Digital workflow for fabrication of bespoke facemask in burn rehabilitation with smartphone 3D scanner and desktop 3D printing: clinical case study.

We present a digital workflow for the production of custom facial orthosis used for burn scar management using smartphone three-dimensional (3D) scanner and desktop 3D printing. 3D facial scan of a 48-year-old lady with facial burn scars was obtained. 3D modeling with open-source programs were used to create facemask then 3D printed using rigid polylactic acid (PLA) filament and semi-rigid thermoplastic polyurethane (TPU). Conventional facemask was used as a control. Each mask was worn for 7 days. Primary outcomes were level of comfort, and adherence to treatment. The conventional facemask was the most convenient followed by the TPU-facemask (mean comfort score of 9/10 and 8.7/10, respectively). Patient's compliance was high for both TPU and conventional masks, each was worn for at least 21 hours/day for 7 days. On the contrary, PLA-facemask was not well tolerated. The proposed digital workflow is simple, patient-friendly and can be adopted for resource-intensive healthcare.

An Unusual Presentation of Large Glomangioma of the Hand.

Glomangiomas are rare and benign hamartomas that commonly occur in the upper extremities. It is not typical for benign glomangiomas to be larger than one centimeter in size, and they usually present as a faint, blue-red subungual papule associated with a triad of symptoms of paroxysmal pain, pain with cold exposure, and tenderness to touch. We herein report a case of a 72-year-old man with multiple comorbidities presented to our clinic as a case of right-hand middle finger swelling for the past five years. Initially, it was not painful. However, the pain became more noticeable when he lowers his hand, and it was relieved when he kept it elevated. There were no skin changes around it with minimal tenderness over the swelling. Hand MRI demonstrated a well-defined small lobulated nodule at the radial aspect of the middle finger, at the level of the middle phalanx with no invasion to an adjacent structure. Surgical excision was done and the patient was diagnosed by histopathology to have glomangioma. Glomangiomas, also known as glomus tumors, are rare and benign hamartomas that commonly occur in the upper extremities. The hand is the most common site for glomus tumors, particularly the subungual area, the lateral aspect of the digits, and the palms. Female patients are the most common to present with subungual glomangioma. Multiple papers reported different presentations, and due to the rarity of the conditions and overlapping in clinical and imaging characteristics with other conditions, it was challenging to diagnose. Such atypical cases must be approached with high clinical suspicion and proper imaging and investigations so as to not delay diagnosis and management.

Smartphone-assisted Augmented Reality in Craniofacial Surgery.

Augmented reality (AR), a blending of both the physical and digital worlds, can be a valid tool for surgeons wishing to plan interventions and attain symmetry. The use of technology has enabled physicians to achieve desirable results. In this article, we describe a method that uses smartphone's simple AR utilities for convenient, cost effective, and time saving perioperative planning. METHODS: Images of preoperative computed tomography, along with 3D reconstructed scans were uploaded to a smartphone and used in an affordable application (Camera Lucida) to superimpose the loaded pictures over the smartphone camera. In one case, a 3D computed tomography scan of the skull was mirrored to help guide fronto-orbital advancement, and in another case the loaded 3D reconstructed computed tomography scan was used to prioritize areas of scalp coverage in a complicated case of craniosynostosis with major scalp wound dehiscence. DISCUSSION: Adaptation of AR to assist in the field of craniofacial surgery has been introduced before in several studies that reported the use of computer-based guidance for cranial reshaping. The majority of these reports used sophisticated modalities, combining advanced image registration and tracking with specialized equipment. The utility of smartphone AR for cranial vault reconstruction provided good accuracy when visualizing fronto-orbital advancement and remodeling, together with in depth prioritization of areas in need of soft tissue reconstruction. CONCLUSION: Smartphone AR adaptation proved to be a very convenient tool assisting in the planning of different craniofacial conditions that are time saving and do not incur any additional fees beyond those of the surgery.

The Utility of Double Opposing Transposition Flaps in the Management of Inguinal Ectopic Scrotum: Surgical Experience and Literature Review.

An ectopic scrotum (ES) represents a rare developmental anomaly of the male genitalia. The condition usually represents a part of a wide spectrum pathology associated with other anomalies. The different locations in which an ectopic scrotum is found include inguinal, suprainguinal, infrainguinal, and/or perineum. There are several surgical techniques described in the literature related to the management of ES, but none of them showed superior results. We present a rare case of ectopic hemiscrotum managed as part of a multidisciplinary team approach, showing the utility of double opposing transposition z-plasty flaps in managing such a case.

Pseudotumor of hemophilia of the thumb.

[No Abstract Available].

A successful surgical treatment of a closed rupture of flexor digitorum superficialis in surgeon's hand. A case report and review of literature.

INTRODUCTION: Isolated closed rupture or avulsion of the flexor digitomm superficialis (FDS) tendon at its insertion is a rare diagnosis. It can be related to a pathology such as rheumatoid arthritis, bony abnormalities, tenosynovitis, fractures, or tuberculosis. A review of the literature identified only few cases of closed avulsion or rupture of FDS tendons nonpathologically. We hope this report will help to gather more experience for the surgical intervention in a delayed presentation of ruptured flexor digitorm superficialis tendon. The work has been reported in line with the SCARE criteria. PRESENTATION OF CASE: We report a case of 48-year-old surgeon who sustained a trauma to her left middle finger. The patient presented three months after injury with complaints of pain and decreased range of motion of involved digit. Patient was treated conservatively and after failure of conservative treatment surgical intervention was done with complete tendon excision and capsulotomy of Proximal interphalangeal joint. Patient retained full range of motion and pain subsided. DISCUSSION: Isolated closed avulsions or rupture of the FDS tendon is a challenging entity in hand surgery in diagnosis and treatment. Nonsurgical treatment with splinting and physiotherapy might help to prevent flexion deformity. The surgical treatment include tenolysis, flexor digitorum superficialis tendon excision, and in selected patients capsulotomies of involved joints. CONCLUSION: A review of the literature identified only few cases of closed avulsion of FDS tendons nonpathologically. Early diagnosis and intervention can prevent sequel of flexion contracture.

Primary actinomycosis of the big toe: a case report and literature review.

Actinomyces are Gram-positive branching bacteria that are part of the human gastrointestinal microflora. These organisms can cause actinomycosis, which is a slowly progressive suppurative infection involving the cervicofacial region. Primary involvement of extremities is very rare. Here, we present primary actinomycosis of the lower extremity and a review of related literature. A 35-year-old female from Al-Kharj City (agricultural area) presented to our plastic surgery clinic with complaints of a large mass on the left big toe that caused embarrassment and difficulty in wearing footwear. The patient underwent wide local excision and coverage of the big toe defect with Kutler bilateral V-Y advancement flaps. A high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions. Proper surgical intervention and antimicrobial are essential to treat the disease. We conclude that a high index of suspicion is required to diagnose actinomycosis in subacute or chronic inflammatory soft tissue lesions.

Trans-styloid, trans-hamate dorsal lunate dislocation: A case report.

INTRODUCTION: Lunate dislocation is a rare and serious injury, frequently due to high-energy trauma such as a fall from height or a motor vehicle accident. Lunate dislocation is usually in the volar direction; however, dorsal dislocation of the lunate is extremely rare. PRESENTATION OF CASE: We report a case of 55-year-old male who sustained a high-energy trauma; he was hit by a car while crossing the street. The patient was referred to department of Plastic Surgery for left wrist dorsal dislocation of the lunate and bilateral multiple carpal bone fractures. He was managed by open reduction and internal fixation with scapholunate ligament repair for the left wrist, while the right wrist was treated conservatively. DISCUSSION: Such cases must be treated urgently to avoid complications such as avascular necrosis of the lunate, median nerve injury, complex regional pain syndrome, and chronic carpal instability. CONCLUSION: This case is one of few cases reported in the literature highlighting the rarity of this injury pattern.

Fibro-osseous pseudotumor of the digit: Case report and surgical experience with extensive digital lesion abutting on neurovascular bundles.

BACKGROUND: Fibro-osseous pseudotumor (FOPD) of the digit is a rare benign lesion of subcutaneous tissue characterized by fibroblastic proliferation and osteoid formation. Herein, we present a case of massive FOPD lesion in the base of ring finger with extensive involvement of the neurovascular bundles with challenging surgical approach. CASE DESCRIPTION: A 27-year old female patient, presented with 7-months history of a progressively enlarging mass on her left hand. Upon assessment, the mass was located over the proximal phalanx of the left ring finger with extensive involvement of the 4th web space. Her neurovascular examination was normal. Radiological investigations showed partial involvement of the radial sided bundle together with complete involvement of the ulnar sided neurovascular bundle. The patient was bothered by the mass being painful with overlying skin ulceration. She was taken afterwards to the operating room where the mass was dissected freely from those bundles while preserving the radial and ulnar structures. The resected margins were however, positive for residual lesions due to the extensive nature of the mass. The patient was informed about the need for close follow-ups for both clinical and radiological signs of lesion recurrence pending early surgical intervention. CONCLUSION: FOPD although benign, a soft tissue osteosarcoma is one of the differential diagnosis. Meticulous attention to the clinical, pathological and histological features of FOPD is required. Early diagnosis and treatment of FOPD is very crucial in optimizing the overall outcome. Pre-operative planning with various radiological modalities was of great help anticipating the surgical course.