Touch localization after nerve repair in the hand: insights from a new measurement tool.

Errors of touch localization after hand nerve injuries are common, and their measurement is important for evaluating functional recovery. Available empirical accounts have significant methodological limitations, however, and a quantitatively rigorous and detailed description of touch localization in nerve injury is lacking. Here, we develop a new method of measuring touch localization and evaluate its value for use in nerve injury. Eighteen patients with transection injuries to the median/ulnar nerves and 33 healthy controls were examined. The hand was blocked from the participant's view and points were marked on the volar surface using an ultraviolet (UV) pen. These points served as targets for touch stimulation. Two photographs were taken, one with and one without UV lighting, rendering targets seen and unseen, respectively. The experimenter used the photograph with visible targets to register their locations, and participants reported the felt position of each stimulation on the photograph with unseen targets. The error of localization and its directional components were measured, separate from misreferrals-errors made across digits, or from a digit to the palm. Nerve injury was found to significantly increase the error of localization. These effects were specific to the territory of the repaired nerve and showed considerable variability at the individual level, with some patients showing no evidence of impairment. A few patients also made abnormally high numbers of misreferrals, and the pattern of misreferrals in patients differed from that observed in healthy controls.NEW & NOTEWORTHY We provide a more rigorous and comprehensive account of touch localization in nerve injury than previously available. Our results show that touch localization is significantly impaired following median/ulnar nerve transection injuries and that these impairments are specific to the territory of the repaired nerve(s), vary considerably between patients, and can involve frequent errors spanning between digits.

Double perforators-based superior gluteal artery propeller flap for reconstruction of lumbar defects.

Wide local excision of skin cancer in the lumbar area is a challenge to reconstruct. We report on the successful use of a two perforators-based superior gluteal artery perforator propeller flap, for the reconstruction of a lumbar defect.

Primary spindle cell sarcoma of the breast masquerading as necrotizing fasciitis.

Breast sarcomas are rare neoplasms arising from the few epithelial elements of the gland. It represents much <1% of all breast cancer. Of the heterogeneous group of sarcomas, the more common subtypes include spindle cell sarcoma. The main risk factor for the development of breast sarcomas is previous radiation therapy following breast-conservation surgery for breast cancer or non-Hodgkin's lymphoma. We report on an idiopathic presentation of spindle cell sarcoma in an otherwise healthy middle-aged woman. An emphasis is made on the rare occurrence of lymphatic metastasis. We discuss our recommended management strategy with particular reference to the benefit of multidisciplinary team decision-making.