Expanding the applications of intramedullary cannulated screw fixation in the hand.

OBJECTIVES: Intramedullary cannulated headless compression screw fixation (ICHCS) is gaining popularity for managing metacarpal and phalangeal fractures, but is still relatively new to the surgical landscape. We aim to further illustrate its utility and versatility by presenting the outcomes of such fractures treated with ICHCS at two tertiary plastic surgery centres. Primary objectives were to assess functional range of motion, patient-reported outcomes, and complication rates. MATERIALS AND METHODS: All patients with metacarpal or phalangeal fractures treated with ICHCS (n = 49) between September 2018 and December 2020 were retrospectively reviewed. Outcomes were active ranges of motion (TAM), QuickDASH scores (obtained via telephone), and complication rates. Two-tailed Student's t-tests evaluated differences between centres. RESULTS: TAMs were available for 59% (n = 34/58) of fractures; 70.7% were metacarpal and 29.3% were phalangeal. The mean cohort metacarpal TAMs and phalangeal TAMs were 237.7° and 234.5°, respectively. QuickDASH scores were available for 69% (n = 34/49) of patients. The mean cohort score for metacarpal fractures was 8.23, and 5.13 for phalangeal. Differences between the two centres were statistically significant (p < 0.05). Two complications occurred, giving an overall complication rate of 3.45%. CONCLUSION: Our results corroborate previous reports on ICHCS, further demonstrating its versatility and capacity to provide excellent outcomes. More prospective, comparative studies are needed to fully determine the suitability of ICHCS.

Symphyseal fracture in a three-month-old infant.

Mandibular fractures are rare in infants, and diagnosis can be easily missed due to the difficulty in obtaining an adequate history and the subtle signs. A high index of suspicion and detailed history taking from the caregiver are mandatory to pick up these cases.There are a plethora of management options that have been reported in dealing with such fractures. They range from conservative management to internal fixation by absorbable plates. While conservative management does not interfere with mandibular growth and teeth development, any surgical intervention can carry this risk. Nevertheless, a severely displaced fracture may need anatomical reduction and fixation to allow early nutrition.This study reports a 3-month-old male infant with a fracture in the mandibular symphysis who underwent reduction of the fracture and circummandibular fixation using immobilisation by an acrylic splint for 4 weeks. His long-term follow-up after 20 months showed adequate dentition with proper healing of the fracture site.

Acne Keloidalis Nuchae: A Staged Reconstruction.

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis that affects the occipital area. It is characterized by papule and pustule formation which eventually leads to tumor-like mass. Early cases can be managed by medical treatment that may require months, and, usually, lesions recur. In more severe cases, surgical excision is the mainstay of treatment. In our case, we proposed a staged approach when dealing with advanced stages of AKN. This includes deep excision of the lesion down to deep subcutaneous tissue with application of negative-pressure wound therapy (NPWT) for a week followed by resurfacing of the resultant defect with a split-thickness skin graft and NPWT for another week. This approach achieved quicker wound healing with no recurrence compared with other techniques such as healing by secondary intention. To our knowledge, this case is one of the most extensive cases published in the literature.

Angiolymphoid Hyperplasia With Eosinophilia: New Concept to Lower Recurrence.

Angiolymphoid Hyperplasia with Eosinophilia (AHLE) is a rare benign vascular disorder of unknown etiology. While World Health Organization recognizes it as a benign neoplasm, its progressive nature and high recurrence rate are consistent with being a locally malignant tumor. It may present as solitary or multiple nodules with more predilection to head and neck region, especially auricular area. Despite variety of available treatment options, high recurrence rate remains a compelling issue. The spectrum of these treatment modalities includes topical or systemic steroids use, intralesional injection of certain materials such as Bleomycin, Vinblastine or interferon, or even surgical excision.In our study, the authors present a case of middle-aged female with recurrent AHLE in left concha and preauricular region. Excision of the lesion with 4 mm of the normal surrounding skin, preserving auricular cartilage, was done while the resultant defect was covered by grafted Temporoparietal Fascia Flap. Our 1-year follow-up period showed aesthetically accepted outcome with no recurrence.The authors hypothesize that treating AHLE as a locally malignant tumor by excising the lesion with 4 mm safety margin decreases recurrence rates. Moreover, reconstruction by grafted temporoparietal fascia flap achieves a reasonable aesthetic outcome with minimal donor site morbidity.

Supernumerary Nostril: Two Years Follow-Up.

Supernumerary nostril is a very rare congenital anomaly of the nose. Since the first patient reported by Lindsay in 1906, few number of patients were reported in the literature. Various types had been described with different surgical modalities for correction. It can be isolated or associated with other malformations such as facial cleft, esophageal atresia, and imperforate anus. Most of the patients are unilateral, but it may be bilateral. It may have a communication with a normal nasal cavity or not.In this study, the authors present a case of a 1-year-old male with a positive perinatal history of teratogen exposure had isolated supernumerary left nostril with communication to the nasal cavity.The authors will discuss different theories related to supernumerary nostril development, differences between published reports, the proposed surgical techniques, and the outcome of their treatment approach.