The first reported case of fibrous hamartoma of infancy in Syria: A rare case and review of literature.

INTRODUCTION AND IMPORTANCE: Fibrous hamartoma of infancy (FHI) is an anomaly in the soft tissue. It is usually benign and rare, with most cases found in children under the age of two. CASE PRESENTATION: A case is reported involving an 11-year-old boy who visited a plastic and reconstructive surgery clinic with a painless mass on his left iliac region. The mass had been there since birth and had been growing gradually in size. After obtaining informed consent, surgical exploration was conducted. Following that, the mass was completely surgically removed with appropriate dissection and layer-by-layer suturing. An excisional biopsy was sent to the pathology department for further analysis. The final diagnosis was FHI, and no signs of malignancy were found. CLINICAL DISCUSSION: According to our knowledge, this is the first documented case in medical literature in Syria describing the clinicopathologic features and follow-up results of an 11-year-old boy diagnosed with FHI. Typically, the tumor is detected within the first two years of life, but in some cases, up to 23% of cases are already present at birth. It is interesting that our case was discovered at the age of 11, due to its small size when it developed after birth, and because the patient's family believed that it would heal spontaneously as it gradually increased in size, which prompted them to come to the clinic. CONCLUSION: Misdiagnosis may lead to unnecessary consequences, such as concerns of the patient's family, and invasive procedures. Therefore, FHI should be considered in the differential of a solitary mass in infants.

Late management of amniotic bands syndrome with incomplete syndactyly: A case report of 4-year-old child.

INTRODUCTION: Amniotic band syndrome is a fetal entrapment in strands of amniotic tissue. This condition causes multiple deformities ranging from simple constricting bands to lymphedema, autoamputation, syndactyly and other congenital anomalies. Reconstructive surgery is the main treatment for ABS. PRESENTATION OF CASE: A 4-year-old male presented with multiple constricting bands affecting both hands in addition to an incomplete syndactyly between the third and fourth left digits. A two-staged operation was performed to repair the deformities with 6 months interval. Series of Z-plasties were used to release the constricting bands and the syndactyly was separated by a web zigzag incision approach and full-thickness skin grafting. DISCUSSION: Management of ABS must be individualized. The urgency of the surgical release depends on the depth of the constricting bands and their influence on circulation and lymphatic drainage. Superficial bands can be released electively for cosmetic appearance while deep bands should be released as soon as possible. The separation of syndactyly should be done at the first year of life to maintain the digits functionality and parallel growth. CONCLUSION: This paper emphasizes the importance of early repair of constricting bands associated with syndactyly to avoid the consequences of the delay on digital growth.

Successful reconstruction using three flaps combination after wide excision due to basosquamous carcinoma: A case report.

INTRODUCTION: Basosquamous carcinoma (BSC) is an uncommon and malignant subtype of non-melanoma skin cancer. It has features that are halfway between basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). CASE PRESENTATION: An 87-year-old female presented with a lesion on her left cheek, nasal ala, medial canthal area, and eyelids. After investigations, which included biopsies and a computed tomography scan (CT), surgery was decided upon to completely remove the mass. A 5 × 4 cm defect after the surgery was reconstructed by mobilizing three flaps, including the McGregor flap, VY glabellar flap, and nasolabial laterally based cheek flap. The excisional biopsy detected malignancy at the lateral border of the upper lid, which led to the patient undergoing surgery to remove the tumor formation. After the second surgery, the histopathology confirmed no malignancy. The patient had functionally and aesthetically pleasing results, preserved eyelid movement and visual field. No surgical complications or recurrences occurred within the first year after the surgery. DISCUSSION: BSC is a neoplasm without well-defined histologic characteristics or standardized treatment procedures compared to other non-melanoma skin cancers. However, several studies recommend using wide excision. In our case, Reconstructing the area was challenging due to important anatomical structures and finding tissue that matches the desired appearance, while preserving functional and aesthetic results. CONCLUSION: In this case report, we highlight the value of reconstructing face defects after wide excision due to BSC using three flaps.

Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria.

INTRODUCTION AND IMPORTANCE: Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant. CASE PRESENTATION: A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence. CLINICAL DISCUSSION: Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint. CONCLUSION: Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.

Massive scar contractures in unique presentation: Case report.

INTRODUCTION: Scar contractures are a common complication of burn injuries, especially in the head and neck region. This paper presents a case of a middle-aged female who suffered severe scar contracture after a burn injury during the war in Syria. PRESENTATION OF CASE: A 33-year-old woman with a severe neck scar contracture resulting from a neglected burn injury presented to a plastic surgery department. The contractures extended to the chin, mandible, chest, and upper limbs. The patient underwent contracture release and reconstruction surgery, which involved the removal of the platysma and the placement of split-thickness skin grafts. The patient was discharged after one month of hospitalization. However, burn injuries require immediate and deliberate treatment, which may include reconstructive surgery. DISCUSSION: Despite various efforts have been made to prevent the development of contractures, the contraction ratio of burn scars is still a badly controlled process, and reconstructive surgery is often indicated. There are many options to achieving the surgery, which vary in complexity. However, there is no preferable strategy and each option has advantages and disadvantages. CONCLUSION: Reconstructive is complete and technically demanded surgery, which needs special centers and professionals, this leads to poor results, especially in development countries like Syria.

Triphalangeal thump, thumb duplication, and syndactyly: The first case report in the literature.

RATIONALE: Triphalangeal thumb (TPT) is a rare congenital malformation where the thumb has three phalanges instead of two. Syndactyly is a condition in which children are born with fused or webbed fingers. The combination of TPT, Syndactyly, and thumb duplication is extremely rare, especially when these deformities are combined in one hand. PATIENT CONCERNS: Hand abnormalities and polydactyl have been reported in a 1-year-old boy. DIAGNOSIS: A clinical examination reveals two thumb duplications, finger fusion (Syndactyly), and a thumb with three phalanges (TPT). The diagnosis was based on clinical findings and an X-ray image of the hand. INTERVENTIONS: The Z-plasty method was used to remove the adhesion between the thumb and forefinger, as well as the removal of the medial and distal phalanx of the thumb's medial tip. OUTCOMES: The patient was followed for 2 months and found him in good health. To authors' knowledge, we described an unusual case from Syria, considered the first in medical history. LESSONS LEARNED: General and plastic surgeons should be aware about this unusual mix of the three abnormalities. The family history must also be carefully investigated to explore the occurrence of hereditary illnesses.

Successful management of scalp avulsion with full-thickness graft.

Scalp avulsion injuries are one of the life-threatening traumatic injuries. Rapid management in the emergency department is vital to the successful rescue of an avulsed scalp. There are many replantation methods to treat scalp avulsion, so the best aesthetic and functional results are achieved. Skin grafting, free flaps, microvascular surgery, and hyperbaric oxygen are all suitable for reconstructive plans. We report a rare case of a scalp avulsion injury in a female due to an entanglement of a headscarf in a motorized machine resulting in defects and tissue loss of the hair-bearing skin, nasal area, forehead, left ear, and bilateral eyelids and eyebrows. Preoperative management included early blood transfusion, intravenous fluids, and wound compression after rapid physical examination. Reconstructive surgery was performed using a full-thickness skin graft and the outcomes were pristine. There are no clear guidelines to determine which reconstructive method is superior to another in each condition. Our case demonstrates that relatively primitive methods like skin grafting can give greater results if done with circumspection.

Amelanotic nodular melanoma misdiagnosed as a benign skin lesion: A rare case report from Syria.

INTRODUCTION: and importance: Amelanotic melanoma is a rare and aggressive type of melanoma. It is often diagnosed late because of the lack of melanin in its cells, and this causes treatment delay and, eventually, poor prognosis. CASE PRESENTATION: We report a case of a 79-year-old female patient that presented to the dermatology clinic with an asymptomatic lesion on the medial heel of the right foot, with no medical history of previous melanoma or related skin cancer. To get the right diagnosis, an incisional biopsy was performed, and the sample was sent to the pathology laboratory. The sample was stained with S100 and HMB-45 stains, and both were positive. Also, no melanin pigmented cells were seen, so the diagnosis was amelanotic nodular melanoma. The patient was then referred to surgery. The lesion was successfully excised with 5cm safety margins, and the whole lesion was sent to the pathology laboratory to ensure that the edges are malignancy-free. After 18 months of follow-up, the patient is in good health. CONCLUSION: Accurate and early diagnosis with appropriate clinical intervention can improve the prognosis and reduce mortality and morbidity rates.

Primary cutaneous Leiomyosarcoma on the left iliac region: A rare case report from Syria.

INTRODUCTION: and importance: Leiomyosarcoma is a rare aggressive soft-tissue malignancy typically originating from embryonic mesoderm or mesenchymal cell lines in smooth muscles.Leiomyosarcoma of the skin is termed as "Dermal Leiomyosarcoma", and is categorized into two subdivisions; superficial cutaneous and deep subcutaneous.Both types begin either as primary lesions or metastatic lesions from distant sites. CASE PRESENTATION: We report the case of a 60-year-old male patient with Primary Cutaneous Leiomyosarcoma (PCL) located in the left iliac region.His history is insignificant and he has no family or genetic history of leiomyosarcoma. The lesion was itchy without any other symptoms and existed 20 years before our evaluation.A biopsy from the nodule was performed and sent to the pathology department, where the section was stained with smooth muscle actin stain (SMA) and the result was positive.We referred the patient to a surgeon to excise the nodule. The lesion was excised with a 3cm safety margin, the eradication includes also the of the major iliac muscle.After one year of follow-up there was no metastasis nor recurrence. CONCLUSION: Primary Cutaneous Leiomyosarcoma is a very rare malignancy and it is hard to diagnose without biopsy and pathological examination.