Soft tissue epithelioid hemangioendothelioma on the palm of the hand. Case report.

Hemangioendothelioma is a malignant vascular tumor, according to ISSVA classification of vascular tumors. This patient presented an epithelioid hemangioendothelioma; this type of tumor can exhibit significant local destruction, sometimes requiring limb amputation. With deferred Mohs micrographic surgery and reconstructive surgery with multiple conventional and microsurgical techniques, partial or total amputation of the hand was avoided.

Breast Implant-associated Anaplastic Large Cell Lymphoma after Breast Reconstruction for Breast Cancer.

A patient initially operated on for aesthetic breast augmentation had a round-textured silicone gel prosthesis, Poly Implants Prothèse, placed in a subglandular plane. The patient developed a bilateral capsular contracture, and 4 years later, underwent a complete bilateral capsulectomy with an exchange of Mentor 215 cm3 textured cohesive silicone-gel ultra-high profile breast implants in the same subglandular plane. One year later, the patient developed cancer in the right breast, so it was decided to perform a bilateral mastectomy and reconstruction with 265 cm3 (left) and 310 cm3 (right) Natrelle (Allergan) round-textured silicone-gel implants in a submuscular plane. Seven years after the last surgery, the patient developed a seroma in the left breast (breast opposite to the one that developed the cancer), and seroma studies reported a CD30-positive anaplastic large cell lymphoma associated with the breast prosthesis. Therefore, bilateral capsulectomy and explantation of both implants with breast reconstruction with autologous tissue were performed.

Intercostal Artery Perforator Flap for Salvage Breast Reconstruction with Exposed Breast Implants.

Multiple techniques have been described for breast reconstruction surgery after breast implant exposure; breast implant removal and delayed breast reconstruction is the procedure of choice. However, in some mild exposures and infections, we propose an alternative treatment. Methods: This is a case series of a 14-year study in 16 female patients with mild exposure of a breast implant after breast reconstruction surgery. Salvage surgery was performed on these cases. The defects were between 1 and 6 cm, with a median size of 3.9 × 2.9 cm. Eighteen intercostal artery perforator flaps were used with an island of skin from the inframammary fold; 83.3% were anterior intercostal artery perforator flaps' and 16.7% were lateral intercostal artery perforator flaps. Results: Thirteen of the 16 patients presented infection (81.25%). There was no necrosis of any flap, and the success rate of salvage surgery was 62.5% of all patients. The success of surgery was 53.8% in patients with breast infection and 100% in patients without infection. Seven patients received chemotherapy and radiotherapy, six received only chemotherapy, and nine patients received only radiotherapy. Five of the six patients whose salvage surgery failed were treated with radiotherapy. Conclusion: This technique can be used as an alternative when there is exposure of the implant' even in cases with a mild breast infection and in patients undergoing radiotherapy and chemotherapy.

Merkel cell carcinoma in the hand. Report of two cases.

Merkel-cell-carcinoma of the hand is rare. The Pathological and Immunohistochemical diagnosis helps us to focus the treatment. Immunotherapy has shown beneficial effects in unresectable/advanced/metastatic stages. The quantification of antibodies against Merkel-cell-polyomavirus (MCPyV) can be a useful for prognosis and follow-up. A wide margin in surgery and the sentinel node are the first option with Radiotherapy.

Study of Infections in Breast Augmentation Surgery with Implants in 9,691 Patients over 5 Years.

BACKGROUND: This study presents a review of a single retrospective cohort of patients who underwent surgery for breast augmentation with implants, during a period of 5 years, aged 17-60 years (mean 32 years), in a single institution, IQ Interquirofanos, a private clinic in the city of Medellín, Colombia. METHOD: A single retrospective cohort study was carried out, in which the database of patients who underwent breast augmentation with implants during 5 years was analyzed. RESULTS: In this period of time, 9,691 female patients and a total of 19,382 breast implants implanted by 66 plastic surgeons underwent breast augmentation surgery. All the breast prostheses used were round, made of silicone gel in all cases and textured in most of them. 37 patients presented infection at the surgical site, 33 were unilateral and four bilateral, with an incidence of 0.38% per patient. The form of presentation was cellulitis in 46% of the cases, followed by seroma and hematoma in 25%. It was found that there is no difference in the incidence of infection between patients with breast augmentation for the first time and implant replacement due to different causes (OR 1.25, 95% CI 0.66-2.3, P = 0.49). One of the surgeons was associated with 37.8% of the infections and was found to be an asymptomatic carrier of Staphylococcus aureus, requiring medical treatment. The relationship of the infection with the treating surgeons was also analyzed and it was found that there is an association between these two variables. The infection appeared in the first 2 weeks after surgery in 92.7% of the cases. The main isolated germ was Staphylococcus aureus, followed by Pseudomona aeruginosa, Staphylococcus epidermidis, Serratia marcescens, Candida parapsilosis, Enterobacter cloacae, and a patient with Mycobacterium fortuitum in both breasts. Of the 37 patients with infection, six breast implants were required to be explanted in five patients, who were repositioned 3-6 months later without complications. CONCLUSIONS: Incidence of infection in augmentation mammoplasty with implants was 0.38% in patients infected in one or both breasts, during 5 years. There is a relationship between the presence of breast infection and the surgeon who performed the intervention. The most frequent germs found in breast implant infections continue to be Staphylococcus aureus followed by Pseudomonas aeruginosa.

Interpositional Arthroplasty Using Mammary Capsule for Finger Joints: A Novel Technique.

Degenerative osteoarthritis frequently affects the hands, altering the movements; surgical therapy includes arthrodesis and arthroplasty. We report the case of a female patient who presented arthrosis in the hands, severe on the proximal interphalangeal (PIP) joints, initially in her right index finger, and subsequently in the index and middle left fingers. At first, she received treatment in the PIP joint of the right index finger with a silicone implant; later on, she presented fracture of it and required replacement 8 years later. In the PIP joints of index and middle left fingers, treatment was made with interposition arthroplasty by mammary implant capsule. We present the postoperative progression of the silicone versus mammary capsule interposition arthroplasty. It is remarkable that, over time, articular function of the intervened joints with capsular arthroplasty remained stable with good motion, while range of motion in other fingers was reduced as a consequence of osteoarthritis. The frequency of patients presenting simultaneously with mammary capsule contracture and osteoarthritis is low, but this novel technique is nonetheless worthwhile to take into consideration.

The Abductor Pollicis Longus Tendon as an Alternative Graft in Hand Surgery.

Initial treatment of damaged tendons after soft tissue trauma of the hand can be performed with primary tendon reconstruction or with tendon grafts if indicated. The most frequently used tendons are from the palmaris longus and plantaris muscles. Nonetheless, these muscles may not be present or their anatomic characteristics might not suitable for reconstructive procedures. Here, we present an alternative surgical technique for tendon reconstruction of the hand using abductor pollicis longus accessory tendons as grafts. The abductor pollicis longus can be considered an excellent choice of graft for tendon reconstruction of the hand because of its multiple bellies, ease of extraction, and limited donor site morbidity and the frequent absence of the palmaris longus tendon.

Ecografía Vs. Colecistografía oral en enfermedades de la vesícula / Ultrasound vs. oral cholecystography in gallbladder diseases

Se estudiaron 100 pacientes en un lapso de 2 años, los cuales manifestaron sintomatología biliar. Con edades comprendidas entre los 12 y 88 años, de los cuales 18 eran hombres y 82 mujeres. Se sometieron a Colecistografía Oral inicialmente y luego a Ecografía Biliar. Se agruparon los resultados en 4 grupos según los hallazgos de la colecistografía y se compararon posteriormente con los resultados ecográficos. Se encontró una eficacia para la ecografía del 99 por ciento y para la colecistografía de un 97 por ciento. Aunque ambos métodos son útiles y necesarios para el diagnóstico de las afecciones biliares, en un buen número de casos ellos se complementan...