Case Reports in Plastic Surgery and Hand Surgery最新文献

Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication of antiresorptive therapy that may require free tissue reconstruction. A 57-year-old woman with metastatic breast cancer developed refractory mandibular MRONJ after intravenous zoledronic acid and underwent reconstruction with a medial femoral condylar (MFC) free flap. She recovered without complications and maintained normal function at two-year follow-up. This case supports the MFC free flap as a viable option for small, partial-thickness mandibular defects in selected patients with MRONJ.

Cross-toe flaps are traditionally harvested from the second toe to reconstruct great toe defects. We present a novel approach using the great toe pulp to reconstruct a second toe dorsal defect, providing durable coverage while preserving toe length and aesthetics. A 19-year-old female sustained full-thickness soft tissue and extensor tendon loss over the right second toe following a road traffic accident. After initial debridement, definitive reconstruction was performed using a cross-toe flap from the lateral plantar pulp of the great toe. The flap was designed elliptically based on the plantar digital neurovascular bundle. A medial incision was made, and dissection proceeded to just above the periosteum, preserving a thin layer of soft tissue over bone. The flap was elevated laterally and dorsally to the extent required for a tension-free inset over the second toe defect. Flap division was performed ten weeks after the index reconstructive surgery. The flap demonstrated excellent perfusion post-inset and remained neurovascularly intact after division. The second toe was salvaged with good aesthetic and functional outcomes while avoiding disarticulation, and the great toe donor site healed without complication. To the authors' knowledge, this is the first reported case of a cross-toe flap harvested from the great toe for reconstruction of the second toe, providing a viable option for distal toe salvage in selected patients seeking optimal aesthetic and functional outcomes.

Advanced lymphoedema and morbid obesity complicate soft-tissue reconstruction following open fractures. A 43-year-old woman with a Gustilo-Anderson IIIb ankle fracture underwent suction-assisted liposuction to reduce limb volume and improve tissue compliance, enabling tension-free rotational flap coverage. Healing was uncomplicated, with fracture union and functional recovery.

Breast augmentation is among the most frequently performed aesthetic procedures worldwide. Although postoperative infections are uncommon, breast implant-associated infections can be severe and challenging to treat. Nipple piercings, increasingly popular among young women, are a recognized source of local infection, yet their implications in patients with implants remains poorly characterized. This report describes a case of breast infection following nipple piercing in a woman with breast implants and to review the relevant literature. A 23-year-old woman with a history of subpectoral breast augmentation underwent bilateral nipple piercing and subsequently developed rapidly progressive left breast pain, erythema and purulent drainage. Ultrasound revealed a multiloculated abscess. Aspiration cultures grew Streptococcus pyogenes, while intraoperative cultures from both implant pockets were sterile. Despite the absence of direct pocket involvement, her clinical deterioration warranted urgent abscess drainage and bilateral explantation, after which she recovered fully on antibiotic therapy. A targeted literature review identified four published cases of breast or chest implant infections associated with nipple piercing. Reported infections occurred 2-50 weeks after piercing and most involved Staphylococcus or Streptococcus species. Management ranged from antibiotics alone to explantation, though follow-up in most reports was limited. Breast infections following nipple piercing in augmented patients are rare but potentially severe. Significant soft-tissue infections may necessitate explantation, even when pockets appear uninvolved. Patients considering nipple piercing after augmentation should be counseled about these risks, and further systematic reporting is needed to guide prevention and treatment strategies.

Peri-prosthetic late hematoma following breast implant procedure is defined as a hematoma presenting longer than 6 months after operation and is a rare complication with sporadic cases reported throughout literature. We present a case of an 85-year-old patient who developed a spontaneous late hematoma nearly 20 years following implant-based breast reconstruction and adjuvant chemotherapy to illustrate the importance of maintaining a wide differential when approaching a chest wall mass that cannot be biopsied in a patient who has previously received breast implants. MRI revealed a peri-implant effusion with a heterogeneous mixed signal partially enhancing mass measuring 3.2 x 4.3 x 1.7 cm, posterior to the left breast implant. The patient had bilateral Mentor smooth, round, silicone, 350 cc implants in the submuscular plane. Ultrasound-guided biopsy was attempted and unsuccessful due to inability to displace the implant and access the mass, indicating the need for an open biopsy. The patient underwent radical left chest wall mass excision of the posterior implant capsule, removal of the left implant, and closure of the anterior capsule. Final pathology confirmed the diagnosis of organized hematoma. Immunophenotyping flow cytometry was utilized to rule out BIA-ALCL or BIA-SCC. Our case is unique in that biopsy was unable to be obtained given retro-implant position of the mass and that the diagnosis and etiology of late hematoma formation following smooth round silicone implants has been infrequently discussed in literature. Providing a comprehensive workup considering patient history, physical exam findings, imaging, and pathology ensures a wide differential optimizing patient outcomes.

To reconstruct finger extension in distal-type cervical spondylotic amyotrophy, wrist flexor tendons are commonly selected as the donor tendons. However, distal-type cervical spondylotic amyotrophy predominantly affects the C8 myotome, and therefore the wrist flexor muscles may also be impaired. The brachioradialis is mainly innervated by the C6 and is therefore less likely to be affected, it represents a favorable option as a donor tendon. However, there are few reports describing the use of the brachioradialis as a donor tendon. A 72-year-old man presented with limited active extension of his left ring and small fingers and thumb. Posterior cervical decompression was performed for cervical spondylotic amyotrophy (C8 segment involvement); however, at 12 months postoperatively, thumb and finger extension remained impaired. Instead of a wrist flexor transfer, we performed a brachioradialis tendon transfer to the extensor pollicis longus and extensor digitorum communis tendons. At 2 - year postoperative final follow-up, the extension lags of the 4^th and 5^th metacarpophalangeal joints and thumb had improved. His Disabilities of the Arm, Shoulder, and Hand score improved from 30 to 11.6 postoperatively. In finger and thumb extensor paralysis owing to distal cervical spondylotic amyotrophy, the brachioradialis muscle is typically spared and can be considered a donor for tendon transfer. This procedure, combined with extensive release of the fascial attachments, effectively improved dysfunction of finger and thumb extension without resulting in significant functional loss.

Background: Lipomas are common benign tumors, but giant bicompartmental bilobed lipomas in the hand are rare and pose unique diagnostic and surgical challenges due to the hand's complex anatomy and the proximity of neurovascular structures.

Case presentation: We report the case of a 67-year-old woman with a slowly enlarging, painless mass in her left hand, located between the second and third metacarpals, with both dorsal and volar extensions. Physical examination revealed a firm, well-defined lesion measuring approximately 5 cm in length, associated with mild paresthesia and decreased range of motion. Magnetic Resonance Imaging (MRI) confirmed a well-encapsulated, hyperintense mass consistent with a benign lipoma, exhibiting bicompartmental extension without signs of malignancy.

A dual approach was employed for complete excision: an S-shaped dorsal incision followed by a volar zigzag incision. Intraoperatively, the lesion demonstrated a bilobed hourglass shape crossing through a constriction ring formed by surrounding anatomical structures. Meticulous dissection enabled safe en bloc removal while preserving the extensor tendons and common digital nerves.

The postoperative course was uneventful. The patient resumed active motion two weeks postoperatively, with full recovery of hand function and no recurrence at 6-month follow-up. Histopathological examination confirmed a spindle cell lipoma with no malignant features.

Conclusion: This case highlights the importance of preoperative imaging, surgical planning, and a dual dorsal-volar approach for managing complex lipomas of the hand. Tailoring the surgical strategy to the lesion's anatomy allows complete excision while minimizing the risk to vital structures and optimizing both functional and cosmetic outcomes.

Reconstruction of the distal radius after en bloc bone tumor resection is challenging. Among various surgical reconstruction methods, ulnar translocation is a simple approach that does not require vascular anastomosis, autograft harvesting, or prosthesis preparation. This report describes the 7-year follow-up of a patient who underwent reconstruction with ulnar translocation following resection of a recurrent giant cell tumor of the bone. A 57-year-old woman was diagnosed with multiple recurrent giant cell tumor of the bone involving the distal radius. The patient underwent en bloc resection of the tumor with osteotomy of the distal radius 5 cm proximal to the wrist joint through a dorsal incision. The distal ulna was osteotomized at the same level and translocated with preservation of the vascularity of the posterior interosseous artery. Then, the translocated ulna was fixed to the carpal bone and distal radius and aligned in the mid-supination and pronation positions; fixation at 10° of wrist dorsiflexion was performed using locking plates. Bone union between the metacarpal bone, grafted bone and proximal radius was achieved at 9 months postoperatively. At the 1-year follow-up examination, the range of motion of the wrist was 90°/65° (supination/pronation), and the grip strength was 9.1 kg. At the final follow-up examination (7 years postoperatively), the range of motion of the wrist was 90°/90° (supination/pronation) and the grip strength was 19 kg (20 kg on the lateral side). The patient's QuickDASH and Hand 20 scores were 25 and 43, respectively, indicating minor difficulties in daily activities. Ulnar translocation is regarded as a practical alternative to more complex reconstructive procedures for the distal radius following en bloc tumor resection. Its benefits include surgical simplicity, long-term durability, and preservation of forearm rotation.

Primary malignant melanoma of the umbilicus is extremely rare; evidence guiding optimal resection and reconstruction is limited. A 47-year-old man with primary umbilical melanoma underwent full-thickness abdominal wall resection including the peritoneum. The abdominal wall defect was reconstructed using an autologous fascia lata graft. Histopathology confirmed malignant melanoma with a tumor thickness of 18 mm (pT4bN1aM0, Stage IIIC). At 6-month follow-up, no local recurrence or incisional hernia was observed, and at one year after surgery, no evidence of herniation or recurrence was noted. Autologous fascia lata offers a practical option for abdominal wall reconstruction after extensive oncologic resection of the umbilical region, achieving early freedom from recurrence and hernia in this case.

Trapezoid dislocations are extremely uncommon injuries because of the strong intercarpal and carpometacarpal ligaments that provide greater stability to the trapezoid-metacarpal joint compared with the more ulnar carpometacarpal joints. We report a case of trapezoid dislocation, emphasizing the radiographic features essential for diagnosis and the fixation strategy used for management. A 50-year-old woman sustained a sliding fall while riding a scooter, resulting in a trapezoid dislocation from the carpometacarpal joint accompanied by a fracture at the base of the right third metacarpal. The injury was managed with retrograde intramedullary K-wire transfixation of the second metacarpal-trapezoid joint combined with a spanning plate across the thrid metacarpal-capitate joint. The spanning plate maintained the length of the third metacarpal relative to the capitate, thereby indirectly restoring the anatomical alignment of the second metacarpal and stabilizing the reduced trapezoid. The retrograde intramedullary K-wire was easily positioned so that its tip did not extend beyond the trapezoid, thus preventing potential irritation of surrounding vital structures that might result from an obliquely placed K-wire. The 'missing carpal sign' serves as an important radiographic clue suggestive of trapezoid dislocation. Given the strong surrounding interosseous ligaments, it is important to recognize the possible occurrence of trapezoid dislocation in association with fractures or dislocations involving structures adjacent to the trapezoid. We present a retrograde intramedullary K-wire fixation technique for stabilizing the trapezoid-metacarpal joint, which can be easily and effectively applied after anatomical reduction of the trapezoid.