Skin Preservation in the Debridement of Necrotizing Fasciitis: A Demonstrative Case Report.

Necrotizing fasciitis (NF) is a rare yet potentially fatal soft-tissue, polymicrobial infection. Aggressive debridement of the fascia and overlying skin as well as antimicrobial coverage constitute the mainstay of management, often leaving large skin defects. However, we demonstrate in this paper a case of a young woman who developed NF after liposuction and was treated by fascial debridement with minimal skin excision. Skin preservation will reduce the morbidity and improve the final aesthetic outcome.

Simultaneous Central Slip and Volar Plate Injuries at PIP Joint: A Novel Therapeutic Approach.

BACKGROUND: Central slip and volar plate injuries rarely occur in the same finger, with only two cases previously reported in published literature. In these two patients, both teenagers, two highly distinct protocols were used. Here, we report a third case involving a 51-year-old gentleman who closed a door on his left third finger. METHODS: Because the fractures were noncomminuted and only minimally displaced, he was treated nonsurgically using a multi-step process of splinting to prevent impairment of either proximal interphalangeal joint extension or flexion, combined with active range of motion exercises. This included five weeks of splinting in neutral, 24-hour daily use of a proximal interphalangeal dorsal block, followed by active range of motion exercises combined with nocturnal splinting using a PIP volar block over the next 7 weeks, with relative motion and Joint Jack splints added over the final 4 of these 7 weeks. RESULTS: Twelve weeks after initial splinting, the patient's finger was pain free, with swelling largely resolved, normal extension (-10 degrees) and near-normal flexion (95 degrees) achieved, and full function restored. The patient was very satisfied with the result. CONCLUSIONS: Ours is just the third case of concomitant central slip and volar plate injuries reported in the literature. Other surgeons are strongly encouraged to publish similar cases, approaches, and results, as clinical wisdom can sometimes be gleaned from even a small number of well-documented clinical cases.

Multiple bilateral trigger fingers in a child with neurofibromatosis type I following an acute viral infection: A case report.

INTRODUCTION: Triggering of the fingers in children is an uncommon entity. A review of the literature on the topic did not reveal any reports of multiple triggering in patients with neurofibromatosis. CASE REPORT: Our patient is a known case of neurofibromatosis type I (NF 1). At the age of 4 years, the child required chemotherapy to treat symptomatic bilateral optic glioma. Chemotherapy was complicated by severe viral upper respiratory tract infection with concurrent multi-joint synovitis and mild triggering of the fingers. A second course of chemotherapy was required 2 years later. This was also complicated by a viral infection, joint synovitis, and worsening of the triggering. Surgical release of the A1 and part of the A2 pulleys was curative. DISCUSSION: Two factors contributed to the development of multiple triggering in our pediatric patient. The NF 1 itself predisposes to fibrosis. The second factor is the synovitis that accompanied the acute viral infection. CONCLUSION: We report on a case of multiple bilateral trigger fingers in a child with NF 1 following an acute viral infection and discuss the pathogenesis.