Case Reports in Plastic Surgery and Hand Surgery最新文献

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous tumor predominantly affecting young to middle-aged adults, characterized by a slow-growing, indurated plaque or nodule. The diagnosis and treatment of DFSP can be challenging due to its rarity, growth pattern and variable clinical presentation. A 40-year-old male presented with a firm lump of 8 mm on his forehead for one year. It was initially suspected to be a benign lipoma or atheroma and removed accordingly by a private plastic surgeon. However, histopathological examination revealed dermatofibrosarcoma protuberans (DFSP) that was not radically removed, prompting referral for removal at our department. Here, he presented with a scar of 10 mm with no visible or palpable residual tumor. A planned excision of 20 mm and reconstruction with split thickness skin graft (STSG) was performed. Histopathology showed tumor activity at several margins, with perineural and periosteal invasion. MRI was inconclusive, and therefore PET-CT was added, which showed possible residual tumor. Re-excision including mapping biopsies was performed. Wide re-excision was performed three times to achieve clear surgical margins, yielding a tumor size of approximately 8x10 cm and a final defect measuring 10x12 cm. The defect was reconstructed with a dermal template (Integra^®) and STSG. Our case underscores the propensity of DFSP for significant subclinical extension, including potential perineural and periosteal invasion. Despite the aesthetically challenging location, a satisfactory cosmetic result was achieved, and there was no recurrence during the two-year follow-up.

Titanium miniplates, though biocompatible, often require removal due to infections (3-18%), primarily from Staphylococcus aureus. Biofilms, which resist antibiotics, drive persistent infections. We analyzed 10 infected miniplates via SEM, revealing dense polymicrobial biofilms, especially near screw holes. These structured microbial communities underscore the need for biofilm-targeted treatments to improve outcomes.

In postoperative scenarios, arterial embolisms, while not rare, can profoundly affect flap viability. This case study elucidates a distinctive occurrence of embolism a week after surgery, underscoring the importance of examining areas beyond anastomotic sites. Surgeons must scrutinize distal vessel segments for discoloration to ensure successful flap rescue.

A 42-year-old mother underwent a combined abdominal cosmetic procedure with fat grafting to the rectus muscle. Twenty-four days post-surgery, she developed a voluminous abdominal mass corresponding to cytosteatonecrosis. Ultrasound-guided fluid aspirations failed to treat her, and surgical drainage was necessary. The limits of combined procedures need to be discussed.

Wiskott-Aldrich Syndrome presents unique diagnostic and therapeutic challenges. Our case highlights a rare clinical complication associated with WAS and emphasizes the importance of prompt recognition and management. Dissemination of such rare presentations is crucial for enhancing clinical awareness and optimizing patient outcomes.

Surgical excision of glomuvenous malformation leads to high recurrence likely occurring because of incomplete resection. We utilized intraoperative laser-assisted ICG fluorescent dye angiography to visualize extent of glomuvenous malformation in a 19-year-old female during excision with no recurrence. Laser-assisted ICG fluorescent dye angiography could help in future glomuvenous malformation management.

Masson's tumor, or intravascular papillary endothelial hyperplasia (IPEH), is a rare benign vascular lesion that can mimic other soft-tissue tumors. We present a case of a 33-year-old woman with a painful digital mass. Excision confirmed IPEH. Literature review identified eight similar cases, highlighting its rarity and diagnostic challenge.

Introduction: Microwave ablation (MWA) utilizes electromagnetic methods to destroy tumors, employing devices operating at 900 MHz or above frequencies. MWA has emerged as a recent alternative for treating osteoid osteoma (OO), providing similar accessibility, safety, and technical effectiveness as radiofrequency ablation. This systematic review aims to evaluate the safety and efficacy of MWA in treating OO.

Methods: A systematic review of published studies on the use of MWA in managing OO was conducted. Studies were excluded if they were 1) not written in English, 2) case reports, 3) lacked adequate peer review, or 4) consisted solely of abstracts. Before full-text assessment, titles, and abstracts were screened. Extracted data included author, year, study design, patient count, age, gender, OO site, ablation power (watts), duration, complications, outcome, and recurrence. The data were analyzed and presented as means, frequencies, and percentages.

Results: Eight studies, including 143 cases, met the inclusion criteria; among these cases, 59.44% were male, and the mean age was 19.03 ± 7.09. Most of the OOs were in the femur, 54.54%. MWA at 60 W was the prevailing power setting, utilized in 37 cases (25.87%), with an ablation time of 90 s for 95 cases (66.43%). Clinical success was achieved in 137 (95.80%) cases, with recurrence observed in 4 cases (2.80%). However, 16 minor and major complications were observed despite the overall success.

Conclusion: Percutaneous MWA may represent an efficient choice for the minimally invasive management of OO, demonstrating a minimal risk of complications and recurrence.

Silicone lymphadenopathy and granuloma formation can result from breast implants. A 71-year-old presented with implant rupture 30 years after a breast augmentation, causing left-sided silicone lymphadenopathy and extensive migration to the breast parenchyma and skin. Management included a mastectomy, lymph node resection, implant removal with complete intact capsulectomy, and latissimus-dorsi-based reconstruction.

Metaplastic carcinoma of the breast (MBC) is an uncommon disease that accounts for 0.2-1% of all invasive breast carcinomas, comprising a heterogeneous group of diseases characterized by differentiation of the neoplastic epithelium to squamous cells and/or mesenchymal-looking elements. Breast implant-associated squamous cell carcinoma (BIA-SCC) is a rare complication of breast implantation, with 22 cases reported in the literature. Due to the histological overlap between MBC and BIA-SCC, the differential diagnosis may be challenging, especially in patients with an advanced cancer-bearing breast implant, in which assessing the tumor's primary site may be difficult. The limited amount of scientific data on BIA-SCC implies the absence of a standardized diagnostic method and of a specific staging system to guide patients' clinical management. Of the 22 BIA-SCC cases reported in the literature, 14 (64%) had squamous metaplasia of the inner surface of the capsule, whereas in 10 (45%), there was a histologically proven spread to the extracapsular tissues without a detailed description of the capsule infiltration. Herein, we describe the case of a peri-implant tumor mass with squamous histology in a patient treated with mastectomy and implant-based breast reconstruction for a microinvasive breast carcinoma, in which the absence of squamous metaplasia of the capsule and of its neoplastic infiltration favored a diagnosis of MBC likely originating from the peri-implant tissue. This case suggests that in patients with peri-implant cancers with squamous differentiation, the extension of the tumor throughout the capsule thickness and the presence of squamous metaplasia of the capsule are critical factors that should be considered in the differential diagnosis between BIA-SCC and MBC. In addition, even in cases with capsule-confined tumors, the depth of the capsular involvement can be used to stage the disease, similar to what is currently recommended for BIA-ALCL.