Chronic Knee and Ankle Pain Treatment through Selective Microsurgical Approaches: A Minimally Invasive Option in the Treatment Algorithm for Refractory Lower Limb Pain

 Injury or compression of a sensory nerve is an under-reported source of disabling pain in the lower limb. It is known that peripheral nerve microsurgeons can reconstruct and rewire injured nerves to relieve chronic pain but this option remains not completely understood and ignored by most orthopaedic surgeons, neurologists, and pain therapists. In this paper, we describe our experience with knee and ankle peripheral nerve surgery to improve the condition of patients suffering from chronic, posttraumatic lower limb pain

Breast amyloidosis: a case report

Amyloidosis is an uncommon disorder characterized by extracellular deposition of abnormal proteins. Breast involvement has rarely been reported and can clinically be misdiagnosed as breast cancer. A 60-year-old woman presented with a 3-mm diameter mass in the right breast close to a silicon implant positioned 20 years before. A core biopsy, performed to rule out breast cancer, showed amyloid deposit. Further exams confirmed a systemic amyloid light chain amyloidosis. After few months the mass increased causing breast volume and shape distortion. Since breast cancer may be the cause of amyloid deposits or be hidden by it, the patient underwent a bilateral skin sparing mastectomy and expander and fat grafting breast reconstruction. The resection specimens showed amyloid deposits only, no evidence of cancer. At 2 years follow-up, no breast amyloidosis recurrence was shown. Breast amyloidosis is rare but can occur in a plastic surgeon\u2019s practice. It is mandatory to rule out a comitant breast cancer or systemic amyloidosis

Salvage procedure after sternochondroplasty for pectus excavatum.

Vacuum-Assisted Closure in association to flap reconstruction is a well-established approach for treating complicated wounds. Case presentation: The authors present a case of soft-tissue breakdown with hardware exposure in a patient treated with strenochondroplasty for pectus excavatum. VAC therapy was applied in association to multiple debridement procedures and final flap closure. This was achieved without the need for hardware removal, thus maintaining adequate skeletal fixation. To our knowledge this approach has not yet been described into the literature after sternochondroplasty procedure. Conclusion Aggressive debridement and VAC therapy before final closure may represent a new, conservative method for managing surgical complications after sternochondroplasty procedures

Salvage of Exposed Breast Implant Using Capsular Flaps

Objective: Extrusion represents potential complications associated with the use of breast implants. Attempts to salvage the exposed implants are rarely successful when poor tissue coverage or radiotherpy is present and therefore removal of implant and wound healing are mandatory. In these refractory complicated cases the use of capsular flaps can represent a useful tool to save the implant and achieve definitive healing. Methods: Capsular flaps have been performed on 6 patients with implant extrusion and 11 patients with breast contour deformities over the last 6 years. The authors describe an innovative technique using capsular flaps which are harvested from thicker viable tissues and inset in multiple layers into the fistula tract to reinforce the breast envelope and prevent recurrence of implant extrusion. Results: Complete healing and implant salvage were achieved in all patients treated. No major complications occurred and only minor contour deformities, that regressed spontaneously after surgery, were observed for 2 weeks. Conclusions: Although capsular flaps have been previously described to correct breast shape deformities, no previous report has yet suggested its utility in breast implant salvage in case of extrusion. The authors advocate the use of capsular flap to save the exposed breast implant especially when poor tissue coverage is present and other surgical options to save the implant have already failed