Cavernous haemangioma in the hand mimicking subacute tenosynovitis.

A case of cavernous haemangioma arising from the superficial palmar arch is described. The initial symptoms were those of a subacute tenosynovitis. Surgical exploration showed that the tumor was not affecting the flexor tendons. It was completely resected and the patient had full recovery of hand function

The pulp ring avulsion lesion as a new indication for the free dorsal middle phalangeal finger flap: a case report.

An ideal reconstruction of fingertip injuries should provide good sensibility and no pain in the activities of daily life. We report a case of a professional trumpet player who sustained a severe avulsion injury when his right index finger was crushed in a slamming door. The soft tissue of the distal finger was debrided circumferentially. To cover the defect we performed a free dorsal middle phalangeal finger flap from the ipsilateral ring finger. This flap provides excellent sensory recovery and an aesthetic outcome

Vermeintliche Pseudarthrose am Daumen [Apparent pseudarthrosis of the thumb]

Pseudarthrosis in the hand are defined as a non-union of a fracture after 6 month. Reasons might be biological disorders, mechanical instability or infection after fracture treatment. Pseudoarthrotic bone demands stable osteosynthesis and often bone grafting. The presented case is about a dislocated osseous fragment attached to the Aponeurosis dorsalis mimicking clinical and radiological a Pseudarthrosis of the proximal phalanx of the thumb. We would like to draw attention that osseous fragments may present very similarly to a pseudoarthrosis of a phalanx

High magnification assessment improves complete resection of facial tumors

Complete resection with minimal sacrifice of healthy skin is the goal in treatment of basal cell carcinoma (BCC) of the face. In a randomized trial, preoperative assessment of tumor extension with the Varioscope, a combination of microscope and loupe glasses with strong illumination and a maximal magnification of 7X, was compared with tumor assessment without. Forty consecutive, primary BCC of the solid subtype of the face were randomly assigned to the study groups. Preoperative tumor marking was done by a surgeon not involved in tumor resection, reconstruction, and patient follow-up. All BCC marked with the high magnification were completely excised in the first resection. In the control group, frozen section was used in 12 tumors and permanent section in the remaining 8. The first resection did not yield tumor-free margins as assessed in the frozen section analysis in 3 tumors. In 2 of 8 tumors not supported by frozen section analysis, incomplete excision was detected, and 1 case of false-negative frozen section analysis occurred. In conclusion, the use of high magnification resulted in a trend towards reduction of positive tumor margins in the subgroups that were performed under either intraoperative frozen section or permanent, fixed section histology control, and a significant reduction in tumor-positive margins of all first resections. This was attributed to enhanced preoperative tumor visualization by high (7X) loupe magnification and additional lightin

Laser surface scanning analysis in reconstructive rhytidectomy

The implementation of laser surface scanning to assess facial symmetry after unilateral face-lift procedures used to reconstruct defects after skin tumor resection is presented. Six patients who had undergone defect reconstruction with a flap raised from the subcutaneous plane were included in the study. Immediate postoperative photographic evaluation confirmed facial asymmetry because of unilateral skin tension. After a minimum follow-up period of 1 year, photographic and laser surface scanning analysis showed restored facial symmetry. In conclusion, laser surface scanning is a promising technology for objectifying results obtained and could be implemented for evaluation of the immediate and long-term effects from rhytidectomy procedures. Subcutaneous flaps without duplication or resection of the superficial musculoaponeurotic system are ideal for unilateral procedures because facial symmetry is restored after 1 yea

Die sechs Behandlungsprinzipien des Basler Dekubituskonzepts [Six treatment principles of the basle pressure sore concept]

The treatment of pressure sores has gained importance due to the increase of geriatric patients and general life expectancy as well as improved therapeutic options in patients with spinal cord injuries. The aetiology of pressure sores is multifactorial. Risk factors such as immobility, malnutrition, and other co-morbidities have to be considered. Therapy of pressure sores is time- and cost-consuming and recurrence rates are high. Successful treatment is based on the interdisciplinary cooperation between conservative and surgical disciplines, nursing, as well as on continuous patient education. The Basle pressure sore concept consists of six principles. Over a total treatment period of approximately three months usually two operative interventions are performed. For effective relief of pressure (1st principle) patients are placed on low-airloss beds. Operative debridement of pressure sores is performed early and systemic or local infection is treated (2nd principle). The wound is then conditioned with moist dressings or VAC (3rd principle). Simultaneously concomitant malnutrition is quantified clinically and chemically and treated by oral or, if necessary, parenteral nutrition. Other risk factors are optimised as well as possible (4th principle). Hereby optimal conditions for plastic-surgical coverage are provided (5th principle). Postoperatively a standardised concept of pressure relief and mobilisation is adhered to (6th principle). This multimodal treatment concept is well established at the University Hospital of Basle for many years. Combined with an effective prevention, the rate of pressure sores could be significantly reduced, wounds could be healed, and the number of recurrences diminished. In a two-year period between January 2004 and December 2005 the Basle plastic surgery team treated 170 pressure sores in 142 patients according to this concept in the Swiss paraplegic centre in Nottwil. In 2006, 78 % of these patients (111 patients) were followed up and recurrence rates of 23 % (26 pressure sores) were found. The Basle pressure sore concept is well established for an interdisciplinary and structured treatment of geriatric and paraplegic patients with pressure sores and provides a reliable basis for effective treatment for this complex disease