The surgical management of a hypogastric dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumor with intermediate grade of malignancy. Wide surgical resection with disease-free margin offers an excellent probability of cure. These large excisions cause large skin defect that can be difficult to cover. Through this case report we describe a surgically treated DFSP that was covered by a Mc Gregor flap; which despite its seniority is still relevant and continues to serve plastic surgery.

A Rare Case of Glomus Tumor of the Thigh with Literature Review.

INTRODUCTION: GTs are rare, benign tumors, developing from a neuro-myo-arterial structure. Their typical location is in the hand, but they may develop anywhere else. Extra-digital glumus tumors GTs, like the location in the thigh, are rare and much more difficult to diagnose. They are usually misdiagnosed and unproperly treated, due to the absence of the typical symptoms. CASE REPORT: We report a case of a GT of the thigh in a 25-year-old female, presenting with a painful mass on the posterior side of her left thigh, evolving for 15 months. She was suffering from pain and hyperesthesia of the underlying skin exacerbated by movements. The patient was successfully treated by excisional biopsy. CONCLUSION: Gts of the thigh represent an exceptional location of extra-digital Gts, very rare themselves. Pain, hypersensitivity to cold, and severe amyotrophy should raise suspicion for Gts. Through this case we discuss the diagnostic difficulties and the treatment of extra-digital Gts.

Glomus tumor of the leg: a case report.

Glomus tumors are uncommon benign tumors developing from the neuro-myo-arterial glomus body. They are typically located in the fingers. The extra-digital involvement is unusual and makes diagnosis difficult. Only few cases have been reported in literature. We report an exceptional case of a glomus tumor of the lower leg in a 65-year-old male. The diagnosis was clinically suspected and confirmed by a biopsy. Surgical excision gave immediate pain relief. The aim of this report is to make the surgical community more aware of this entity based on the analysis of our own experience and a review of the literature.

Place of the reposition flap in the treatment of distal amputations of the fingers.

PURPOSE: Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. METHODS: The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. RESULTS: The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal (DIP) joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash (350 against 500 for regularizations). CONCLUSION: The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.

An exceptional location of tuberculous arthritis: The metatarsal phalangeal joint.

Osteoarticular tuberculosis is a rare type of tuberculosis. The spine is the most frequent location, while peripheral locations in the limbs are rare. We report a case of tuberculous osteoarthritis of the metatarsophalangeal joint of the first ray of the foot in a 48-year-old woman. The patient presented with painful swelling of the dorsum of the big toe, insidiously evolving for 6months. Diagnosis was obtained with histological study after surgical biopsy. Antitubercular chemotherapy for 12months promoted healing. Through this clinical case the authors describe the epidemiological, diagnostic features, and treatment of osteoarticular tuberculosis and discuss the causes of delayed diagnosis often encountered in these exceptional locations and differential diagnoses, gout in particular, for this particular case.

Kuhlmann vascularized bone grafting for treatment of Kienböck's disease: a case report.

Treatment of Kienböck's disease has historically been determined by staging, ulnar variance, and presence or absence of arthritic changes. With the advent of newer techniques of vascularized bone grafting, the status of the cartilage shell of the lunate has become another factor that can influence the procedure performed. The purpose of this article is to describe the technique of Kuhlmann vascularized bone graft for Kienböck's disease. In addition, the indications, contraindications, and outcomes are described.

Intraosseous ganglion cyst of the lunate: A case report.

Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.

Transformation of Dermatofibrosarcoma Protuberans into a Fibrosarcoma.

Dermatofibrosarcoma protuberans is a rare cutaneous mesenchymal tumor characterized by a low potential of malignancy with a very low rate of metastasis but an important rate of local recurrence. Its transformation into a fibrosarcoma is exceptional, responsible for a higher metastatic potential. This transformation implies a closer surveillance. Through a case report and literature review, we will try to expose epidemiological, clinical, histological, therapeutic, and outcome particularities of this entity.

Acute carpal tunnel syndrome of the hand following a cat bite.

Cat bites at the hand are common situation in emergency departments. Neglected or poorly supported, these lesions sometimes lead to serious injuries that may compromise the function of the hand. Pasteurellamultocida is the most offending germ in these lesions, despite their sensitivity to antibiotics; it can sometimes lead to deep infections involving the skin, bones and joints. Acute carpal tunnel syndrome is exceptional after cat bite. We report a case of a 56 Year old female presenting with an acute carpal tunnel syndrome associated with compartment syndrome of the right hand 6 days after a cat bite of her right thumb. The patient was treated by surgery to relieve the median nerve. Microbiology identified PasteurellaMultocida.

Teeth syndrome: diagnosis, complications and management.

Teeth syndrome or fight bite is a specific entity in hand surgery that is little known. It includes infectious complications of the hand following a fist against the teeth. Neglected or misdiagnosed this injury frequently leads to serious complications that could compromise the function of the hand. A retrospective study was performed on 20 patients treated for teeth syndrome at our department, during a period of 12 years (January 2003 to April 2015). All young adults with a mean age of 28 years and a significant male predominance. The dominant side was involved in 15 patients. Lesions were divided into 4 cases of simple dorsal wounds facing the MP joint, 8 cases of dorsal hand cellulitis, and 8 cases of arthritis and osteoarthritis of the metacarpophalangeal (MP) joint of the long fingers. The index was the most affected finger. Treatment consisted in debridement of necrotic tissues, stabilization with external fixation for arthritis, skin reconstruction was performed secondarily. Result was assessed as good in 60% of cases. Clenched fist injuries to the mouth (teeth syndrome or fight bite) are known as being the worst human bites. Usually treated as minor injuries, without realizing a breach of the joint capsule, a lesion of the extensor tendon, or a contamination by oral flora. Any patient with a wound near the joint of the hand and was involved in a fight, need an appropriate evaluation and a specialized treatment to avoid serious complications.

Tuberculous flexor tenosynovitis of the hand.

Tuberculosis is a major public health problem in developing countries. Flexor tenosynovitis of the fingers constitutes an exceptional tuberculosis localization (Gabl et al., 1997; Senda et al., 2011) [1,2]. Unusual presentations, such as tuberculous tenosynovitis, often go undetected and are associated with a diagnostic and therapeutic delay, especially when bacteriological research proves to be negative. Here, we report a case of tuberculous flexor tenosynovitis of the hand.

A rare localization of tuberculosis of the wrist: The scapholunate joint.

The tuberculosis of the hand and the wrist is a rare entity. Affecting the scapholunate joint is exceptional. It is usually diagnosed at an advanced stage of carpal destruction, due to slowly development of the symptoms. We report the case of a 58-year-old female, presenting as wrist pain for 3 months. Clinical study showed a local swelling in the left wrist, the mobility of the wrist was normal but painful at the end of motion. The diagnosis of osteoarticular tuberculosis was suspected after radiological and biological study then confirmed after histological study. Antibacillary chemotherapy during 12 months promoted healing and good outcome.

Osteoarticular tuberculosis dactylitis: Four cases.

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country.

[Fournier's gangrene : what are the prognostic factors? Our experience with 40 patients].

BACKGROUND: Fournier's gangrene (FG) is a serious, extensive fulminant infection of the genitals and perineum. Indeed, despite antibiotics and aggressive debridement, the mortality rate of FG remains high. AIM: Through our experience, we intent to identify effective factors in the survival of patients with FG and we try to determine how the Fournier's gangrene severity index score (FGSIS) is accurate. METHODS: Between 1995 and 2010, 40 patients with Fournier's gangrene were treated in our institution. All of them were treated with broad spectrum triple antimicrobial therapy, broad debridement and exhaustive cleaning. Then they underwent skin grafts or delayed closure as needed. Data were collected on demographics, medical history, predisposing factors of FG, etiological infection agents, admission signs and symptoms, physical examination, admission laboratory studies and bacteriology. Timing and degree of surgical debridement as well as outcomes were also reviewed. The extent of disease was calculated from body surface area nomograms. RESULTS: All the 40 patients included in this study were males; their mean age was 52,75 years (21-75 years). Twelve patients (30%) had FG secondary to anorectal pathological conditions. No etiologic factors of FG were found in 6 patients (15%). Diabetes mellitus as predisposing factor was found in 13 patients (32.5%). The mean hospital stay was 8.72 days (range, 3 to 30). All the patients underwent surgical debridement. Orchidectomy was done in 7 cases (17.5%). Skin grafts were applied to 6 patients (15%) and the remaining wounds, once cleaned, were approximated. The overall mortality rate was 17.5% (7 patients) due to severe metabolic acidosis in relation to diabetic decompensation and sepsis. We individualized two groups: those who died (n = 7) and those who survived (n = 33). We evaluated the admission laboratory parameters that are significantly correlated with outcome included hematocrit (p=0.003) and serum sodium (p=0.05). The extent of body surface area involved among patients who died was not found significantly different statistically between the two groups (4.07% and 3,14%, p=0,4). The mean FGSIS (without counting bicarbonate serum level) for survivors was 9.1 compared with 6,8 for nonsurvivors (p=0.16). CONCLUSION: FG is a rapidly progressive, fulminant infection's condition. Hematocrit and serum sodium levels were found to be the only prognostic factors. It doesn't seem that the FGSIS has a prognostic value.

Soft tissues chondromas of the hand: a report of five cases.

Soft tissue chondromas are rare slowly-progressing benign tumours. We report 5 new cases of soft-tissue chondromas of the hand. The median age at the time of diagnosis was 38 years. The evolution ranged from one month to 5 years. Standard radiographs showed variable images depending on the degree of calcification. An excision biopsy was performed in all patients. A well encapsulated and limited tumour was found at surgery. Positive diagnosis was provided by the pathology examination. Simple excision-biopsy should suffice to treat the condition but care should be taken to make the excision complete in order to avoid recurrence.

[Glomus tumours of the hand. About 10 cases]. / Les tumeurs glomiques de la main. A propos de 10 cas.

BACKGROUND: The glomus tumour is a rare benign cutaneous tumour, it is characterized by its clinical and evolutive particular features. AIM: The aim of this work is to bring out the various characteristics of the glomus tumours of the hand which remain relatively ignored by practioners. METHODS: The authors report a series of 10 cases of glomus tumours of the hand, the mean age at the moment of diagnosis was 36 years with a female prevalence of 70% of the cases. The diagnosis delay average was 2 years and half. The tumour was located on the right side in 6 cases and on the left one in 4 cases. The glomus tumour was developed under the nail in 8 cases and was latero pulpar in the both other cases. The diagnosis of glomus tumour was clinical in front of the existence of the three painful symptoms: spontaneous pain, pain on the cold and pain on the pressure. An RMI complement was carried out for two patients having no univocal symptomatology what made possible to confirm the diagnosis and to locate the tumour. A surgical biopsy of the tumour was performed for all patients. The histological study confirmed our clinical and per operational presumptions and showed a glomus tumour. RESULTS: After one year and two months of average retreat, our patients announced a spectacular transformation of their daily activities because of the disappearance of painful symptomatology, two cases of nail dystrophia were noted and there was no recurrence. CONCLUSION: The glomus tumour are rare benign cutaneous tumours, its diagnostic is essentially clinical and the treatment is exclusively surgical.

[About a short series of Swanson arthroplasty]. / A propos d'une courte série d'arthroplastie de swanson.

The authors report a series of 12 patients who underwent digital arthroplasty using a swanson implant. Six patients had the sequellae of an injured hand, and the other six patients had rheumatoid arthritis. The majority of patients were men with an average age of 33 years. The patients were examined again about 4 years later on average. The lateral stability of the operated finger was considered to be satisfactory in 11 cases. The mean movement gain was 40 degrees. There was no sign of silicone particle synovitis, because it was fixed arthroplasty.

[Pathomimia in upper limb]. / La pathomimie au membre supérieur.

Pathomimia, or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considerd as a psychatric disorder, pathomimuia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms, A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements.