Treatment of malar mound and festoon with fractional microneedle bipolar radiofrequency combined with 15% TCA peel.

BACKGROUND: Anatomy of the periorbital region is very complex. Malar oedema/mounds/festoons often remain unaddressed. There are various treatments proposed for this pathologic entity as well as non-standardized nomenclature. Implementation of technology in aesthetic medicine and surgery resulted in novel treatments for this entity. AIMS: The aim of this case presentation was to show the combination of fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel as a great tool in treating malar bags with no complication and excellent result. PATIENTS/METHODS: We report a case of 44-year-old women with malar mound and festoon. The treatment consisted of rejuvenation of whole periorbital region- upper and lower blepharoplasty and novel treatment combination-fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel in 2 sittings. RESULTS: After 6 weeks, excellent results can be observed with malar mound and festoon completely resolved. No complications were observed. CONCLUSION: Fractional microneedle bipolar radiofrequency with medium depth 15%TCA peel is a safe and effective treatment option for malar bags.

Isolated inferior peroneal retinculum tear in professional soccer players.

INTRODUCTION: Peroneal tendon dislocations are rare injuries that can easily be misdiagnosed. Up to date literature mostly describes proximal peroneal tendon dislocations due to superior peroneal retinaculum (SPR) tear. In this article, we present the assessment, diagnostic algorithm and a new therapeutic option for the distal dislocation of the long peroneal tendon due to isolated inferior peroneal retinaculum (IPR) tear. PATIENTS AND METHODS: Between 2001 and 2011 three patients with distal peroneal tendon dislocation were operated. All of them were competitive athletes in the national soccer league. They presented with an ankle sprain and prolonged problems on the lateral side of the foot with no improvement after conservative therapy measures. Coleman block test was performed; ultrasound and MRI showed a tendon dislocation under the IPR. The patients underwent surgical repair that consisted of peroneal tubercle excision, a new lateral calcanear groove formation for both peroneal tendons and IPR plasty. RESULTS: At the two year follow up the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score showed a significant increase. The decrease of painful stimuli assessed by a Visual Analogue Scale (VAS) was significant as well. At an average of 12 weeks after the surgery, the patients returned to their level of sport activity before injury and didn't report similar problems later. CONCLUSION: Description of distal peroneal tendon dislocations is limited in the literature. This topic should be considered in differential diagnostics of an acute and chronic ankle sprain which leads to chronic ankle pain and instability. The authors recommend surgical treatment as a method of choice especially in professional athletes.

Aggressive granulomatosis after cementless total hip arthroplasty as a result of inflammatory reaction to metal debris: case report.

Massive osteolysis and granulomatous pseudotumor tissue reactions are long-term complications of total hip replacement. It is a condition of localized bone resorption in contact with prosthetic material. It is speculated to be a consequence of metal hypersensitivity or inflammatory reaction to excessive wear. Ten years after total cementless hip replacement (metal on polyethylene surface), a 70-year-old patient presented with hip pain and pseudotumor with massive osteolysis of proximal femur on x-ray. Intraoperatively, extensive metallosis with significantly worn metal head (316L stainless steel) and only slightly worn polyethylene insert was found. Upon extraction, parts of the affected tissue and bone that were in direct contact with the prosthesis were sent for histopathologic analysis. Microscopic examination showed necrotic soft and bone tissue, mainly bone marrow with numerous histiocytes and multinucleated giant cells containing lots of pigmented particles (presumed to be metal particles as a result of implant surface wear). In this case, the primary cause of osteolysis and granulomatosis was inflammatory reaction to metal debris. Aggressive granulomatosis has been first described in cemented prostheses and afterwards also in cementless ones. Conditions such as primary or metastatic neoplastic processes and infection should be excluded. The presence of foreign molecular particles due to wear of the prosthesis by different mediators has been presumed to cause an inflammatory reaction that leads to bone resorption and loosening of the prosthesis.