The use of simultaneous free latissimus dorsi tissue transfers for reconstruction of bilateral upper extremities in a case of purpura fulminans.

We report a case of extensive purpura fulminans destroying the soft tissue over the posterior aspect of both elbows. Simultaneous, bilateral free latissimus dorsi muscle transfers were used to close both wounds in a single procedure. The wounds resulting from severe purpura fulminans can be extensive and limb threatening. The simultaneous transfer of 2 free flaps can provide expeditious soft tissue repair while minimizing the risk of repeat anesthesia in these critically ill patients. We found that certain details concerning planning and performing the procedure fostered its successful outcome.

Prospective, randomized trial of splinting after carpal tunnel release.

To determine the possible beneficial effect of postoperative splint immobilization after open carpal tunnel release, we performed a prospective, randomized study comparing 2 weeks of postoperative wrist splinting versus a bulky dressing only. Forty patients with 43 carpal tunnel releases were evaluated. There were no statistically significant differences between the two groups using subjective parameters of patient satisfaction with their outcome and objective parameters of grip and lateral pinch strength, complication rates, and digital and wrist range of motion. No clinical evidence of bowstringing could be noted in either group of patients. We found no beneficial effect from postoperative splinting after open carpal tunnel release when compared to a bulky dressing alone.

Closure of massive chest wall defects after full-thickness chest wall resection.

We report an unusual repair of a massive chest wall defect resulting from resection of a chronic ulcer after radiation therapy for stage IV breast carcinoma. The defect was 690 cm2 and included the body of the sternum, 10 ribs, and the anterior portion of the diaphragm. Chest wall reconstruction was accomplished with multiple flaps: a pectoralis major advancement flap, a reversed abdominoplasty, an omental flap, and a latissimus dorsiscapular-parascapular musculofasciocutaneous (hemiback) flap. Skeletal reconstruction with prosthetic material or bone grafts was not performed in this patient. The problems associated with complex chest wall reconstructions are discussed.

Malignant transformation of benign mesenteric cyst.

We describe the clinical and pathological features of a case of mesenteric cyst which was incompletely excised, recurred over several years, and eventually underwent malignant transformation. A review of the literature shows how mesenteric cysts are still poorly understood clinical entities, often difficult to classify even after histopathological evaluation. This is the first reported case of transformation of a benign mesenteric cyst into adenocarcinoma. Complete excision of all mesenteric cysts should be carried out, to prevent recurrence and possible malignant transformation.

Strut fracture after Greenfield filter placement.

We present the unusual event of strut fracture of a Greenfield filter. This being an extremely rare complication, we postulate a possible cause of fracture and present a review of literature.

Repair of the proximal interphalangeal joint with a homograft.

We describe the delayed reconstruction of a destroyed proximal interphalangeal joint by implantation of a partial articular homograft in a 17-year-old boy. One year after the operation the joint is painless and has a normal range of motion.