Hair Today; Scalped Tomorrow: Massive Subgaleal Haematoma Following Sudden Hair Pulling in an Adolescent in the Absence of Haematological Abnormality or Skull Fracture.

Subgaleal haematoma (SH) is a rare condition, most frequently observed in neonates as a complication of Ventouse-assisted delivery. There have been few patients reported beyond this period. Those that are present within the literature have typically resulted from significant blunt scalp trauma, with or without associated skull fracture. Those resulting secondary to relatively minor trauma, such as hair braiding or hair pulling, are rare but have been reported and are often associated with underlying haematological abnormalities or nonaccidental injury patients. Most patients resolve spontaneously and without complication. The authors report a rare patient of a delayed presentation of a massive SH in an adolescent following a seemingly innocuous episode of hair pulling whilst play-fighting, in the absence of any underlying haematological or anatomical abnormality. Due to the size of the SH and the appearance of large areas of calcification within the haematoma, early liaison with senior neuroradiologists and haematologists, to rule out underlying anatomical and haematological abnormalities, respectively, was essential to guide appropriate management. Our patient highlights the need for an awareness of the possible aetiologies of SH and the necessity of early active multidisciplinary team involvement in the management of such patients, which is critical to ensure optimum patient outcomes.

A liposuction technique for extraction of Bio-Alcamid and other permanent fillers.

Bio-Alcamid (Polymekon Research, Brindisi, Italy) is a permanent soft tissue filler that has been injected for the correction of contour deformities. It has a number of indications, including pectus excavatum. Infection and migration seem to be the most common complications with this product. The authors report an illustrative case of pectus excavatum deformity treated with Bio-Alcamid. Results highlight the successful treatment of gel migration with liposuction, which has not been recommended by the manufacturer nor reported in the literature to date.

CASE REPORT Acute Compartment Syndrome of the Forearm Following Blood Gas Analysis Postthrombolysis for Pulmonary Embolism.

OBJECTIVES: Acute compartment syndrome is an important condition with potentially serious consequences if not diagnosed and treated promptly. This report highlights a case of acute compartment syndrome of the forearm after radial artery blood gas analysis in a patient who had been thrombolyzed for a pulmonary embolus. Methods/Case Report: We present a case of a 54-year-old lady, admitted and treated for a pulmonary embolism with tenecteplase for thrombolysis. As per routine management, she had taken an arterial blood gas sample, which caused hematoma in the wrist and a few hours later developed pain and a tense right forearm being diagnosed with compartment syndrome. RESULTS: She underwent fasciotomies and subsequent split skin grafting. We discuss the different etiologies of compartment syndrome, clinical signs, and available investigations as well as immediate and definitive management options including fasciotomy techniques. We present the latest literature on the subject and extract valuable learning points from this case. CONCLUSIONS: With the common use of thrombolysis for the management of a myocardial infarction or pulmonary embolus, compartment syndrome is an uncommon but potentially associated problem. Furthermore, with blood gas sampling being part of daily clinical practice and a potential cause of this condition, the compartment syndrome becomes iatrogenic and potentiates serious litigation. As many junior doctors are performing blood gas analysis postthrombolysis, they need to assess patients adequately and realize the risk of possible sequelae such as compartment syndrome in this group and inform patients of such complications.

Necrotizing fasciitis versus pyoderma gangrenosum: securing the correct diagnosis! A case report and literature review.

OBJECTIVE: To highlight the key differences in history, examination, and management of pyoderma gangrenosum and necrotizing fasciitis and to outline the importance of distinguishing these 2 conditions. METHOD: We present a case report of a gentleman with a background of ulcerative colitis having a 1-week history of an erythematous wound and localized abscess to the right leg that failed to respond to antibiotic treatment and later on to surgical debridement of a presumed necrotizing fasciitis. Following referral to our plastic surgery unit, a diagnosis of pyoderma gangrenosum was made and this was confirmed following a response to steroid therapy within 48 hours. A literature review of pyoderma gangrenosum cases misdiagnosed for necrotizing fasciitis was carried out to compare and contrast pitfalls in misdiagnosing these 2 conditions. RESULTS: Literature review of 10 cases confirmed the association of pyoderma gangrenosum with inflammatory bowel disease, hematological disease, and surgical trauma. The presence of necrotic tissue in a pyoderma gangrenosum lesion can be a diagnostic pitfall; although blood and tissue culture investigations are usually negative in pyoderma gangrenosum, this may not always be the case. Inflammatory markers can be significantly high in pyoderma gangrenosum and pyrexia is not a feature limited to necrotizing fasciitis. CONCLUSIONS: Inappropriate surgical debridement of pyoderma gangrenosum can cause rapid extension of the lesion by enhancing the posttraumatic response and lead to potential reconstructive challenges with psychological repercussions. On the contrary, treating necrotizing fasciitis with immunosuppressive therapy may worsen the condition. The importance of understanding the pathogenesis, clinical features, and management of both conditions cannot be overemphasized.