Granular cell tumor of the toe: a case report

Granular cell tumor is a rare tumor of unknown etiology that more commonly affects the oral cavity but can also occur at other sites. The majorities of granular cell tumors are benign and present as a singular dermal nodule. We discuss a case of granular cell tumor of the fourth toe in a 54-year-old patient that was treated with conservative surgery, instead of amputation, and reconstruction with a dermal regeneration template

The proximal ulnar perforator flap (PUPF) for hand digital reconstruction: an anatomical study

Degloving injuries of the fingers represent a reconstructive challenge. Even if poorly described in literature, the proximal ulnar perforator flap (PUPF), based on perforator of the anterior ulnar recurrent artery or directly on a perforator branch of the ulnar artery, meets the requested criteria for the ideal coverage. We performed a cadaveric study in order to clarify the anatomical basis and vascularization of the PUPF flap. Eight injected upper limb specimens were dissected for this study: perforators were followed down to their origin and classified in terms of number, length, diameters and distances between their emergence and specific pre-determined landmarks as the medial humeral epicondyle. At least one ulnar perforator in the proximal third of the forearm was identified in all the specimens. In 50% of the upper limbs, the perforator branch came directly from the ulnar artery, while in the 87.5% a perforator branch came from the anterior recurrent ulnar artery; in 3 out of 8 cases both perforator branches were described. Mean lengths of the perforator branch were 57.9 mm and 44.3 mm, respectively and the mean diameters measured at their origin were 0.99 mm and 1.17 mm respectively. Our data illustrate the consistency of at least one perforator branch from the proximal third of the ulnar artery, most commonly coming from the anterior recurrent ulnar artery. Considering our results, the PUPF could be a good alternative to the classical free flaps for the resurfacing of the finger defects

A novel method to medicate local cv flaps in nipple reconstruction

Besides surgical technique related variables, post-operative care after nipple reconstruction with CV flaps is important for an satisfactory final result. We present a novel method to prepare a protective and sealing medication in order to minimize traumas to the new nipple. We found the silicone cap plunger of a 50cc syringe suitable for our purpose. It was applied over a non-adherent dressing and TNT gauze to avoid decubitus and fixed it with a steri-strip before covering with a sticking plaster. Analyzing 118 nipples casistic, reconstructed with a CV flaps technique, between January 2011 and June 2012 and medicated with the presented technique in the last six months considered, we noticed a reduction in partial loss of flap vitality and nipple reabsorption. The main advantages of the dressing technique we propose are the ease and rapidity in the preparation and availability of all materials used in every operation room or outpatient clinic. We believe that our technique of medication may reduce traumas to delicate vascularization of the new nipple, avoiding the partial or total loss of vitality and reabsorption of the flaps

Squamous Cell Carcinoma and Ledderhose Disease: A Case Report

Ledderhose disease is disorder of the plantar aponeurosis. This disease is not so common and can be tackled with a surgical or conservative approach. A case of a 73-year-old man came to our attention who had a 26-year history of painless bilateral plantar nodules coalescing into an indurated mass. An ulcerative nodule had been noted in the last 16 months on the right foot, in the absence of trauma, not responsive to conservative treatment, so we decided to perform a biopsy. The histopatologic examination showed squamous cell carcinoma, with warty, well-differentiated, low-grade malignancy. Surgical treatment was suggested, so, in pneumoischemia, we made a surgical incision including the skin lesion. Then we proceeded to sculpture the anterolateral thigh fasciacutaneous flap to obtain adequate soft tissue coverage. The tumor was completely removed. Current reconstructive possibilities comprise a good anatomofunctional recovery even in the case of large demolition requests for the therapy of advanced cases of the disease described in this article. Correlation between Ledderhose disease and the formation of malignant tumors has not been made as yet, but perhaps an element that could unite these pathologies can be researched in the lively cell proliferation that characterizes both. It would be interesting to analyze the biological substrate, as well as the systemic and local levels, in patients where both diseases are manifested

The “Sombrero-Shape” Super-Thin Pedicled ALT Flap for Complete Scrotal Reconstruction Following Fournier’s Gangrene

When the scrotal sac is entirely debrided following a Fournier gangrene, testes exposure poses unique challenges for the reconstructive surgeon. Despite the anterolateral thigh (ALT) flap is considered a workhorse in such context, aesthetic results are often suboptimal because of the lack of natural ptosis and patchwork appearance. We describe the use of a super-thin pedicled ALT flap for total scrotal reconstruction, modified according to a peculiar flap design and inset technique. A 42-year-old man was referred to our department for delayed total scrotal reconstruction 8 months after a Fournier gangrene extensive debridement. A super-thin pedicled ALT flap from the right thigh was designed: in the central portion of the ALT, a lateral skin paddle extension was marked to guarantee adequate posterior anchorage during insetting and ptosis of the scrotal sac. This particular flap arrangement has inspired the name “sombrero” as the shape is akin to the famous hat. No secondary refinements were needed, and the patient showed satisfying aesthetic and functional results at 12 months’ follow-up. The ALT flap design “sombrero” modification proposed in this article can improve scrotum cosmesis and patient satisfaction in a single-stage single-flap procedure

Initial experience with Vanguard(R) total knee arthroplasty

Introduction Biomet Vanguard(R) Complete Knee System is a total knee replacement system, introduced into the market in 2003: thissystem boasts a designed kneecap track or groove which allows for greater mobility and decreased loss of healthy bone during the replacement process. Clinical and radiographic results in Varese Orthopaedics Unit initial experience are reported. Materials and methods Clinical and radiographic parameters are evaluated in 29 patients who underwent TKA (Vanguard(R) Complete Knee System- Biomet Inc.) for primary gonarthrosis during the last 2 years at Orthopaedics and Traumatology Unit of Ospedale di Circolo\u2014Fondazione Macchi in Varese. ROM, type of anaesthesia, patellar pain, clinical and functional Knee Score (pre-operative), size of implant, ROM, blooding, patellar pain, VAS, clinical and func- tional Knee Score (post-operative) are analyzed. Radiographic follow-up is made at 6 and 12 months. Results Clinical and Functional Knee Score respectively improve from 47 to 88 pts and from 51 to 88 pts in pre- and post-operative period (p\0.001). Post-operatively no patellar pain, 2 pts VAS and 1215 cc blooding are reported. ROM doesn\u2019t significantly improve from pre- to post-operative. No relevant complications are reported. Due to the short follow-up, radiographic evaluation does not allow to demonstrate polyethylene liner wear. Conclusions Vanguard(R) Knee Replacement significantly shows a clinical and functional improvement in patients affected by primary gonarthrosis. Moreover, post-operative pain decrease allows early mobilization and rehabilitation

Chronic exertional compartment syndrome of the forearm: a systematic review

The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm. We searched Medline (PubMed), Web of Science, Embase and Scopus databases on 8 July 2020. Twelve studies were included in this review. We assessed the quality of the studies using the Coleman Methodological Score. Data on demographic features, operative readings, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to sport activity, and outcome measures were recorded. In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications

Growth factors for clinical-scale expansion of human articular chondrocytes : Relevance for automated bioreactor systems

The expansion of chondrocytes in automated bioreactors for clinical use requires that a relevant number of cells be generated, starting from variable initial seeding densities in one passage and using autologous serum. We investigated whether the growth factor combination transforming growth factor beta 1/fibroblast growth factor 2/platelet-derived growth factor BB (TFP), recently shown to enhance the proliferation capacity of human articular chondrocytes (HACs), allows the efficiency of chondrocyte use to be increased at different seeding densities and percentages of human serum (HS). HACs were seeded at 1,000, 5,000, and 10,000 celIS/cm(2) in medium containing 10 bovine serum or 10,000 cells/cm(2) with 1 chondrogenic capacity of post-expanded HACs was then assessed in pellet cultures. Expansion with TFP allowed a sufficient number of HACs to be obtained in one passage even at the lowest seeding density and HS percentage and variability in cartilage-forming capacity of HACs expanded under the different conditions to be reduced. Instead, larger variations and insufficient yields were found in the absence of TFP. By allowing large numbers of cells to be obtained, starting from a wide range of initial seeding densities and HS percentages, the use of TFP may represent a viable solution for the efficient expansion of HACs and addresses constraints of automated clinical bioreactor systems