The inflatable carrot-An orthosis for fingertip wound healing in flexion contractures of the hand: A case report.

STUDY DESIGN: Case report. INTRODUCTION: Severe flexure contractures of the hand secondary to upper limb spasticity (ULS) cause pain, palmar hyperhidrosis, ulceration, and nail plate deformities. Nonoperative management includes traditional orthotic devices that can be very painful for severe contractures and Botox injections, which provide a temporary solution. Surgical treatment comprises of soft tissue releases, tendon transfers, and release of the flexor and intrinsic muscles, which can cause permanent functional problems. CASE DESCRIPTION: In a 28-year-old male, unfit for surgery, we present the first documented case report in literature of flexion contractures of the hand secondary to upper limb spasticity managed using the "Inflatable Carrot" orthosis, where other conservative measures failed. RESULTS: At 4 weeks, the pulp to palm distance improved from 0 to 2 cm. At 3 months, the patient regained normal nail plate architecture, improved hand hygiene, reduced infection and pain. The patient reported improved psychological well-being and motivation to engage further with our therapists. CONCLUSIONS: The inflatable carrot provided an alternative nonsurgical solution for management of flexion contractures of the hand when surgical intervention was not considered in the patient's best interests. Awareness of this orthosis among hand therapists and surgeons will broaden our armamentarium for this challenging clinical problem.

Histological Peripheral Margins and Recurrence of Melanoma In Situ Treated with Wide Local Excision.

BACKGROUND: The incidence of melanoma in situ (MIS) is increasing faster compared to invasive melanoma. Despite varying international practice, a minimum of 5 mm surgical excision margin is currently recommended in the UK. There is no clear guidance on the minimum histological peripheral clearance margins. AIM: This study compares the histological peripheral clearance margins of MIS using wide local excision (WLE) to the rate of recurrence and progression to invasive disease. METHODS: A retrospective single-center review was performed over a 5-year period. Inclusion criteria consisted of MIS diagnosis, ≥16 years of age, and treatment with WLE with curative intent. Those patients with a recurrence of a previous MIS or with a reported focus of invasion/regression were also included. Clinicopathological data and follow-up were recorded. RESULTS: 167 MIS were identified in 155 patients, 80% of which were lentigo maligna subtype. Of patients with completely excised MIS on histology (>0 mm), 9% had recurrence with a median time to recurrence of 36 months. Three (1.8%) cases recurred as invasive disease. Age, MIS site, MIS subtype, and histological evidence of foci of invasion/regression did not predict recurrence nor progression to invasive disease (p > 0.05). The recurrence rate of MIS with a histological excision margin ≤3.0 mm was 13% compared to 3% in those with histology margins of >3.0 mm (p=0.049). CONCLUSION: A histological peripheral clearance of at least 3.0 mm is advocated to achieve lower recurrence rates. The follow-up duration should be reviewed due to the median recurrence occurring at 36 months in our cohort. Cumulative work on MIS needs to be collated and completed in a large multicenter study with a long follow-up period.