Skin Allograft after Bone Marrow Transplantation of Patient with Recessive Dystrophic Epidermolysis Bullosa.

In this study, we present a 26-year-old woman with case presentation of recessive dystrophic epidermolysis bullosa who had developed squamous cell carcinoma. The patient underwent bone marrow transplant and skin grafting with the same bone marrow donor. After excision of squamous cell carcinoma and skin grafting, no tumor was observed; thus, chemotherapy and radiation were no longer needed.

Distal Phalanx Intraosseous Epidermoid Cyst.

An intraosseous epidermal cyst is a benign cystic lesion that occurs in the bones. It is assumed to be caused by congenital causes or trauma, and because the cyst forms in the soft tissue surrounding the bone, it can lead to bone loss. Intraosseous epidermal cysts have a well-defined radiolucent lesion with cortical extension on radiography. Due to clinical and radiological signs being similar, it is vital to distinguish an intraosseous epidermal cyst from other diseases that develop at the distal phalanx. A rare example of intraosseous epidermal cysts at the distal phalanx is reported. We describe the clinical, radiological, and pathologic aspect of this lesion, as well as our current therapeutic strategy.

Rare complication of coupled VASER liposuction and Renuvion technologies: a case report.

This study presents the case of a women, who underwent VASER-assisted liposuction of the abdomen coupled with Renuvion skin tightening by J-Plasma for skin retraction. She developed pain and moderate surgical emphysema. Radiological findings showed moderate subcutaneous emphysema. There were no signs of viscus perforation, or pneumothorax.

Tibialis Anterior Muscle Hernia in a Young Woman.

Muscle herniation is defined as a myofascial defect resulting in protruding of the muscle through the fascia covering it. It can present anywhere in the body, the most common is the lower limbs. Tibialis muscle herniation is considered a rare entity with few reported cases. Here, we present the case of a 24-year-old Saudi female patient who complained of swelling and pain in the anterior aspect of the left leg for three months. She underwent surgical repair of the fascia with a good outcome. This case presentation aims to contribute to the literature on myofascial herniation by specifically addressing tibialis anterior herniation of the leg and emphasizing the importance of considering it a differential diagnosis in similar presentations. This report highlights the excellent surgical outcomes and satisfactory results in patients with muscle herniation.

A Rare Case of Painful Hand Swelling.

Many conditions are known to cause chronic wrist pain, one of which is accessory muscles which can be easily overlooked as the cause of pain. Here we present a case of chronic wrist pain in a 33-year-old male who presented with painful dorsal unilateral right-hand swelling associated with increased activity. This patient was referred to the radiology department and was found to have an accessory muscle along the dorsal aspect of the wrist consistent with the extensor digitorum brevis manus muscle. The report includes the clinical presentation, radiologic findings, and management.

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.

Challenging the Subcostal Incision Scar with the Two-staged Abdominoplasty: An Innovative Approach.

Abdominoplasty is a commonly sought-after procedure due to its life-transforming results, but is limited, as in any other operation, by a number of contraindications. One of these contraindications is a subcostal scar, which may jeopardize blood supply to the upper flap of the abdominoplasty, resulting in skin necrosis. Herein, we challenge this dogma by introducing the two-staged abdominoplasty with the utilization of a delayed flap in a 48-year-old multiparous woman presenting with a Kocher incision of open cholecystectomy, with good results and a complication-free course of 3 postoperative months. We recommend this approach in patients with subcostal scars. However, more research into the utilization of delayed flaps in abdominoplasty should be done to have a more well-founded conclusion.

Tongue Flap for Total Full Thickness Upper Lip with Vermillion Reconstruction: Case Report.

Lips play an important role in the function of the oral stoma. Lips also have a vital aesthetic role in the face. Lips are typically reconstructed by local, regional, or free flaps. Tongue flaps have been used for reconstruction of oral and palate defects resulting from congenital disorders, trauma, infection, and surgery. Because of its versatility, rich blood supply, and position, the tongue flap is reliable for defect reconstruction. In this study, we report a case of an upper lip full thickness defect managed with a tongue flap. The results were functionally and aesthetically excellent. To the best of our knowledge, this is the first attempt to reconstruct a full upper lip defect using the tongue.

The pedicled lateral forehead flap in reconstructing oral floor defect - The last resort; case report.

INTRODUCTION AND IMPORTANCE: Locoregional flaps, particularly the pedicled lateral forehead flap, are not usually used in reconstructing oral floor defects following oncologic resection. Rather, microscopic free flaps have evolved to be the standard of care in head and neck reconstruction. However, the pedicled lateral forehead flap could be valuable in floor of the mouth reconstruction in the absence of resources or other options. CASE PRESENTATION: A-56 years old lady with multiple comorbidities who underwent near total glossectomy, bilateral supraomohyoid neck dissection, and right lateral mandibulotomy due to a locally advanced lingual squamous carcinoma. The last resort was the pedicled lateral forehead flap after many unsuccessful reconstructive attempts utilizing the free anterolateral flap, free radial forearm flap, and pedicled pectoralis major flap. CLINICAL DISCUSSION: Decreased donor site morbidity and reliable anatomy are among many of the advantages that made free flaps favorable over locoregional pedicled flaps, especially in oral cavity defects coverage. Of the latter, the pedicled forehead flap, rich in vascularity and neighboring the oropharyngeal defects, could be used with different techniques and modifications. Close monitoring and patient condition optimization is required. CONCLUSION: Choosing a particular reconstructive option should be done considering the available resources and expertise and the patient's condition. The pedicled forehead flap remains valuable when other options are inappropriate or have failed.

Pedicled Abdominal Flaps for Hand Reconstruction in Adults: Physiotherapy of the Attached Hand.

Hand reconstruction using pedicled abdominal flaps has several disadvantages, including delayed hand therapy leading to stiffness. METHODS: This is a retrospective study of 70 cases of pedicled abdominal flaps used for hand reconstruction in adults in whom physiotherapy of the attached hand was implemented. The review aims to investigate the rate of flap dehiscence, infection, hematoma, and flap edge necrosis in our cases, and to establish that physiotherapy of the attached hand is not associated with an increased risk of complications. The review also aims to establish the effectiveness of physiotherapy of the attached hand in reducing the risk of stiffness by documenting the range of motion of the uninjured digits immediately after flap division and at final follow-up. RESULTS: There were no cases of flap dehiscence, infection, or hematoma. Six cases had minor partial flap edge necrosis that was treated conservatively and allowed to heal by secondary intention. In 62 patients, the range of motion of the uninjured digits was 90%-100% of the normal range of motion at day 1 post-flap division, and all of these patients recovered a full range of motion (in the uninjured digits) within 2 weeks of follow-up. Eight patients were reluctant to do the exercises as instructed because of low pain threshold; 4 of these 8 patients had residual stiffness at the final follow-up. CONCLUSION: The implementation of active exercises of the attached hand is feasible in selected cases and it helps minimize the risk of stiffness of the hand.

Gestational gigantomastia on a Saudi woman: A case report on surgical removal and reconstruction and management of complications, KFSH&RC.

INTRODUCTION: Gestational gigantomastia (GG) is a rare condition manifesting as a fast and excessive growth of the breasts in pregnant women. Its etiology is still unclear, with theories ranging from hormonal imbalances, unregulated immune response, to hypersensitivity. Medical interventions are mainly surgical in nature, though some pharmacological medications are of debatable efficacy. CASE PRESENTATION: A 33-year old Saudi gravida 3 para 2 presents continuous breast enlargement since the start of her pregnancy. She complains of skin ulcerations and discharge which was initially treated conservatively with topical antibiotics. Days after she came back with worsening GG symptoms, and was admitted for bilateral skin sparing mastectomy and reconstruction, and successfully recovered. The patient came back with problems concerning the surgical implant and wound infection. Emergency operation was performed for implant removal and wound treatment. Labor induction was performed by the OB-GYN on her 39 week. The patient opted for autogenous reconstruction by bilateral latissimus dorsi flap months after delivery. After treatment of minor surgical complications, the patient successfully recovered. DISCUSSION: Surgery is one of the most effective interventions for GG. Total mastectomy is preferred due to lesser risk of recurrence in subsequent pregnancies. Reduction mammoplasty offers the breastfeeding option if conducted before the delivery, but poses higher risk of recurrence in future pregnancies. CONCLUSION: The patient's gestational gigantomastia condition was complicated by several ulcerations and infections. Surgery was conducted alongside antibiotic treatment. This report also highlights the importance of follow ups in managing complications.

Surgical application of the keystone island flap for closure of thoracolumbar myelomeningocele defects - A case report.

INTRODUCTION: Myelomeningocele (MMC) is the most common neural tube defect that can occur due to neural tube's failure to fuse properly during embryonic life. To prevent this, keystone island flap can be used for closure of large MMCs. PRESENTATION OF CASE: A new-born girl born as a product of 36 weeks of gestation had a weight of 3.020 kg and had multiple congenital anomalies including hydrocephalus, thoracolumbar myelomeningocele at the level of (T10-L4) and an atrial septal defect. Preoperative evaluation showed a head circumference of 42 cm (n: mean 34.4 ± 2SD), no lower limbs movements and a thoracolumbar soft tissue defect around 4 × 8 cm with exposed neuronal tissue and prominent thoracic kyphosis, and no obvious urogenital or limbs anomalies. The large thoracolumbar myelomeningocele was treated at KFSHRC with a Keystone Design Perforator Island Flap (KDPIF) to reconstruct the soft tissue defect following the neurosurgical reconstruction. DISCUSSION: The keystone flaps were deemed as viable as all wounds were healed without any complications, such as flap necrosis, dehiscence, leakage of cerebrospinal fluid, or infection. The technique described in the case report offers a simple and effective method of wound closure in situations that would, otherwise, have required complex flap closure. CONCLUSION: This flap can be an effective method for reconstruction of large thoracolumbar MMC defects that might improve outcome and minimize complications. It also ensures good watertight closure with minimal wound tension and breakdown.

Chromosome 16p13.3 Contiguous Gene Deletion Syndrome including the SLX4, DNASE1, TRAP1, and CREBBP Genes Presenting as a Relatively Mild Rubinstein-Taybi Syndrome Phenotype: A Case Report of a Saudi Boy.

The classic Rubinstein-Taybi syndrome Type 1 (RSTS1, OMIM 180849) is caused by heterozygous mutations or deletions of the CREBBP gene. Herein, we describe the case of a Saudi boy with chromosome 16p13.3 contiguous gene deletion syndrome (OMIM 610543) including the SLX4, DNASE1, TRAP1, and CREBBP genes, but presenting with a relatively mild RSTS1 syndrome phenotype. Compared with previously reported cases with severe phenotypes associated with 16p13.3 contiguous gene deletions, our patient had partial deletion of the CREBBP gene (with a preserved 5' region), which might explain his relatively mild phenotype.

Radicular cysts and Chin implants; An unexpected complication prompting explantation - Case report.

INTRODUCTION: Implant-based genioplasty is a simple and safe but not complication-free cosmetic procedure. Patients are commonly briefed about anticipated complications and their management pre-operatively, but few unexpected complications may arise; and this case report is an example. This paper is the first to report a radicular cyst fistulating through chin implant pocket to the skin. Moreover, we present our prevention strategy and recommendations. PRESENTATION OF CASE: A 39-year-old-lady underwent a silicone implant-based genioplasty that was uneventful. Later, she developed a reddish nodule on the chin necessitating fistulectomy followed by a recurrence leading to explantation. It was not until the second recurrence that a fistulating radicular cyst was discovered and was treated with the help of a dentist. DISCUSSION: Radicular cysts are benign, inflammatory cysts that arise in a background of dental trauma or caries. No link has been discovered yet between silicone implants and radicular cysts or fistulating cysts. Moreover, we propose that poor oral hygiene could be implicated in the development of these cysts. Dental panoramic X-ray has been used to diagnose radicular cysts, but its efficacy as a screening tool needs to be studied. Finally, the recurrence rate of radicular cysts is unknown. CONCLUSION: In a patient with chin implant, radicular cysts could lead to a disastrous outcome. Through history and physical examination, a plastic surgeon should identify patients with poor oral hygiene and dental trauma prior to implant-based genioplasty to arrange for a dental panoramic X-ray. Patients known to have radicular cysts should not undergo an implant-based genioplasty.

Functional Subunit Reconstruction of Giant Facial Congenital Melanocytic Nevi in Children With the Use of Matriderm and Skin Graft: Surgical Experience and Literature Review.

Introduction: Facial giant congenital melanocytic nevus represents a major cosmetic deformity for the child and parents and is a challenge for the plastic surgeons to achieve best cosmetic results. Herein, we present a case of single-stage surgical reconstruction using partial-thickness scalp skin graft aided with Matriderm dermal substitute for a facial giant congenital melanocytic nevus. Methods: An 8-year-old boy presented with a facial giant congenital melanocytic nevus without leptomeningeal involvement. A single-stage complete excision of the nevus was performed. A split-thickness skin graft, 12/1000-inch thick, was then harvested from the anterior scalp region for reconstruction. A 1-mm Matriderm dermal substitute was first applied, on which functional subunit skin graft was then secured to cover the defect. Eyelid reconstruction was reconstructed separately using full-thickness postauricular skin grafts. Results: Histopathology of the excised specimen confirmed the diagnosis of congenital melanocytic nevus, with no evidence of melanoma. The donor area healed with a favorable scar and no donor site morbidity or complications such as alopecia or hypertrophic scar. The postoperative result was satisfactory with minimal residual nevus around the eye, and the patient was fully satisfied with the cosmetic and functional results. Discussion and Conclusions: Resection of facial congenital melanocytic nevi, followed by single-stage reconstruction using Matriderm and skin graft from the scalp, is an excellent and fast reconstructive method with promising aesthetic outcomes and greater improvement in physiological outcome, especially in the pediatric population.

Correction to: Characteristics and outcomes of obstetric brachial plexus palsy in a single Saudi centre: an experience of ten years.

The published online version contain mistake in article title. The correct title is "Characteristics and outcomes of obstetric brachial plexus palsy in a single Saudi centre: an experience of ten years".

Characteristics and outcomes of obstetric brachial plexus palsy in a single Saudi center: an experience of ten years.

BACKGROUND: Obstetric brachial plexus palsy (OBPP) is considered a rare, unpredictable, and unavoidable injury of the upper limb. In this study, we presented a retrospective cohort study over a period of ten years in King Faisal Specialists Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia, to assess the characteristics and functional outcomes of OBPP. METHODS: Between January 2005 and December 2015, we carried out 125 repairs of OBPP in KFSH&RC. Out of 71 girls and 54 boys, two babies died of unrelated causes, so they were excluded from the review. All medical records of the patients who attended OBPP clinic at KFSH&RC were reviewed, and relative data were extracted. Descriptive measures for categorical variables and categorical variables were presented. Student's t test and Pearson's χ2 test were used. The level of statistical significance was set at P ≤ 0.05. RESULTS: A total of 123 patients were included in the study with a mean follow-up of 6.1 ± 2.4 years. Of those, 71 (57.7%) were females. Mean age at presentation was 4.2 ± 2.7 months with a birth weight of 3965.9 ± 629.6 g. More than half of the patients (56.1%) sustained the injury in the right side, and 62 patients (50.4%) were classified as Narakas I. Most of the surgeries (96.7%) were nerve grafting. Only 32 (26.0%) patients needed one or more secondary interventions. In the last visit, the mean total score of Mallet was 16.6 ± 2.8. Also, passive external rotation in adduction improved to 38.3 ± 14.5. Last Raimondi hand function grade was 2 ± 1. DISCUSSION: Our experience demonstrated the value of primary and secondary surgeries in patients with OBPP. Also, we presented the patterns of injury in Saudi patients presented to KFSH&RC.

The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine.

Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms "professionalism" AND "duty" AND "assessment" OR "professionalism behavioural" AND "professionalism-cognitive" were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.