Case Reports in Plastic Surgery and Hand Surgery最新文献

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent abscesses, sinus tract formation and extensive scarring. In severe cases, surgical excision and complex reconstruction are often required. This case report aims to highlight the role of modern plastic surgical techniques, including regenerative technologies, in managing severe HS. A 37-year-old Hispanic male with a 17-year history of HS presented with extensive lesions involving the buttocks, groin, genitalia, thighs and perianal region. He underwent staged wide excisions totaling over 2,400 cm². Reconstruction included split-thickness skin grafts (STSG), NovoSorb^® BTM (Biodegradable Temporizing Matrix) and RECELL^® autologous skin cell suspension. Postoperative recovery was marked by successful graft take, wound healing and return to normal function, including physical activity and sexual function, by postoperative day 69. This case underscores both the complexity of managing stage III HS and the evolving role of regenerative technologies in improving outcomes. While wide local excision remains the cornerstone of treatment for extensive disease, adjunctive use of BTM and RECELL enhances dermal regeneration, reduces donor-site morbidity and optimizes aesthetic and functional results. These innovations reflect a shift in reconstructive strategy, emphasizing a more tailored, patient-centered approach. The integration of regenerative modalities such as Biodegradable Temporizing Matrix (BTM) and RECELL autologous cell suspension technology into contemporary plastic surgical reconstruction offers significant benefits in treating severe hidradenitis suppurativa. By complementing traditional excisional techniques, these technologies contribute to improved healing, minimized morbidity and restored function, aligning with the goals of modern, multidisciplinary HS management.

The allograft for humeral reconstruction is a widely used technique in oncology but complication rates are high and Free Vascularized Fibula Graft (FVFG) represents a "strategic" solution to preserve satisfactory upper limb function. We treated 3 cancer patients with allograft failures and FVFG was used to reconstruct complex humeral defects.

Introduction: Necrotizing soft tissue infections (NSTIs) are characterized by rapidly spreading, life-threatening infections with widespread soft tissue necrosis that most commonly infect the extremities, torso, and perineum. Although rare, NSTIs of the head and neck are particularly dangerous given the complex anatomy surrounding the region and demand early diagnosis, antibiotic administration, and surgical debridement.

Case presentation: We report a case of a 64-year-old male who presented with a NSTI of the scalp and face after sustaining a laceration to the posterior scalp. The patient initially presented at his local emergency department with subtle and nonspecific clinical signs and unrevealing imaging, which represented a diagnostic challenge for early intervention. Upon presentation to our facility's emergency department three days later, the patient had already started to develop severe sepsis and systemic involvement. As a result, despite intensive supportive care and surgical debridement, the patient's clinical course was complicated by multisystem organ failure and death.

Discussion: Our case highlights the importance of maintaining a high clinical index of suspicion for NSTIs in patients with soft tissue infections of the head and neck, even when hallmark features are absent. Timeliness to intervention remains the single most important factor in determining survival.

Soft tissue reconstruction around the elbow is challenging due to the need for durable yet pliable coverage that preserves joint mobility and function. We present the case of a 56-year-old gentleman with a chronic elbow wound secondary to osteomyelitis. Following debridement, the defect was reconstructed using a posterior ulnar recurrent artery perforator (PURAP) flap designed in a propeller style. Unlike previous reports that have described PURAP flaps based on arm perforators, this case uniquely utilised perforators arising from the forearm. This forearm-based approach offers several advantages, including reduced donor-site morbidity, and avoidance of dissection near the ulnar nerve. This case highlights the versatility and safety of the forearm-based PURAP flap for elbow reconstruction. Level of evidence: Level 5.

A fifteen-year-old with infratemporal myxoid solitary fibrous tumor underwent en bloc parotid-infratemporal-extradural skull-base resection. Her zygoma was reconstructed using 3D-planned cadaveric fibula allograft and custom plate. At 6 months she maintained facial symmetry and function. Her case demonstrates digital planning, cadaveric bone, and microsurgical adaptability.

Reconstruction of the calcaneal region presents unique challenges due to its complex anatomy and critical weight-bearing function. This retrospective study aims to report our experience in cases of calcaneal defects repaired with various free flap types, and to evaluate the long-term outcomes of the reconstructions. We retrospectively reviewed 25 patients who underwent microsurgical free flap reconstruction for calcaneal defects between January 1997 and March 2022. Demographics, defect characteristics, surgical techniques, and outcomes were analyzed. Out of the 25 cases, 18 patients (72%) were male, with a median age of 55 years. Successful reconstructions were achieved in 24 patients (96%) using various free flap types: ALT flap (8cases), Parascapular flap (4 cases), Gracilis flap (5 cases), TAP flap (5 cases), Radial forearm flap (2 cases), and in one case, deep circumflex iliac artery (DCIA) osteocutaneous flap. These reconstructions demonstrated good functional recovery and minimal complications. Only one case (4%) experienced flap failure due to venous thrombosis, necessitating revision surgery without success. The most frequent complication was the sliding (6 cases) due to the excessive bulk which was addressed with revision surgery. The average follow-up period was 8 months, with patients regaining satisfactory ambulation and improved quality of life. Based on our results, microsurgical free flap reconstruction has proven to be a valuable technique for addressing calcaneal defects and, according to many Authors, it offers a high success rate and favorable long-term outcomes. In selected cases, revision surgery may be necessary to address bulk-related issues.

We describe a singular case in which the patient underwent wide surgical excision of the primary lesion (Pleomorphic Dermal Sarcoma) and reconstruction with a skin graft. After seventy-five days, total clinical and radiological regression of the ipsilateral parotid and neck localizations was observed without the need for adjuvant therapy.

Intraoperative use of urokinase is a recognized method for salvaging compromised free flaps. However, protocols for dosage and administration vary, and no consensus exists regarding the optimal technique. Herein, we report a case of postoperative venous thrombosis in a free fibular flap. Despite the unsuccessful intra-arterial administration of urokinase owing to an extensive venous thrombus, we attempted to dissolve the thrombus through direct intravenous infusion using a 27 G needle at multiple sites in the vein where the thrombus had formed. Ten minutes after direct injection into the venous thrombus, venous blood flowed out and successful thrombolysis was achieved. Re-anastomosis was performed, leading to full use of the skin flap without partial necrosis. No hemorrhagic complications were observed. Intra-arterial injection of urokinase is an effective method of thrombolytic therapy for flap salvage. However, when the vein is completely occluded by thrombus, intraflap circulation of the agent via arterial infusion becomes difficult. Direct injection of urokinase into the occluded vein may serve as a potential method for resolving venous obstruction within the limited ischemic time of the flap.

Facial aging causes skin laxity, volume loss, and wrinkles. This study examines the effects of combining Polydioxanone (PDO) thread lifts and Botulinum Toxin A for non-surgical facial rejuvenation in 10 patients. After four months, 90% reported improved skin texture and brightness. Mild, transient swelling occurred, with no major complications.

Although less commonly in the hand, gouty tenosynovitis may present with symptoms resembling infection. Only a few case reports document such presentations, and reports of coexisting infection and gouty tenosynovitis are even more uncommon. A 32-year-old male with polyarticular tophaceous gout, noncompliant with medications, presented with a one-day history of right index finger swelling and redness. Investigations were suggestive of infectiousious tophus. Despite broad-spectrum antibiotics and rheumatologic interventions (colchicine, allopurinol, and corticosteroids), his condition deteriorated. Multiple incisions and drainages were performed without improvement. Persistent infection, confirmed to be methicillin-resistant Staphylococcus aureus (MRSA), complicated the underlying gouty inflammation. Standard therapies for infective tenosynovitis did not yield clinical resolution, presumably due to ongoing crystal-induced inflammation and compromised tissue. Ultimately, finger amputation was performed to control disease progression after all other salvage options failed. This case underscores the aggressive and destructive potential of gout when complicated by infection. Normal or relatively low serum uric acid levels do not exclude gout, and synovial fluid crystal analysis can be pivotal. Coexisting infection and gouty tenosynovitis in the hand can lead to severe tissue damage if misdiagnosed or inadequately treated. A high index of suspicion, multidisciplinary collaboration, and timely surgical intervention are crucial in preventing further morbidity. This case demonstrates that amputation may be necessary when infection remains unresponsive to standard treatments, emphasizing the importance of early diagnosis and aggressive management.