Congenital hairy nevus: A case report of long-term follow-up following curettage of the nevus at the age of 6 hrs.

INTRODUCTION: Management of giant hairy nevi depends on various factors including the size and anatomical area. CASE PRESENTATION: We report a case of a giant hairy nevus treated successfully with curettage at the age of 6 hrs after birth. There was partial recurrence of pigmentation and hair on long-term (10 years) follow-up. DISCUSSION: Although curettage is a known method of treating hairy nevi, long term results are lacking when the nevus is treated in the first few hours after birth. CONCLUSION: Following curettage of hairy nevi in the first few hours after birth, recurrence of pigmentation and hair may still occur on long term follow up.

Skin Preservation in the Debridement of Necrotizing Fasciitis: A Demonstrative Case Report.

Necrotizing fasciitis (NF) is a rare yet potentially fatal soft-tissue, polymicrobial infection. Aggressive debridement of the fascia and overlying skin as well as antimicrobial coverage constitute the mainstay of management, often leaving large skin defects. However, we demonstrate in this paper a case of a young woman who developed NF after liposuction and was treated by fascial debridement with minimal skin excision. Skin preservation will reduce the morbidity and improve the final aesthetic outcome.

Challenging the Subcostal Incision Scar with the Two-staged Abdominoplasty: An Innovative Approach.

Abdominoplasty is a commonly sought-after procedure due to its life-transforming results, but is limited, as in any other operation, by a number of contraindications. One of these contraindications is a subcostal scar, which may jeopardize blood supply to the upper flap of the abdominoplasty, resulting in skin necrosis. Herein, we challenge this dogma by introducing the two-staged abdominoplasty with the utilization of a delayed flap in a 48-year-old multiparous woman presenting with a Kocher incision of open cholecystectomy, with good results and a complication-free course of 3 postoperative months. We recommend this approach in patients with subcostal scars. However, more research into the utilization of delayed flaps in abdominoplasty should be done to have a more well-founded conclusion.

The pedicled lateral forehead flap in reconstructing oral floor defect - The last resort; case report.

INTRODUCTION AND IMPORTANCE: Locoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options. CASE PRESENTATION: A-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap. CLINICAL DISCUSSION: Decreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required. CONCLUSION: Choosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.

Rhinoplasty for Hypertrophied Transverse Nasalis Muscle: A Case Report.

Negatively impacting the aesthetics of the face, nasal deformities can be attributed to many congenital or acquired causes, of which muscular hypertrophy is uncustomary. In this article, we narrate a case of a 26-year-old woman with a prominently wide mid-vault, in addition to other abnormalities of the nose. It was thought to originate from soft tissue because it was thick and firm to palpation. Open rhinoplasty was done where hypertrophy of the paired transverse nasalis muscle was observed and resected. The patient enjoyed a safe postoperative period with excellent cosmetic results and minimal effect on the nasal function in terms of breathing and pronunciation. We recommend this approach to any patient with a similar disfigurement due to its simplicity and ability to correct other co-existing nasal disfigurements.

Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects - A case report.

INTRODUCTION: Myelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, keystone island flap can be used for closure of large MMCs. PRESENTATION OF CASE: A new-born girl born as a product of 36 weeks of gestation had a weight of 3.020 kg and had multiple congenital anomalies including hydrocephalus, thoracolumbar myelomeningocele at the level of (T10-L4) and an atrial septal defect. Preoperative evaluation showed a head circumference of 42 cm (n: mean 34.4 ± 2SD), no lower limbs movements and a thoracolumbar soft tissue defect around 4 × 8 cm with exposed neuronal tissue and prominent thoracic kyphosis, and no obvious urogenital or limbs anomalies. The large thoracolumbar myelomeningocele was treated at KFSHRC with a Keystone Design Perforator Island Flap (KDPIF) to reconstruct the soft tissue defect following the neurosurgical reconstruction. DISCUSSION: The keystone flaps were deemed as viable as all wounds were healed without any complications, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers a simple and effective method of wound closure in situations that would, otherwise, have required complex flap closure. CONCLUSION: This flap can be an effective method for reconstruction of large thoracolumbar MMC defects that might improve outcome and minimize complications. It also ensures good watertight closure with minimal wound tension and breakdown.

Incisional hernia repair with plication and utilization of Botox injections: First case report from Saudi Arabia for a 19-year-old female.

This article reports on the use of Botox preoperatively for the treatment of a complex ventral hernia which would have typically been treated with component separation technique. The case demonstrates that using the recently developed technique can aid in performing a tension-free hernia repair with potentially lower complication and recurrence rates.

The use of an omental flap for the reconstruction of a burn injury to the scalp: A case report.

INTRODUCTION: Omental free flaps are used in reconstructing a wide range of clinical indications in the head and neck. The first omental flap case to be reported was in 1972 by McLean and Buncke. CASE PRESENTATION: This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically to cover the entire scalp after a burn injury in a young male. It is first to be reported in Saudi Arabia at our institute, Riyadh, 2012. A 14-year-old male had an extensive flame burn at the age of 2 years in the head and neck area. He received multiple skin grafting procedures and an amputation of the right hand, due to his chronic condition of recurrent open wounds the patient was admitted for removal of the unstable ulcer sting and scarred skin of the scalp and for coverage with omental free flap and split thickness skin graft. DISCUSSION: The coverage of wounds in the head and neck is usually done by using a local skin flap. The disadvantage of using the traditional skin flaps is difficulty to shape it in irregular, and large wounds. CONCLUSION: Owing its large size in covering wide defect, easy to shape in irregular edges over the bony surfaces, and high vascularity. This case demonstrate the feasibility of minimal invasive procedure of harvest an omental flap laparoscopically. We think that the use of omental flap is a useful flap and should be considered in the scalp and head and neck reconstruction.

Reconstruction of Congenital Sternal Clefts: Surgical Experience and Literature Review.

BACKGROUND: Sternal cleft is a rare anomaly with a reported incidence of 1:100,000 cases per live births. Surgical intervention represents a crucial factor altering the overall patient prognosis, since they are at high risk of impaired oxygenation, as well as multiple chest infections. Herein, we are reporting our experience of surgical management of such rare cases, alerting plastic surgeons to their possibly crucial role in the reconstructive team. METHODS: A retrospective chart review of 2 cases presenting with chest wall defects. All perioperative data were collected and presented. RESULTS: Two patients with sternal clefts of variable degrees were managed. The first was an 18-month-old boy with partial inferior sternal cleft, who was otherwise asymptomatic. The patient underwent reconstruction at the same age using autologous rib graft and pectoralis major flaps due to ectopia cordis that was putting the patient at higher risk for cardiac trauma. The second patient was a 3-month-old girl having a V-shaped partial superior cleft with lung herniation. Surgical reconstruction was applied due to difficulty in weaning the patient off of ventilator support. Initially, reconstruction was applied with SurgiMend dermal matrix, but this was complicated by chest retraction and high oxygen requirement. Definitive reconstruction was later applied with allogeneic bone graft and pectoralis major flaps. CONCLUSIONS: Meticulous patient assessment and screening for associated anomalies are crucial. Surgical intervention is warranted at an early age. The use of acellular dermal matrix products in the reconstruction is of interest, but should be approached with caution.

Scalp reconstruction with free flaps using the external carotid artery and internal jugular vein as the recipient vessels without the need for interpositional vein grafts or arterio-venous loops.

The technique of lengthening of the pedicles of the rectus abdominus and latissimus dorsi free flaps are described in five patients. Lengthening of these pedicles allowed scalp reconstruction using the external carotid artery and internal jugular vein as the recipient vessels without the need for interpositional vein grafts or arterio-venous loops. Post-operative recovery was uneventful in all cases.

Successful treatment of a child with posttraumatic necrotizing fasciitis caused by Apophysomyces elegans: case report and review of literature.

Apophysomyces elegans is an uncommon human pathogen that causes deeply invasive infections in immunocompromised patients and cutaneous infection in immunocompetent patients. We report the development of severe deep soft tissue zygomycosis caused by A. elegans in an otherwise healthy child after trauma. She was successfully treated with surgical debridements and antifungal therapy with liposomal amphotericin B. A review of the literature indicates that zygomycosis caused by A. elegans is associated with traumatic inoculation.

Oral burn contractures in children.

Oral burn contractures in children present major reconstructive problem. Only few reports in literature discussed oral burns in children. Electrical, chemical, and thermal agents are the main causative agents for oral burns. Oral contractures can be classified into anterior, posterior, and total. Anterior contractures are usually caused by electrical burns and involve the oral commissure, lips, anterior buccal sulcus and surrounding mucosa, and anterior tongue. Posterior oral contractures are caused by caustic ingestion and involve the posterior buccal mucosa, posterior tongue, retro-molar area and oro-pharynx. Total oral contractures involve the lips, tongue, oral cavity, and oro-pharyngeal mucosa and are caused by lye caustic ingestion. This report reviews three children; one with posterior, two with total oral cavity contracture. All cases were managed by linear release of scar contracture and skin grafting followed by a prolonged intra-oral splinting with a fixed mouth-block and commissural splint. A successful outcome was observed in all cases.

Surgical correction of primary cutis vertices gyrata.

Primary cutis vertices gyrata is a rare condition of the scalp characterized by the formation of furrows and folds resembling the convolutions of the brain. A review of the English literature did not reveal any surgically treated cases. The authors report three cases treated by simple excision of the deepest furrows with a satisfactory result.

An unusual case of preaxial polydactyly of the hands and feet: a case report.

An unusual case of polydactyly of the hands and feet is described. The ulnar 4 digits of both hands and the outer 4 digits of both feet appeared normal, and the extra digits were on the radial side of the hands and on the medial side of the feet. The pattern of polydactyly did not fit any of the well-known deformities associated with radial digital duplication such as thumb polydactyly, mirror hand, or duplicated (multiple) hands. The harmonious deformities of the hands and feet suggest a genetic alteration to the development of all 4 limb buds, but the case did not fit any of the known syndromes that have high-level preaxial digital duplication of the hands and feet.