ABSTRACT
Leprosy (Hansen's disease) is a multisystem, chronic infectious disease that still exists. It is caused by Mycobacterium leprae. Musculoskeletal features are non-consistent and can lead to misdiagnosis and mistreatment. We report the case of a 23-year-old male with the right small finger (RSF) proximal interphalangeal (PIP) joint arthropathy related to leprosy. This was his first encounter with seeking medical advice regarding his condition. The patient was diagnosed and treated with surgical debridement, volar plate arthroplasty for the affected proximal interphalangeal joint, and the recommended multi-drug therapy regimen. The pathological effects of leprosy on the bones and joints have been attributed to several theories, with peripheral nerve neuropathy being the primary cause. Early detection of leprosy is crucial for effective management, preventing further disease transmission, and minimizing the risk of developing complications.
ABSTRACT
Lipofibromatous hamartoma (LFH) is a rare benign peripheral nerve tumor. The median nerve (MN) is most commonly affected in the upper extremity. We report a case of a 39-year-old male with LFH of the median nerve presented with swelling and symptoms of carpal tunnel syndrome treated successfully with decompression. LFH is reported with various descriptions because of the proliferative nature of its adipocytes and the fibrofatty infiltration within the peripheral nerves. Swelling around the volar aspect of the wrist remains the most frequent presentation of LFH. Surgical decompression without tumor resection can result in symptom improvement. In addition, post-decompression nerve coverage can be a solution to improve the residual hyperesthesia symptoms.
ABSTRACT
Although obesity is a preventable disease, maintaining a normal body weight can be very challenging and difficult, which has led to a significant increase in the demand for surgical subcutaneous fat removal (SSFR) to improve physical appearance. The need for SSFR is further exacerbated because of the global rise in the number of bariatric surgeries, which is currently the single most durable intervention for mitigating obesity. Fat tissue is now recognized as a vital endocrine organ that produces several bioactive proteins. Thus, SSFR-mediated weight (fat) loss can potentially have significant metabolic effects; however, currently, there is no consensus on this issue. This review focuses on the metabolic sequelae after SSFR interventions for dealing with cosmetic body appearance. Data was extracted from existing systematic reviews and the diversity of possible metabolic changes after SSFR are reported along with gaps in the knowledge and future directions for research and practice. We conclude that there is a potential for metabolic sequelae after SSFR interventions and their clinical implications for the safety of the procedures as well as for our understanding of subcutaneous adipose tissue biology and insulin resistance are discussed.
Subject(s)
Bariatric Surgery , Insulin Resistance , Humans , Obesity/surgery , Subcutaneous Fat/surgery , Bariatric Surgery/adverse effects , Adipose TissueABSTRACT
Background: Posterior neck defects are uncommon and are mainly caused by infections or tumors. Consequently, the reconstruction options are limited in the literature. They vary according to the size and type of the defect, and options range from grafts to free flaps. In this article, we present a series of cases where we used a transpositional locoregional flap as a simple and effective way for the coverage of posterior neck defects. Materials and Methods: In a series of 11 patients, we designed locoregional transpositional flaps unilaterally or bilaterally, according to the defect size. Dissection was carried on a subfascial plane. Results: All flaps survived without necrosis. We had two incidents of minimal wound gaping that healed without any intervention. Conclusion: In this series, we introduce a new option and its algorithm to reconstruct moderate-sized posterior neck defects using locoregional transpositional flaps, either unilaterally or bilaterally. It is simple, easy to conduct, and has a better color match and less complication rate than other options mentioned in the literature.
ABSTRACT
BACKGROUND: Recurrent ptosis may occur after mastopexy procedures over time. The volume distribution mastopexy technique provides breast lifting with projection enhancement and maintains breast suspension. METHOD: Since 2010, 50 patients underwent volume distribution mastopexy procedures. The technique consists of a superior or superomedial pedicle, dissection of a Würinger-septum-based chest wall flap, suspension of the flap to the pectoralis major muscle using a prosthetic mesh, gland suture to the mesh, and fat grafting if required. A prospective study was conducted. Nipple position and length of the lower pole distance of the breast were noted. Patient satisfaction and results evaluation were reported using a Likert scale. RESULTS: A Vicryl mesh was used in the first 23 patients and a mixed polyester/Vicryl mesh was used in the following 27 patients. Wound dehiscence occurred in one patient. At an average follow-up of 3 years, nipple position remained stable in position, but lower pole distance elongation was observed in five patients (20 percent) and in one patient (3 percent) who had Vicryl mesh and mixed mesh respectively (p < 0.05). Only four breasts (4.7 percent) demonstrated significant lower pole elongation over time (>15 percent), all in the Vicryl mesh group. Worth noting, both the patients and the independent evaluators provided high ratings of the result of 4.7 and 4.6, respectively, on a Likert scale. CONCLUSIONS: The volume distribution mastopexy technique repositions the ptotic gland with a mesh to suspend the breast gland and to maintain the lifting effect. However, the synthetic mixed mesh proved to be significantly more effective in achieving this goal. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.