Traumatic bilateral medial patellar instability in a 15-year-old girl.

Introduction: Patellar dislocation encompasses the 2-3% of the knee joint injuries, and lateral patellar luxation is by far more common than the medial one. Medial patellar dislocation is described only by few reports and generally as a consequence of previous surgeries. The purpose of this case report is to describe the surgical management of a rare case of traumatic bilateral medial patellar dislocation in a 15-year-old girl with no previous patellofemoral surgeries. Case Report: The patient underwent a traumatic medial patellar dislocation on the left knee, and 18 months later also on the right one. In both cases, the first proposed treatment was a conservative therapy, encompassing the use of a brace and muscular imbalance correction. After a 6-month period, the patient still referred to the persistent sensation of "giving away," so surgery was advised. The surgical operation consisted of an open medial retinacular release with complete dissection of the hypertrophic medial patellofemoral ligament and a transfer of the vastus medialis oblique to the superior border of the patella. Seven years after surgery, the patient declared to be satisfied with the procedure, referring only slight difficulty in squatting, jumping, and running. So far, no further episodes of dislocation occurred. Conclusions: The present case report showed the favorable result of surgical correction of a unique case of bilateral non-iatrogenic medial patellar luxation, in the absence of any underlying bony-structural abnormality. No other papers dealing with medial traumatic bilateral patellar dislocation are found in current literature.

Giant congenital nevi of the scalp and forehead treated by skin expansion.

Congenital giant melanocytic nevi of the scalp and forehead are rare lesions present at birth. These lesions are associated with risk of malignant transformation, but they primarily represent a psychological problem to both patient and parents and merit early excision and reconstruction. In this study we report our own experience: seven patients, aged 8 months to 9 years, with congenital pigmented nevi involving forehead and scalp, and a 4-year old patient with congenital pigmented nevus of periorbital region and nose were treated successfully with excision and expanded skin flap reconstructions. The mean expansion procedures were 2 (range, 1 to 3), with an average of 8,8 injections for each expansion procedure (range, 6 to 11). In only one patient simultaneous expanders were placed in the scalp and forehead. Follow-up ranged from 4 months to 15 years. We had no rupture, extrusion or infection of the skin expanders. Complications included eyebrow ptosis and asymmetry in two patients underwent correction at a final procedure. In our opinion tissue expansion is an excellent technique for the treatment of giant nevi of the scalp and forehead because it offers the best aesthetic and functional outcomes.