Risk factors for trigger finger occurrence after carpal tunnel release.

Carpal tunnel syndrome and trigger finger (TF) are common ailments managed by hand surgeons, but it is unclear whether these conditions are related. The purpose of this study was to determine whether there are risk factors for the new-onset of TF after carpal tunnel release (CTR). A retrospective chart review was performed on 792 CTR surgeries and multiple variables were compared between patients who did and did not develop TF after CTR. The incidence of new-onset TF after CTR was 6.3%. Multivariate regression analysis showed that osteoarthritis and undergoing an endoscopic procedure were the only two independent risk factors. Based on these results, we recommend that for endoscopic CTR, the higher incidence of TF should be discussed preoperatively as a potential sequelae. Further, patients with osteoarthritis should be informed of their greater risk of developing TF postoperatively and should be monitored closely for expeditious detection and management of new-onset TF.

A novel approach to the management of pyoderma gangrenosum complicating reduction mammaplasty.

Reduction mammaplasty is a common procedure performed by plastic and reconstructive surgeons to relieve chronic back and neck pain associated with macromastia, with the added benefit of an improvement in the aesthetic contour of the ptotic breast. Complications related to this procedure are fortunately uncommon, but include hematoma, infection, and wound breakdown. The authors report an interesting case of reduction mammaplasty complicated postoperatively by pyoderma gangrenosum (PG), which is a rare inflammatory disorder leading to progressive skin necrosis. The destructive process, which involved both breast incisions, was managed successfully with immunosuppressive therapy and intensive wound care, followed by a novel method of coverage with a dermal regeneration template and subsequent epidermal autograft that led to stable coverage of the open wounds. PG is frequently misdiagnosed as a necrotizing infection, leading to improper debridement with exacerbation of the disease process. The mainstay of therapy for PG is still nonoperative and focuses on immunosuppressive medications and local wound care, which allows healing in most cases. However, there are a few indications for surgical intervention, including significantly large wounds that are refractory to medical management. It is important for plastic surgeons and other clinicians to be cognizant of this entity, as a delay in diagnosis and management of PG can lead to serious consequences, with considerable soft tissue loss and disfigurement of the breast.

Autologous breast reconstruction with the inchworm flap in an obese woman.

Breast cancer may particularly occur in the obese female population. Although mastectomy can be a life-saving procedure, it frequently leaves soft tissue defects and deformities that can be psychologically and esthetically upsetting to the patient. A number of reconstructive methods have been utilized including prosthetic implants, TRAM flaps, and latissimus dorsi myocutaneous flaps. We present an obese woman who underwent a novel method of post-mastectomy breast reconstruction using a staged lateral chest wall fasciocutaneous advancement flap which we term the 'inchworm flap'. The patient had good outcome with no complications. In a select group of obese patients who have redundant lateral chest wall soft tissue following mastectomy, this technique can be a successful means of recreating the breast mound using autologous tissue.

Lipomatous disorder of the peri-trochanteric soft tissue: case report and review.

Disorders of fatty tissue metabolism and body contour are frequently described in the literature. Several different syndromes have been ascribed to recurring characteristics of fatty deposition with similar underlying etiologies. These syndromes can generally be classified into the lipomatoses (abnormal accumulations of fat) and the lipodystrophies (abnormal fat atrophy). The authors describe a case of isolated symmetrical lipomatosis of the soft tissue overlying the trochanters that developed a recurrence after treatment with liposuction. They have attempted to match this patient's disorder into 1 of several reported syndromes, with benign symmetric lipomatosis and acquired partial lipodystrophy at the top of the differential diagnosis. However, some characteristics of this patient may warrant a separate categorization for her condition. In this case report, the current literature on disorders of fatty tissue metabolism is reviewed and a discussion of relevant factors and issues surrounding their clinical significance and management is provided.

Pseudosarcoma: massive localized lymphedema of the morbidly obese.

Massive localized lymphedema is a term used to describe a benign overgrowth of lymphoproliferative tissue in morbidly obese patients, which is characterized by fibrotic and edematous fibroadipose tissue. Because of its large size and similar appearance to sarcomas, it has often been termed a pseudosarcoma. Patients tend to seek treatment only when the masses reach a sufficient size to alter their activities of daily living or have problems with excoriation or wound breakdown. Resection is indicated in these cases or if there is any question as to underlying malignancy of the lesion. Although recurrence is common, overall prognosis is good, with only anecdotal reports of transformation to angiosarcoma in the literature. We report a patient afflicted with this unique disorder.

Recurrent aortoenteric fistula: case report and review.

Aortoenteric fistulas (AEFs) are abnormal communications between the aorta and the bowel most frequently resulting from prosthetic graft erosion. Despite advances in surgery and medical technology, these entities are still associated with significant morbidity and mortality for the patient. Multiple case reports and reviews have attempted to elucidate the nature of AEFs in an effort to better characterize and manage these entities. However, reports of recurrence of this process are extremely rare. In this article, we describe a unique case of recurrence of an AEF that was successfully managed with primary aortic oversew and bowel resection. We will also review the literature on AEFs with a comprehensive overview on background, presentation, diagnosis, and current management options.