Dermal Fenestration With Negative Pressure Wound Therapy: A Technique for Managing Soft Tissue Injuries Associated With High-Energy Complex Foot Fractures.

Military casualties can sustain complex foot fractures from blast incidents. This frequently involves the calcaneum and is commonly associated with mid-foot fracture dislocations. The foot is at risk of both compartment syndrome and the development of fracture blisters after such injuries. The amount of energy transfer and the environment in which the injury was sustained also predispose patients to potential skin necrosis and deep infection. Decompression of the compartments is a part of accepted practice in civilian trauma to reduce the risk of complications associated with significant soft tissue swelling. The traditional methods of foot fasciotomy, however, are not without significant complications. We report a simple technique of dermal fenestration combined with the use of negative pressure wound therapy, which aims to preserve the skin integrity of the foot without resorting to formal fasciotomy.

A safety technique for Mitek anchor suture rupture: a useful trick.

We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair.

Could it still be malignant melanoma or just a poorly differentiated neoplasm?

The present case, characterised by an aggressive and poorly differentiated skin malignancy, contributes to a wider discussion on such tumours. Despite repeated histological examinations, including immunohistochemistry, and thorough radiological investigation, diagnosis of melanoma was not easy.