Case Report

Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.

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Penetrating Orbitocranial Injury With a Good Aesthetic and Functional Outcome: A Case Report

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.8 ◽

2021 ◽

Vol 7 (1) ◽

pp. 61-66

Author(s):

Youssef Fahde ◽

◽

Davis Mpando ◽

Mehdi Laghmari ◽

Houssine Ghannane ◽

...

Keyword(s):

Case Report ◽

Multidisciplinary Approach ◽

Violent Behavior ◽

Case Presentation ◽

Frontal Horn ◽

Patient Reported ◽

Long Term Follow Up ◽

Life Threatening

Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.

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Mini-implants: Alternative for Oral Rehabilitation of a Child with Ectodermal Dysplasia

Brazilian Dental Journal ◽

10.1590/0103-6440201300111 ◽

2015 ◽

Vol 26 (1) ◽

pp. 75-78 ◽

Cited By ~ 3

Author(s):

Bianca Zeponi Fernandes Mello ◽

Thiago Cruvinel Silva ◽

Daniela Rios ◽

Maria Aparecida Andrade Moreira Machado ◽

Fabrício Pinelli Valarelli ◽

...

Keyword(s):

Case Report ◽

Ectodermal Dysplasia ◽

Oral Rehabilitation ◽

Mini Implants ◽

Prosthesis Retention ◽

Patient Reported ◽

Long Term Follow Up ◽

Socialization Skills

Ectodermal dysplasia is a rare congenital disease that affects several structures of ectodermal origin. The most commonly related oral characteristics are hypodontia, malformed teeth and underdeveloped alveolar ridges. New alternative treatments are needed due to the failure of the conventional prosthesis retention. This case report outlines the oral rehabilitation treatment of a 9-year-old girl with ectodermal dysplasia. The treatment was performed with conventional prosthesis upon mini-implants. The mini-implants provided prosthetic retention. The patient reported a good adaptation of the dental prosthesis and satisfaction with the treatment. The increased self-esteem improved the socialization skills of the girl. In this case report, use of prosthesis with mini-implants was satisfactory for prosthetic retention. However, clinical studies with long-term follow-up are needed to test the mini-implants as an alternative for oral rehabilitation of children with ectodermal dysplasia.

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Long-term follow-up of donor site morbidity after defect coverage with Integra following radial forearm flap elevation

European Journal of Plastic Surgery ◽

10.1007/s00238-013-0918-0 ◽

2014 ◽

Vol 37 (3) ◽

pp. 159-166 ◽

Cited By ~ 15

Author(s):

Anna Wirthmann ◽

Juliane C. Finke ◽

Pietro Giovanoli ◽

Nicole Lindenblatt

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Radial Forearm Flap ◽

Defect Coverage ◽

Forearm Flap ◽

Long Term Follow Up ◽

Radial Forearm ◽

Flap Elevation

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Nipple Reconstruction Techniques: Which is the Best Choice?

Open Medicine Journal ◽

10.2174/1874220301805010062 ◽

2018 ◽

Vol 5 (1) ◽

pp. 62-75 ◽

Cited By ~ 1

Author(s):

Nicolò Bertozzi ◽

Francesco Simonacci ◽

Marianna Pesce ◽

PierLuigi Santi ◽

Edoardo Raposio

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Contralateral Side ◽

Skin Thickness ◽

Nipple Reconstruction ◽

Areolar Complex ◽

Long Term Follow Up ◽

Case Basis

Nipple-Areolar Complex (NAC) reconstruction represents the final, concluding journey of breast reconstruction by being able to give to reconstructed breasts the shape of a natural breast mound. Nevertheless an enormous amount of nipple reconstruction techniques are described in literature, given the fact that most reconstructive options fail to give satisfactory outcomes in relation to the long-term nipple projection. In this review, the authors will browse most common nipple reconstruction techniques, taking into account: Indication, outcome, and side effect. Composite nipple grafts, traditional flaps, flaps with autologous graft augmentation, flaps with allograft augmentation, and flaps with alloplastic augmentation are the main strategies employed nowadays. Composite nipple grafts give the best guarantee of color-texture match with the contralateral side and show satisfactory nipple projection even at long-term follow-up. Skate, star, C-V, and arrow flap are by far the most commonly employed and the most reliable local flaps, however loss of projection of up to 70 percent are reported in literature. Alloplastic grafts were associated with the lowest rates of projection loss followed by autologous and allogenic ones. Nevertheless allogenic grafts are also associated with the highest complication rate, while autologous and allogenic ones have similar rates. Infection, seroma, and fat necrosis are the more commonly reported complications of autologous grafting along with donor site morbidity, while allogenic and alloplastic augmentation grafts may also experience the risk of overcorrection and graft exposure. Given the numerous techniques described in literature it is clear that the ideal nipple reconstruction hasn’t been found yet. Whereas it should be chosen on case to case basis depending on type of mastectomy, radiotherapy, type of reconstruction, skin thickness, tissue condition, and patients’ expectations to ensure the best cosmetic outcome.

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Long Term Follow-Up of Composite Non-Vascularized Toe Phalanx Transfers for Aphalangia

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.06.001 ◽

2005 ◽

Vol 30 (5) ◽

pp. 452-458 ◽

Cited By ~ 18

Author(s):

M. A. TONKIN ◽

A. K. DEVA ◽

S. L. FILAN

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Proximal Phalanx ◽

Donor Site Morbidity ◽

Joint Motion ◽

Active Joint ◽

Long Term Follow Up

The results of 21 non-vascularized toe phalanx transfers in 13 patients were reviewed radiologically with respect to function, physeal patency, growth and donor site morbidity at a mean follow-up of 7.4 (range 2.9–13.6) years. Physeal patency was maintained in 4 of 18 surviving transfers. The length of the transferred phalanx averaged 75% of the contralateral comparable toe phalanx and 44% of the contralateral digit proximal phalanx. Most patients had good or simple use of the hand with active joint motion. There was universal shortening of the donor toe with hypoplasia of the middle and distal phalanges. This review suggests that transfer of a non-vascularized toe phalanx provides a reliable but limited means for increasing length of a digit, stabilizing soft tissue “nubbins” and improving function. Longer follow-up has shown more modest gains in growth than in some previous reports.

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Auricular composite grafting to repair nasal vestibular stenosis

Otolaryngology ◽

10.1067/mhn.2000.104631 ◽

2000 ◽

Vol 122 (4) ◽

pp. 529-532 ◽

Cited By ~ 1

Author(s):

Matthew Karen ◽

Edward Chang ◽

Monte S. Keen

Keyword(s):

Donor Site ◽

Donor Site Morbidity ◽

Senior Author ◽

Nasal Surgery ◽

Common Causes ◽

Long Term Follow Up ◽

Nasal Trauma ◽

Surgical Treatments

Nasal vestibular stenosis is defined as a narrowing of the nasal inlet resulting in airway obstruction. Causes include nasal trauma, infection, and iatrogenic insults. The objectives of this article are to illustrate nasal vestibular stenosis and to analyze common causes and surgical treatments. The operative technique of the senior author (M.S.K.), will be presented. Donor site morbidity and patient outcomes will be discussed. Sixteen patients were seen during a 5-year period. Eleven women and 5 men were evaluated and found to have nasal vestibular stenosis. Three patients had stenosis as a result of nasal fracture or laceration. Stenosis developed in the remaining 13 as a result of nasal surgery. All patients underwent auricular composite grafting, and grafts took in 100%. Partial skin slough occurred in up to 50%; however, re-epithelialization was seen within 3 weeks. Complications were seen at the donor site. Immediate patient satisfaction was seen and continues during long-term follow-up.

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Partial second toe pulp free flaps in early childhood

Archives of Plastic Surgery ◽

10.5999/aps.2020.01137 ◽

2020 ◽

Vol 47 (6) ◽

pp. 590-596

Author(s):

Min Ki Hong ◽

Dong Chul Lee ◽

Min Suk Choi ◽

Sung Hoon Koh ◽

Jin Soo Kim ◽

...

Keyword(s):

Pearson Correlation ◽

Demographic Data ◽

Donor Site ◽

Free Flaps ◽

No Donor ◽

Long Term Follow Up ◽

Fingertip Reconstruction ◽

Second Toe

Background The introduction of the partial second toe pulp free flap has enabled superior aesthetic and functional results for fingertip reconstruction in adults. Children undergoing fingertip amputation for various reasons have limited options for reconstruction. Conventional treatment could shorten the finger, leading to poor cosmesis and function. We report 18 years of our experiences with fingertip reconstruction using partial second toe pulp free flaps in patients in early childhood.Methods Medical charts of children who had undergone fingertip reconstruction using partial second toe pulp free flaps from 2001 to 2018 were retrospectively reviewed. The surgical procedures were identical to those for adults, except for the usage of 11-0 nylon sutures. Patients’ demographic data, vessel size, flap dimensions, length of the distal phalanx, and functional outcomes over the course of long-term follow-up were documented. The statistical analysis was performed with the Student t-test, the Mann-Whitney U test, and Pearson correlation analysis.Results Eighteen toe pulp flaps in 17 patients (mean age, 3.0 years) were identified. All the flaps survived without any major complications. In long-term follow-up, the flap-covered distal phalanges showed growth in line with regular development. There was no donor-site morbidity, and all children adapted to daily life without any problems. In two-point discrimination tests, the fingertip sensation recovered to almost the same level as that in the contralateral finger.Conclusions Partial second toe pulp free flaps are an excellent option for fingertip reconstruction in young children, as well as in adults.

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