Plastic Surgery Case Studies最新文献

{"title":"The Gluteal Thigh Flap in Hidradenitis Suppurativa Groin Reconstruction: A Case Report","authors":"Raghad A. Alhuzaim, Salma Alajmi, F. Ashkanani, Mahmoud A. Abdullatif","doi":"10.1177/2513826x211055698","DOIUrl":"https://doi.org/10.1177/2513826x211055698","url":null,"abstract":"Different methods have been reported to reconstruct groin defects brought about by hidradenitis suppurativa (HS); however, it has been challenging to achieve favourable outcomes that serve both cosmetic and functional purposes. In this report, we present a case of a groin HS defect that was reconstructed using a combination of abdominal flap and gluteal thigh flap (GTF). A 47-year-old female patient underwent extensive excision of the infra-umbilical abdominal and bilateral groin HS, resulting in a defect that was reconstructed using a combination of abdominoplasty, skin grafts, and bilateral GTFs. The use of the GTF in this reconstruction has achieved beneficial outcomes.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124991699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duplication of the Extensor Pollicis Longus and Index Extensor Digitorum Communis: Report of a Novel Anomaly and Review of Literature","authors":"B. Qin, D. Chiu, C. Melone","doi":"10.1177/2513826x211047903","DOIUrl":"https://doi.org/10.1177/2513826x211047903","url":null,"abstract":"Accessory extensor tendons in the hand are not rare, usually asymptomatic, and recognized incidentally during elective surgery or cadaveric dissection. This report describes a novel case of symptomatic duplication of accessory extensor tendons to both the thumb and the index finger causing a painful dorsal wrist tenosynovitis. Excision of the accessory tendons with decompression and tenosynovectomy of the fourth extensor compartment alleviated the patient’s symptoms without compromising motion or function.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128050935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Divide or Not to Divide? A Case Report Using Near-Infrared Spectroscopy to Assist With Decision Making on Timing of Division of Forehead Flaps","authors":"S. Yakaback, C. Webb, C. Temple-Oberle","doi":"10.1177/2513826x211051107","DOIUrl":"https://doi.org/10.1177/2513826x211051107","url":null,"abstract":"Paramedian forehead flaps (PMFFs) are commonly performed procedures for the reconstruction of complex nasal defects and require multiple stages predicated on when the interpolated pedicle is no longer required to provide perfusion to the neo-nose. As the presence of the pedicle is disfiguring, the flap is therefore divided ideally as soon as safely possible, but that determination is challenging. Recently, a novel device that uses near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation has been developed and may provide an accurate and cost-effective tool to assess tissue perfusion. Here we present the use of this technology in the management of 2 patients who underwent successful oncologic nasal reconstructions using PMFFs. Using the device as a clinical adjunct, we measured tissue oxygen saturation values in the flaps before and after pedicle division, which assisted us in deciding when to safely divide the flaps, as well as with post-division management, particularly when a low tissue oxygen saturation reading ultimately necessitated the use of nitroglycerine past to improve flap perfusion in one of our patients. Interestingly, the values we recorded corresponded well to previously published cut-off values for adequate tissue perfusion, which have to date only been reported for free flaps. To our knowledge, this is the first description of the use of NIRS in the division of PMFFs, which we overall found to be a useful and reliable adjunct to a clinical examination in assessing flap neovascularization.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115487827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digit Necrosis After Hand Surgery in Pregnancy: A Case Report","authors":"N. Ziolkowski, J. Dengler, C. Goldberg","doi":"10.1177/2513826x211027015","DOIUrl":"https://doi.org/10.1177/2513826x211027015","url":null,"abstract":"Digital blocks are routinely used for excision of lesions. We describe a unique presentation of digit necrosis after excisional biopsy with digital block and finger tourniquet in a pregnant patient with a history of ulcerative colitis. The patient had a history of a long-standing painful dorsal PIP joint mass and was scheduled for excision under local anaesthetic. On the day of the procedure, she disclosed that she was pregnant in the second trimester. After extensive discussion of risks and benefits between the patient and the surgeon, the decision was made to proceed with an excisional biopsy of the lesion because of its impact on her quality of life. Twelve hours after the procedure, she presented to the emergency department with blistering and severe pain to the digit. Doppler ultrasound showed flow through both digital arteries and the digit appeared viable. Over the coming days her pain continued to worsen and on post-operative day 3, she was admitted to hospital for attempted salvage of the digit using conservative methods. Her digit went on to demarcate at the level of the middle phalanx. Five weeks after her initial procedure, the patient underwent partial amputation of the small finger at the level of the DIP joint and 2-stage groin flap for soft tissue coverage. We discuss the effects of pregnancy and ulcerative colitis on thromboembolic events, and review the literature on digital blocks, digital tourniquet use and management of early digit necrosis. This case highlights the importance of delaying elective hand procedures in pregnant patients, especially if they have additional comorbidities such as pro-thrombotic diseases like inflammatory bowel disease.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123588763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polyurethane-Coated Implants for Prevention of Double-Bubble Effect in Breast Augmentation","authors":"V. Bagirov","doi":"10.1177/2513826x211028926","DOIUrl":"https://doi.org/10.1177/2513826x211028926","url":null,"abstract":"Breast augmentation is the most frequently performed cosmetic surgery in the United States, with approximately 279,000 patients every year. The so-called double-bubble effect (DBE) is a common complication in breast augmentation. This complication is characterized by folds running along the lower pole of the breast, forming distinct bubble-like protrusions above and below the fold. Factors that increase the risk of DBE include bulbous breasts and a large native breast volume. There is evidence that polyurethane-coated (PU) implants may help to reduce the risk of DBE. We describe here the case of a 47-year old patient for whom DBE has recurred in each of 4 tandem breast surgeries. PU implants ultimately appeared to prevent the DBE, leading to an aesthetically satisfying treatment result for the patient. This case adds weigh to the growing body of evidence that supports the use of polyurethane implants to prevent DBE.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133724926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractory Donor-Site Seroma Following DIEP Breast Reconstruction","authors":"Trina V Stephens, N. Van Laeken, S. Macadam","doi":"10.1177/2513826X19898831","DOIUrl":"https://doi.org/10.1177/2513826X19898831","url":null,"abstract":"Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122290687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilomatrix Carcinoma in a Patient With Type 1 Myotonic Dystrophy: A Case Report","authors":"Sarah L. Zhu, David L. Choi, J. Santos, B. Jackson, Matthew C. McRae","doi":"10.1177/2513826X19898833","DOIUrl":"https://doi.org/10.1177/2513826X19898833","url":null,"abstract":"This is the first report of pilomatrix carcinoma in a man with C282Y myotonic dystrophy type 1. This pilomatrix carcinoma had originally presented as a rapidly growing recurrence of a histopathologically confirmed pilomatrixoma, removed a year prior. On examination, the fungating mass had measured 10 × 23 cm. A wide local resection with removal of suspicious lymph nodes was preformed, and the resulting defect was reconstructed with a latissimus dorsi myocutaneous flap and skin graft. Histologic investigation of the excised mass confirmed the diagnosis of pilomatrix carcinoma. This is the first reported case of pilomatrix carcinoma in a patient with a genetic condition that often presents with scalp pilomatrixomas. Potential implications of myotonic dystrophy on developing pilomatrix carcinoma are discussed.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124632425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reverse Sural Flap for Repair of Foot and Ankle Defects: Our Cases, Modifications, and a Literature Review","authors":"R. Anlatıcı","doi":"10.1177/2513826X20947981","DOIUrl":"https://doi.org/10.1177/2513826X20947981","url":null,"abstract":"Introduction: Reverse-flow sural flap is a valuable option in cases of lower extremity repair. In this study, we aimed to present our sural flap applications and modifications for the treatment of ankle and foot defects and to evaluate our results in the light of historical process and current literature. Materials and Methods: A reverse-flow fasciocutaneous flap was performed in 14 patients to repair foot and ankle defects. In 6 cases (42.86%), we chose to perform interpolation sural flaps where we aimed to repair the distal defects of the foot and/or in order to prevent patients from having trouble wearing shoes due to bulkiness of the flap pedicle at the ankle. In other cases (tunnel flap group, 57.14%), the pedicle of the flap was passed through the subcutaneous tunnel. Wide and meticulous dissection of the tunnel, nitroglycerine application on the flap, and close flap monitoring were our protective measures. Our results were analyzed statistically. The literature review was performed from Medline and PubMed. Results: Sural flap repair was performed in 14 patients. The mean age was 32.75 years. Etiologic factors were traffic accidents, spinal cord injuries, and hyperkeratotic lesions. The defects were localized in the ankle or proximal foot in 12 (85.71%) patients and the distal foot in the remaining patients (14.29%). The mean area of the defects was 46.75 cm2. Partial necrosis at the distal flap developed in 2 (25%) cases in the tunnel group and in 1 (16.67%) in the interpolation group (3 cases in total, 21.43% in the study population). No statistical difference was found between the flap groups in terms of patient distribution and complications. Conclusion: Wide dissection of the subcutaneous tunnel through which the pedicle is passed (in the tunnel group), application of nitroglycerin, meticulous hemostasis, and postoperative follow-ups are important factors for a successful reverse sural flap application. Sural interpolation modification is advantageous in several cases as the flap can reach farther and does not cause bulkiness in the ankle that would impair shoe wear. However, the disadvantage is that it requires 2 sessions.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"113 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114865087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyoderma Gangrenosum Following Deep Inferior Epigastric Perforator (DIEP) Breast Reconstruction: A Case Report","authors":"N. Stone, Victoria E. McKinnon, Judy Wismer, Mark H. McRae","doi":"10.1177/2513826X19898809","DOIUrl":"https://doi.org/10.1177/2513826X19898809","url":null,"abstract":"Pyoderma gangrenosum (PG) is a rare dermatologic condition manifesting as sterile, rapidly progressing painful skin ulcerations. It is commonly associated with autoimmune disorders such as inflammatory bowel disease. This case report illustrates a severe case of post-surgical pyoderma gangrenosum (PSPG) following bilateral deep inferior epigastric perforator flap breast reconstruction in a 56-year-old Caucasian woman. Factors delaying diagnosis included negative personal/family history of inflammatory disorders and a clinical presentation more suggestive of breast cellulitis. Refractory antibiotic therapy, subsequent ulceration at multiple breast and abdominal incisions, and pathergic response to tissue biopsy supported an eventual clinical diagnosis of PSPG, 12 days postoperatively, despite equivocal histopathologic findings. Initiation of intravenous immunoglobulin, prednisone therapy, local wound care, and avoidance of debridement led to a full resolution by 5 months postoperatively. This study raises awareness for PSPG and highlights the importance of early recognition and urgent dermatology consultation to expedite optimal treatment and minimize subsequent fat necrosis.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130926017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regeneration of Functional, Full-Thickness Skin With Minimal Donor Site Contribution Using Autologous Homologous Skin Construct","authors":"Kelsey A. Isbester, Corinne E. Wee, Samual Boas, N. Sopko, Amit Kumar","doi":"10.1177/2513826X19898810","DOIUrl":"https://doi.org/10.1177/2513826X19898810","url":null,"abstract":"Autologous skin grafts (autografts) remain the gold standard in the treatment of skin loss. For extensive wounds or burns, however, identifying adequate donor sites can be the limiting factor. Additionally, donor sites are associated with pain, risk of infection, and poor cosmetic outcomes. Many skin substitutes have been engineered as alternatives to traditional autografts. These substitutes, however, all leave something to be desired either functionally or cosmetically. This report describes the use of a new technology, autologous homologous skin constructs, to regenerate full-thickness skin grafts that maintain functional polarity, allowing important components of skin such as glands and hair follicles to regenerate. These grafts only require small samples of full-thickness skin from the patient, decreasing issues of donor site availability.","PeriodicalId":396131,"journal":{"name":"Plastic Surgery Case Studies","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127280441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}