Using BTM to reconstruct a complex dorsal hand wound with segmental loss of EDC tendon: Case report and review of the literature.

We present the case of a 65 year old man who sustained a complex dorsal hand degloving injury with segmental loss of EDC tendon to middle finger, which was reconstructed using BTM. He returned to near full function despite not having a tendon reconstruction, and the uninjured tendons were able to glide without restriction beneath the BTM. We review the case and the literature surrounding the use of BTM in this clinical scenario.

Don't Shoot Yourself in the Foot: Reconstruction of a Through-and-Through Gunshot Wound of the Foot.

A 69-year-old man presented with an accidental, self-inflicted, through-and-through left foot gunshot wound. An entry wound on the dorsum of the foot was noted, with a larger exit wound on the plantar aspect. X-ray revealed comminuted fractures of the second, third, fourth, and fifth metatarsals with numerous foreign bodies. Immediate excisional debridement was performed, and negative-pressure wound therapy was applied. A second look was performed 48 hours later. Five days after initial debridement, a Kirschner wire was utilized for fixation of the second metatarsal fracture, and an external fixator applied to the fifth metatarsal due to extensive bone loss. A free gracilis muscle flap was used to fill the defect, with plans for a vascularized bone graft at a later date. The flap was tunneled through the wound to the plantar aspect of the foot, with an overlying split-thickness skin graft. The patient's postoperative course was uncomplicated, and secondary bone grafting was not required. The gracilis flap was used to reconstruct the bony and soft tissue defects, and secondary muscle fibrosis appeared to provide adequate skeletal support. The patient was full weight-bearing by 4 months and has since returned to his preoperative activities, baseline gait, and regular footwear. The free gracilis muscle flap may serve as a valuable reconstructive option for through-and-through gunshot wounds to the foot, restoring both contour and function, while eliminating the need for secondary bone grafting.

Novel oral anticoagulant induced upper limb haematoma: A case report.

The development of novel oral anticoagulant agents (NOACs) such as dabigatran, rivaroxaban, apixaban and edoxaban has given patients better treatment alternatives to aspirin, clopidogrel, heparin and warfarin, mainly for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF), prophylaxis/treatment of venous thromboembolism (VTE) and also for the secondary prophylaxis of acute coronary syndromes. These agents are gaining in popularity due to their more stable pharmacokinetic profile, fewer drug interactions, as well as eliminating the need for routine monitoring. NOAC induced haematomas of the upper limb are rare and there is no real consensus on management. We present a case of a 70-year-old male on rivaroxaban who developed a delayed onset intramuscular forearm haematoma after a simple fall onto his left arm. Simple elevation of the limb was successful in leading to resolution of symptoms. As these agents increase in popularity, clinicians need to be more aware of potential risks of treatment and subsequent management.

Liposuction for lower limb lipodystrophy in congenital analbuminaemia: a case report.

Congenital analbuminaemia is a very rare autosomal dominant disorder in which patients have no serum albumin and markedly low serum total protein concentration. Clinically patients present with mild oedema, hypotension, fatigue and lipodystrophy often with abnormal body habitus. With only around 50 reported cases in the literature worldwide, management of the resulting lipodystrophy remains unclear. A 42-year-old male who was diagnosed with congenital analbuminaemia presented with bilateral lower limb lipodystrophy disproportionately affecting his thighs. This was associated with concerns over appearance, difficulties with mobility and finding clothing. He successfully underwent bilateral lower leg liposuction and has had no recurrence of his symptoms after 12 months. We have demonstrated that liposuction along with controlled compression therapy is a safe and effective treatment for managing lipodystrophy secondary to congenital analbuminaemia. Although rare, clinicians need to be aware that liposuction is a successful treatment modality, which should be made available to this select group of patients.

Basal cell carcinoma presenting late in a shotgun scar.

The development of a basal cell carcinoma (BCC) as a late complication of a shotgun injury is a rare clinical entity. We report the case of a 68-year-old Caucasian man who developed a BCC at the site of a scar from a shotgun pellet entry wound that was sustained 14 years previously. We emphasize the importance of excluding malignancy in a non-healing lesion and discuss the possible etiologic factors in the development of a BCC at the site of previous trauma.

Carbon dioxide laser ablation as first-line management of in-transit cutaneous malignant melanoma metastases.

INTRODUCTION: In-transit cutaneous malignant melanoma metastases remains a difficult and distressing disease. It is a sequela to the primary lesion represented by melanoma deposits between the site of excision and the draining lymph nodes. We present our experience of carbon dioxide ablation of in-transit cutaneous malignant melanoma metastases and discuss the role of laser ablation as first-line management of the disease. METHOD: Using a departmental database and case notes, all patients who had undergone carbon dioxide laser ablation for malignant melanoma metastases in the authors' unit between December 1996 and December 2007 were reviewed. RESULTS: The total number of lesions ablated was 559 in 16 patients on 91 separate occasions. The mean number of lesions ablated at each treatment was 6 (range 4-200) and the mean number of treatments per patient was 5.7 (range 1-14). All patients had undergone previous surgical procedures for disease control (total 28, range 1-4). Ten patients remained clinically disease-free at 1-year follow-up. Of these ten patients. six achieved remission with a median time from first ablation of 7.5 years (range 2-10 years). CONCLUSION: Carbon dioxide laser ablation should be offered as first-line treatment in the management of cutaneous malignant melanoma metastases. A subgroup of patients were clinically disease-free with no systemic progression, following treatment, the reasons for which have not yet been fully explained.