Trauma-induced dual-plane hemangioma in the hand: A case report.

INTRODUCTION AND IMPORTANCE: Hemangioma is a neoplastic disorder of vascular structures that can manifest at any site of the body. It is a rare ailment in general, and the intramuscular type is particularly uncommon and accounts for approximately 1 % of all hemangiomas. The presentation of hand hemangioma differs from other sites due to the restricted space and compression of vital structures, which frequently manifests as pain and functional impairment alongside mass. In this article, we present a case of trauma-induced dual-plane hemangioma in the hand. CASE PRESENTATION: A 55-year-old right-handed individual, without any significant medical background, sought medical attention for a painful mass on his right hand that had developed over the past year. He indicated a history of blunt trauma to the hand, with the mass becoming apparent two months post-injury. With the growth of the mass, the severity of pain progressively escalates; however, there is no loss of function observed. The diagnosis was established through duplex ultrasonography, and the patient received surgical excision utilizing the WALANT technique. Intraoperatively, the hemangioma was identified in two planes: one beneath the skin over the thenar eminence and another within the adductor pollicis muscle. The follow-up period proceeded without any complications or recurrence of the condition. CLINICAL DISCUSSION: Hand hemangiomas are relatively rare, and a history of trauma may lead to misdiagnosis as other conditions. There are various management strategies that are not suitable for hand hemangiomas. While surgical excision can alleviate symptoms, it carries the risk of increasing disability if muscle tissue is excised. CONCLUSION: Trauma-induced dual-plane hemangioma in the hand is a phenomenal condition that has been successfully treated surgically. Despite the removal of a portion of the adductor pollicis, both functional and aesthetic satisfaction was achieved. Hence, it is advisable to employ surgical management for such a presentation.

Re-innovation of split lateral gastrocnemius muscle flap for complicated proximal tibia open fracture: Case report.

INTRODUCTION AND IMPORTANCE: Maintaining mobility and hence the productivity of individuals depends on the preservation of lower limb integrity. Increasing violence, mainly triggered by weapons, inversely impacts limb functionality, and the resulting wounds require proper care. CASE PRESENTATION: A 47-year-old African man without any previous medical conditions experienced an injury to his right leg from a high-speed accident, resulting in an open fracture in the upper third of the tibia with missing tissue. At first, he received care from orthopedic surgeons and had debridement done along with the use of an external fixation device to stabilize his limb. Two weeks later, he was referred to the plastic surgery unit and was preparing for urgent surgery. A split lateral gastrocnemius muscle flap was used to reconstruct him after a surgical debridement. CLINICAL DISCUSSION: Proximal leg trauma can be managed successfully by rearrangement of local tissue, resulting in a perfect outcome with less donor site morbidity and a long, complex surgery compared to free tissue transfer. Gastrocnemius muscle or myocutaneous flap, is a gold standard for proximal leg trauma, mainly when a cavity exists, and it is able to create satisfactory reconstruction. CONCLUSION: The split lateral gastrocnemius muscle flap is an effective modification of the flap, resulting in greater surface area coverage, less bulk and shape distortion, and reliable blood supply. Furthermore, it is easy to harvest and apply, deferring the need for step-curve microsurgical procedures.

Retrospective cross-sectional study to evaluate outcome of loco-regional flaps in head and neck reconstruction in Sudanese patients.

Introduction: The soft tissue of the head and neck region poses both esthetic and functional aspects and must be retorted simultaneously, as any defect will be easy recognizable and will affect the quality of patient's life. Reconstruction by local- regional flap still the most popular approach used and outcome also better than other options. Objectives: To assess the outcome of loco-regional flaps in head and neck reconstruction in Sudanese patients. Patients and methods: Retrospective cross-sectional, multicenteric study (Soba University Hospital, Khartoum North Teaching Hospital and an associated specialized hospital) - Khartoum, Sudan, 84 patients underwent head/neck reconstruction during the period from 2017 up to 2021 were included. Results: Out of 84 patients, 47.6% were female and 52.4% were male. The etiology of head and neck defects in the majority (69%) was neoplastic, and in 11.9% it was trauma. According to site of defect, in 23.8% of patients was Cheek unit, 21.4% was nasal site, and 16.7% was neck site. Surgery in 85.7% of patients were primary, while in 14.3 was delayed. Fasciocutaneous flaps were used in 64.3%, followed by myocutaneous flap in 28.6%; functional outcome was excellent in 61.9%, adequate in 35.7%, and was inadequate in only 2.4%. The majority of patients 66.2% did not develop any complications. Conclusion: Loco-regional flaps are ideally useful in covering head and neck defects. It has an acceptable esthetic and functional outcome in the majority of cases. It can be considered as a reliable option for reconstruction especially in resource constrained centers.

Case report of substantial reconstruction of second ray segment by osteo-tendo-cutaneous pedicled radial forearm flap.

Introduction and importance: The hand is one of the most vital organ that the surgeon aims to preserve its function and natural appearance. Gunshot injuries are common, especially in a war zone, and unfortunately, they create complex wounds that are hard to reconstruct and infection is very common. In this article, we report rebuilding segment of index finger with a pedicled osteo-tendo-cutaneous radial forearm flap. Case presentation: A 50-year-old man-African with no past medical comorbidities, sustained trauma to his left index finger by high-velocity injury that led to composite tissue loss including metacarpal and proximal phalanx. After applying the initial irrigation and dressing to the wound, his hand was supported by a volar cast then he was referred to the hospital. The hand was examined at the operation room and the index finger was found to be hanged with a medial skin pedicle with necrotic and exposed bone and tendon. He underwent a session of debridement followed by reconstruction using a pedicled osteo-cutaneous radial forearm flap accompanied with metacarpophalangeal joint arthrodesis. Clinical discussion: A significant number of war-related hand injuries resulted in amputations because there were not enough facilities or doctors. While they are alternatives to free flap, abdominal and regional flaps won't yield the same outcomes. The second ray of the hand is reshaped using a radial flap, producing an acceptable result. Conclusion: The Radial forearm flap was used to reconstruct segment of index finger and fulfill our requirements, which include bone, tendon, and skin cover. Additionally, this is a simple and single stage procedure and micro-surgical equipment is not necessary.

Modified intermittent low negative pressure wound therapy for complex injuries: A case series.

INTRODUCTION AND IMPORTANCE: Combat wounds can be difficult to manage and can lead to disfigurement and infection. The closure of these wounds is crucial, as delayed closure also increases the risk of further complications. Military medicine has introduced negative pressure wound therapy, which modulates wounds perfectly through the microscopic and macroscopic configurations of the wound environment. It is expensive and not available worldwide, and several modifications using low cast materials were mentioned in literature. METHODS: We present a case series of four patients using the previously mentioned modified technique in combat wound management, and discuss the results, outcome, and justification for choosing this modality of treatment. All patients underwent a thorough debridement, followed by a modified negative pressure wound treatment for three weeks, employing readily available medical devices. RESULTS: All wounds healed successfully without complication and a simple closure was used to cover the resultant wound. CONCLUSION: Modified NPWT with limited resources is capable of promoting healing in conflict-related wounds through multifactorial properties and transforming reconstructive methods from complex to simple procedures in areas with a shortage of medical supplies and surgeons in addition to busy operating rooms.