Managing longitudinal melanonychia.

Longitudinal melanonychia (LM) is a pigmented band extending from the matrix to the distal edge of a nail. It is caused by increased production of melanin within the matrix, and integration into the nail plate. The origin of this production is usually benign, due to activation, hyperplasia or proliferation of melanocytes normally present in the matrix. In some cases, however, LM is the manifestation of a subungual melanoma, the diagnosis of which must be made early. Biographical, clinical and dermoscopic criteria make it possible to suspect melanoma and decide whether to perform biopsy. None of these criteria, however, are specific and definitive diagnosis requires pathologic examination of a matrix biopsy. The biopsy technique should enable reliable histological study while limiting the risk of secondary nail dystrophy. Initial resection should ideally involve the entire lesion. Complete elevation of the nail plate enables the lesion to be precisely located. Lesions up to 3 mm can be removed by longitudinal resection biopsies without significant sequelae. In more extensive lesions, incision or tangential ("shave") biopsy can be performed without impairing prognosis. In clinical presentations strongly suggestive of melanoma, immediate complete resection of the entire nail unit may be proposed.

Outcomes of ulnar shortening osteotomy using a new compression plate.

Ulnar impaction syndrome (UIS) is a frequent cause of ulnar-sided wrist pain. Several open and arthroscopic surgery techniques have been described. Ulnar shortening osteotomy (USO) is often the method of choice. It has the advantage of leveling the distal radioulnar joint extra-articularly while maintaining the integrity of the soft tissues that stabilize the joint. This retrospective study reports the short-term outcomes of 20 patients who underwent surgery between 2013 and 2015. USO was performed with a locked plate and a new compression device (Alians®, Newclip™, Haute Goulaine, France). Preoperative and postoperative ulnar variance were measured on wrist X-rays in neutral pronation-supination. Functional outcomes were evaluated with the QuickDASH score and the pain on VAS (visual analog scale). Postoperative range of motion and grip strength were compared to those of the contralateral wrist. The average follow-up was 16 months (4 to 28 months). Preoperative ulnar variance was positive with an average of 4mm (1-11mm). The average length of the final ulna shortening was 3.5mm (1.5-6mm); the mean time to union was 4 months (3-12 months). The average QuickDASH was 12 and pain had decreased 2.4mm on the VAS. The results achieved with this new compression plate designed specifically for USO are similar to those described in the literature. This kind of device has an easily reproducible technique and can reduce the operative time. LEVEL OF EVIDENCE: IV.

A case of pyoderma gangrenosum in hand surgery.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that can take many clinical forms. Its diagnosis is difficult and often delayed. We report the case of a 36-year-old man with PG complicating a chemical burn of the wrist. This mode of atypical onset delayed the diagnosis and the initiation of appropriate treatment. This was not sufficient since the patient's hand was amputated at his request because of unbearable pain, and failed treatment. Surgeons should be aware of this pathology in cases of rapidly progressing ulcers, especially if aggravated by repeated debridement.

Upper limb nerve transfers: A review.

While upper limb nerve transfers were first described and performed several years ago, they have seen expanded use in the past 20 years. Initially indicated for surgical repair of brachial plexus injuries with nerve root avulsion, the indications have been extended to post-ganglionic lesions because of the excellent results of certain intraplexus nerve transfers. The traditional nerve repair techniques - primary suture and nerve grafting - form the basis of nerve surgery. Although nerve transfer does not replace them, they are a useful supplement as they provide a targeted approach to reinnervation and recovery of key functions of the upper limb. The goal of this review is to provide an overview of the various possible transfers by the function being restored and the quality of the outcomes.