[A girl with a deviated index finger]. / Een meisje met een gedevieerde wijsvinger.

A 7-year-old girl was seen at the ER with severe pain of her index finger after twisting her hand whilst performing a handstand. Physical examination and X-rays showed an isolated dorsal dislocation of the metacarpophalangeal joint, also known as a Kaplan's lesion. A Kaplan's lesion is a complex dislocation with volar plate interposition. Therefore, most of the lesions require surgical reduction, preferably from a dorsal approach.

The use of SERI™ Surgical Scaffolds in direct-to-implant reconstruction after skin-sparing mastectomy: A retrospective study on surgical outcomes and a systematic review of current literature.

INTRODUCTION: Little is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction. METHODS: A retrospective chart study was conducted of all patients who underwent direct-to-implant reconstruction with a SERI surgical scaffold after skin-sparing mastectomy, recording surgical characteristics, perioperative complications and reoperations. A systematic literature review was conducted focusing on preclinical and clinical studies reporting on use of SERI in breast surgery. RESULTS: A total of 16 patients (22 breasts) were identified (mean age at surgery was 47 ± 6.8 years, mean BMI 23.1 ± 3.1 kg/m2, mean ablation weight 530 ± 221 g, median clinical follow-up time 27 months (range 25-37)). There were no intraoperative complications. Postoperative bleeding, that required reoperation occurred in one (5%) breast, postoperative seroma in 10 (45%) and surgical site infection in 2 (9%). Scaffold-related complications occurred in 3 (14%) breasts, comprising lack of scaffold integration in all, resulting in skin ulceration in 2 and the scaffold lying free in the breast pocket surrounded with seroma in one. Nine articles were selected and reviewed from the 170 identified. DISCUSSION: The role of silk-derived scaffolds in breast reconstruction is yet to be determined. Though first reports have shown promising results, our and others results suggest that scaffold-related complications, such as lack of scaffold integration, may occur more frequently than previously described. Further research is necessary to determine possible (dis)advantages of the scaffold in specific patient groups.