Case Reports in Plastic Surgery and Hand Surgery最新文献

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.

Areolar sebaceous hyperplasia (ASH), also known as Montgomery hyperplasia, is an uncommon benign neoplasm. Despite nearly 40 years since the first case was described, this condition remains rare, with only 20 reported cases. We present a case of ASH in a 44-year-old female and review the existing literature.

Sialolithiasis, or the formation of stones within the salivary glands, is a common cause of the submandibular gland's duct obstruction, which can lead to submandibular abscesses. We reported the case of a 56-year-old man with a submandibular abscess caused by sialolithiasis of the left submandibular gland. A 56-year-old male patient came with complaints of swelling and pain in the left submandibular area for one week. Patients also reported fever, dysphagia, and increased pain while eating. Physical examination showed diffuse swelling and redness in the left submandibular area. Head MSCT and panoramic radiography revealed the presence of stones in the duct of the left submandibular gland. The patient underwent surgical treatment for stone removal and abscess drainage. Postoperative follow-up showed significant improvement in the patient's condition without complications. If left untreated, sialolithiasis is a primary cause of blockage of the submandibular gland's duct, which can result in infections and abscesses. Prompt and appropriate treatment, including abscess drainage and stone removal, is essential to reduce morbidity. Early diagnosis through anamnesis, physical examination, and imaging are the keys to good outcomes. A submandibular abscess caused by sialolithiasis of the submandibular gland requires quick and appropriate treatment. Surgical treatment with abscess drainage and stone removal provides satisfactory results without complications.

Abdominal wall defects can present a challenge for reconstructive surgeons, especially in the presence of major visceral issues. Anterolateral thigh flaps (ALT) are widely used in complex abdominal wall repair, whether pedicled or free, innervated, or denervated. Previous reports primarily focus on reconstruction of the outer layers of the abdominal wall (muscle, fascia, and skin); however, this case highlights the potential of ALT flaps to address complications at the mucosa-skin interface, particularly stomal issues. This case report aims to demonstrate the versatility of the ALT flap at the mucosa-skin contact area, specifically to salvage a stenotic stoma following a Kock pouch (K-pouch) ileostomy. The patient developed multiple complications, including stomal retraction, stenosis, and leakage, which required innovative reconstructive techniques. Here, transposition of a fenestrated ultrathin pedicled ALT flap was used to reconstruct the abdominal wall while accommodating a retracted stoma in the middle of the skin paddle, restoring functional defecation. Initial postoperative complications, such as stomal leak and partial flap dehiscence, were managed with secondary flap adjustments, resulting in long-term successful outcomes. At the two year of follow-up, the stoma remained functional, with no recurrence of stenosis or skin irritation, and the donor site healed without morbidity [1].

A distal phalanx may fracture in an atypical shape after high-energy trauma. A 61-year-old man sustained an open fracture of the distal phalanx of his left thumb while using a power saw. The fracture occurred in the coronal plane and the volar bone fragment was dislocated under traction by the flexor pollicis longus tendon. The patient underwent surgery the day after the injury. A flexion block pin was inserted to reduce the volar bone fragment, and an external flexion force was applied using a dorsal splint to compress the dorsal bone fragment into the volar bone fragment. The pin was removed 6 weeks postoperatively, and active range of motion exercises were started 8 weeks postoperatively. Bone union was achieved with good alignment, and although the interphalangeal joint remained slightly restricted in range of motion, the patient returned to his previous job and was satisfied with the function of the left thumb.

Tuberculosis (TB) is a chronic granulomatous infection caused by Mycobacterium tuberculosis. TB primarily affects the lungs. A small percentage of cases are associated with extrapulmonary TB (EPTB). Of all EPTB, skeletal TB accounts for 1-5% of the cases, with the vertebrae being the most commonly affected. Involvement of the hands usually occurs in children under the age of six, with the bones of the proximal phalanx of the middle and index fingers being the most reported sites of infection. We describe a case of disseminated TB presenting as swelling in the index finger. Due to its nonspecific symptoms and insidious course, this condition is frequently overlooked. The presented case is unique compared to other documented TB cases as the child did not undergone Bacillus Calmette-Guérin (BCG) vaccination, a factor that might have contributed to the disease progression. Additionally, traditional cauterization was noted in the patient's history, a practice that could complicate the diagnosis. Physicians should consider TB osteomyelitis when encountering young patients with finger swelling, particularly in endemic areas. Prompt recognition and diagnosis of TB osteomyelitis are crucial for early intervention and better outcomes.

Background: Epigastric tissue abundancy after abdominoplasty or liposuction is a complicated scenario that requires a precise and targeted approach. Especially when concurrent mammoplasty is planned or has already been done by the patient, a surgical operation through a submammary skin incision can solve this problem.

Aim: To showcase our personal experience regarding reverse abdominoplasty and compare it to the state of the art.

Methods: To identify indications, possible complications and outcomes, detailed surgical insights as well as graphical examples are provided. In addition, our personal experience from the last four years is showcased and compared with the literature using PubMed and Cochrane Library databases with Reverse AND Abdominoplasty as search strings.

Results: All the 12 patients operated in our facilities between 2020 and 2024 had either a pre-existing submammary scar or a plan to undergo a contestual mammoplasty; at a mean of 25,1 weeks follow up, one major complication occurred.

Discussion: There is a lack of publications on reverse abdominoplasty. Small case series are available in the literature, most of which focus on aesthetic indications. Only a few cases address the reconstructive implications of this surgical technique. In our experience, the concomitant desire or necessity of a mammoplasty and an already present inframammary scar favor the surgery. Careful recreation of a new inframammary sulcus must be considered to avoid unpleasant complications.

Conclusions: Despite the poor literature supporting this technique, reverse abdominoplasty is a must-known procedure for successfully addressing thorny abdominal wall conditions and is characterized by consistent, replicable and safe outcomes.

Flexor tendon lacerations require precise surgical repair, often using Mitek suture anchors. This report describes a recurrent infection 10 years post-FDP repair, caused by anchor migration and inflammation. Anchor removal was necessary to prevent further complications, highlighting potential long-term risks.

Carpal tunnel release surgery is a common and relatively safe surgical procedure; however, rare complications such as pseudoaneurysms can occur. Treatment of palmar pseudoaneurysms typically includes endovascular embolization or open ligation. We present a case of open surgical excision and repair of a pseudoaneurysm of the superficial palmar arch following carpal tunnel release surgery. This case study demonstrates how common surgical procedures can yield serious complications, thus highlighting the importance of thorough evaluations in pre-and post-operative care.

Werner syndrome is a rare autosomal recessive disorder caused by WRN gene mutations, leading to premature aging and genomic instability. Clinical symptoms include diabetes, skin lesions, and microvascular issues, with patients frequently developing difficult-to-heal ulcers on the distal legs, feet, and elbows. Surgical treatments, such as flap surgery, are rarely reported. We present the case of a 45-year-old male with Werner syndrome who developed refractory ulcers on both elbows. Despite conservative treatments, the ulcers persisted, leading to successful radial forearm pedicle flap surgeries. Postoperative results were favorable, with no complications, ulcer recurrence, or infections over a 16-year follow-up period. The patient maintained a full range of motion in both elbows. This case highlights the challenges of managing ulcers in Werner syndrome and the successful long-term outcomes of flap surgery, providing valuable insights into this rare condition's treatment.