(252,237,224),'Trunk complications','35.2%','reported overall rate')]: box(s,x,1.38,3.65,4.9,c,c,True);cc=W if x==.75 else (T if x==4.85 else R);tx(s,top,x+.35,1.85,2.95,.45,20,cc,True,PP_ALIGN.CENTER);tx(s,big,x+.5,3.05,2.65,.72,42,A if x==.75 else cc,True,PP_ALIGN.CENTER);tx(s,bot,x+.35,3.92,2.95,.7,15,W if x==.75 else X,False,PP_ALIGN.CENTER) foot(s,'Weinberg et al. 2022, PMID 35477115. Trunk KDPIF systematic review, PMCID PMC7700866. Retrospective, heterogeneous studies.') #14 s=slide('Complications: recognise early, respond proportionately','Wound issue or oncologic issue?',14) for i,(h,b) in enumerate([('Haematoma/bleeding','Evacuate if compromising flap; correct source/coagulopathy.'),('Venous congestion','Release pressure; assess twist/haematoma; return early if progressive.'),('Edge necrosis/delayed healing','Dress, debride when demarcated; graft/revise if necessary.'),('Infection/dehiscence','Culture when appropriate, antibiotics and source control; reassess tension/dead space.'),('Positive margin/recurrence','Return to MDT. This is not a wound problem alone.')]): y=1.25+i*.98;circ(s,.8,y,.38,R,'!');tx(s,h,1.42,y-.01,2.55,.25,17,N,True);tx(s,b,4.15,y-.02,7.85,.46,15) foot(s,'In trunk KDPIF review, common events were infection, dehiscence and delayed healing; partial loss was uncommon.') #15 s=slide('Case presentation template','Replace all placeholders with actual case data',15) for i,(h,b) in enumerate([('Patient/lesion','History, symptoms, prior radiation/lymphoedema, clinical dimensions, photos.'),('Investigations','Biopsy/IHC, MRI local extent, staging, vascular imaging if indicated.'),('MDT decision','Histology/grade, margin plan, adjuvant treatment, reconstruction plan.'),('Operation','Position, resection dimensions/deep plane, blood loss, flap dimensions/drain.'),('Outcome','Final margins/pathology, wound status, healing time, adjuvant therapy, follow-up.')]): x=.8+(i%2)*6.1;y=1.3+(i//2)*1.65;box(s,x,y,5.55,1.18,W,G,True);tx(s,h,x+.25,y+.17,1.85,.24,16,T,True);tx(s,b,x+2.05,y+.14,3.13,.72,13) foot(s,'Obtain consent for identifiable images. State follow-up duration and limitations transparently.') #16 s=slide('MDT prompts and take-home messages','Margin-first reconstruction',16);bl(s,['Is the diagnosis representative of the most aggressive area?','Which deep plane must be resected, and what margin is appropriate for this histology?','Will the resection sacrifice donor perforators or make a keystone flap unsafe?','How does planned radiotherapy affect flap choice and timing?','What is the salvage plan if margins expand the defect?'],.75,1.3,5.65,4.5,18);box(s,7.15,1.3,5.15,4.8,P,P,True);tx(s,'Take-home',7.55,1.72,4.3,.35,21,T,True,PP_ALIGN.CENTER);tx(s,'1. Establish diagnosis first.\n2. Plan biopsy, WLE and cover together.\n3. Keystone flaps work when adjacent tissue and perforators are reliable.\n4. Never compromise clearance to achieve a local closure.',7.62,2.45,4.2,2.7,18,N,True);foot(s,'The final operation is patient-specific and must be driven by pathology, imaging, local tissue quality and MDT judgement.') #17 refs s=slide('Selected references','Primary resources for discussion',17);bl(s,['Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73:112-120. PMID: 12608972.','Weinberg M, et al. Outcomes of the Keystone Island Perforator Flap: A Systematic Review. J Reconstr Microsurg. 2022. PMID: 35477115.','A systematic review of KDPIF in trunk defects. PMCID: PMC7700866.','Behr B, et al. Reconstructive Options for Oncologic Posterior Trunk Defects: A Review. Front Oncol. 2016;6:51. PMCID: PMC4782339.','Sabiston Textbook of Surgery. Angiosarcoma; Soft Tissue Management sections.','Patel AB, et al. Survival Outcomes in Cutaneous Angiosarcoma: A Meta Analysis. Dermatol Surg. 2026. PMID: 40961959.'],.8,1.35,11.6,4.8,16);tx(s,'Evidence caveat: angiosarcoma and keystone-flap evidence is predominantly retrospective and heterogeneous. Use disease-specific guidelines and specialist MDT policy for care.',.85,6.15,11.4,.46,14,R,True);foot(s,'Prepared as an educational conference deck. No patient-specific recommendation is implied.') prs.save(out);print(out) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/back-vascular-tumour-conference/output/Back_Vascular_Tumour_WLE_Keystone_Flap_Conference.pptx') assert p.exists() and p.stat().st_size > 10000 prs=Presentation(p) print('slides',len(prs.slides),'bytes',p.stat().st_size) for i,s in enumerate(prs.slides,1): texts=[sh.text.strip().replace('\n',' / ') for sh in s.shapes if getattr(sh,'has_text_frame',False) and sh.text.strip()] print(i, texts[0][:80] if texts else '[no text]') PY