Ossifying fasciitis at an extraordinary site - a case report and analysis of diagnostic pitfalls.

Ossifying fasciitis is a very rare disease of reactive character; however, it can mimic malignant lesions, especially osteosarcoma. We report a case of a 30-year-old woman, who experienced a rapidly growing painful lesion of the left knee joint, preceded by a trauma. The tumor was resected, and the histopathological image suggested a malignant lesion with features of an osteosarcoma. A detailed correlation with a clinicopathological and radiological analysis led to the final diagnosis of ossifying fasciitis at an extraordinary site of patellar retinaculum. Our case shows that the close similarity between ossifying fasciitis and osteosarcoma may be challenging.

The use of dCELL (decellularized human dermis) for primary and revision hypospadias repair: A case-control study.

INTRODUCTION: A dartos interposition flap is often used as a waterproofing layer in hypospadias repairs. Recently, acellular dermal matrices (ADMs) have been described as an alternative. In this case-control study we compare the outcomes of using dCELL (an ADM) with dartos flap. METHODS: A retrospective, case-control study was conducted, comparing the use of dCELL in primary and revision cases to controls. Patients were matched according to age and surgical technique. Data were analysed using an independent t-test. RESULTS: 13 patients undergoing primary distal hypospadias repair using dCELL as an interposition layer were matched with 13 controls. There was no significant difference in the number of complications between the groups (p = 0.296). 5 patients undergoing revision surgery using dCELL were also matched in the same way. Although a statistically significant lower complication rate was shown in the dCELL group compared to controls (p = 0.029), this may represent a type II error due to the small sample size and heterogeneity. CONCLUSION: Using dCELL as an interposition layer was not associated with any reduction in complication rates for primary distal hypospadias repair and possibly useful in soft tissue-deficient reoperative cases. However, larger randomised controlled trials may be needed to confirm the presence (or absence) of any benefit from using dCELL in hypospadias surgery.

A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective.

BACKGROUND: Studies have suggested that targeted muscle reinnervation (TMR) can improve symptoms of neuroma pain (NP) and phantom limb pain (PLP) in patients. OBJECTIVES: Our primary objective was to measure changes in NP and PLP levels following TMR surgery at 4-time points (baseline, 3, 6- and 12-months postoperatively). Secondary aims included identification of the character and rate of any surgical complications and patients' satisfaction with TMR. METHODS: A retrospective review of outcomes of 36 patients who underwent TMR surgery to treat intractable NP and/or PLP after major amputation of an upper (UL) or lower limb (LL) at a single centre in London, UK over 7 years. The surgical techniques, complications, and satisfaction with TMR are described. RESULTS: Forty TMR procedures were performed on 36 patients. Thirty patients had complete data for NP and PLP levels at all pre-defined time points. Significant improvements (p<0.01) in both types of pain were observed for both upper and LL amputees. However, there were varying patterns of recovery. For example, UL amputees experienced worsening of PLP in the first few months post-operatively whereas surgical complications were more common in LL cases. Patients were overwhelmingly satisfied with the improvements in their symptoms (90%). CONCLUSIONS: TMR surgery appeared to relieve both NP and PLP although the retrospective nature of this study limits the strength of this conclusion. However, complication rates were high, and it is crucial for surgeons and patients to fully understand the course and outcomes of this novel surgery prior to undertaking treatment.

Earfold™: A combined approach with conchal bowl reduction.

BACKGROUND: Prominent ear deformity is common amongst the human population and is partly due to underdevelopment of the antihelical fold, a prominent conchal bowl, or both. Recently, the senior author described a minimally invasive technique for changing the shape of the antihelical fold using the Earfold™ implant (Allergan plc, Dublin, Ireland). However, there is still a paucity of data regarding outcomes from combing this approach with surgical techniques to correct conchal bowl hypertrophy. OBJECTIVES AND METHODS: Questionnaire-based study evaluating outcomes in consecutive patients undergoing treatment with Earfold™ and conchal bowl reduction. Patient reported outcome measures were assessed with a validated questionnaire. Data on complications were obtained from the patient's case notes and free-text sections of the questionnaire. RESULTS: Completed questionnaires were received from 8 patients out of a total of 18 who underwent the combination treatment (44% response rate). Statistically significant differences were noted in nearly all questions (18/19) relating to changes in ear appearance as a result of the surgery, with all patients being satisfied following the combined procedure. Improvements in subjective outcomes were compared to previous studies evaluating treatment with Earfold™. CONCLUSIONS: The Earfold™ implant can be combined safely with other otoplasty techniques to achieve a good outcome in a carefully selected patient population.