Surgical Written Consent in Aesthetic Plastic Surgery: A Plastic Center Audit of Surgical Consent Standards.

Background Informed consent is a fundamental aspect of modern medical practice that requires effective communication and an ample understanding of medical ethics, patient autonomy, and the legal obligations of healthcare professionals. Maintaining high-quality surgical informed consent is a crucial step in the healthcare process. Thus, we aimed to obtain surgical written consent on abdominoplasty, suction-assisted abdominal dermo lipectomy, and lower body lifting from our hospital database over three months (January to March, 2023) to assess our level across the American Society of Plastic Surgeons (ASPS) system. Results A total of 45 surgical written consents were obtained and 37 consents remained after exclusion. Bleeding, infection, and hematoma were mentioned in more than 80% of our consents. However, important complications such as ileus and umbilical malposition were never mentioned. Overall, the completion rate of written complications ranged from 14% to 56% in comparison to data from the ASPS. Conclusions Our results show a measurable inconsistency in surgical written consents at our center. Thus, establishing a comprehensive and accurate surgical written consent will aid in protecting our center against deficient surgical written consent accusations, improve the experience of patients, and enhance the quality of service provided by our center.

A malignant spiradenoma of the forehead: a case report and literature review.

Spiroadenomas, arising from sweat glands, are rare benign skin tumors primarily found as solitary nodules on the head, neck, and trunk. The malignant subtype, Spiradenocarcinoma (MSA), originating from benign spiradenomas, is extremely rare and occurs mainly in individuals over 50. MSA exhibits aggressiveness with higher metastasis rates and lower survival rates. Surgical excision is the standard management, supported by imaging modalities like MRI, CT-scan, and ultrasound. We present a 69-year-old female with a medical history of diabetes, hypertension, and dyslipidemia who presented in 2014 with multiple swellings on the forehead and left arm. Initial excisions revealed capillary hemangioma lesions. Subsequent visits involved the excision of further facial and body lesions, with some identified as intradermal nevi. In 2022, she presented to plastic surgery clinic with forehead swelling. The biopsy showed MSA lesion with involved margins. Thus, subsequent re-excision was carried out. One year later, she came with recurrent forehead swelling. Excision and direct closure of the lesion showed involvement of part of the subcutaneous tissue (fat globule) showing residual/recurrent MSA that is very close to nerve trunks. Malignant Spiradenomas (MSAs) usually arise from benign spiradenomas. Therefore, consideration is given to preemptive removal of these tumors due to their potential evolution. The primary treatment approach involves surgery, with a focus on wide local excision and a minimum margin of 1 cm to diminish the risk of metastasis. Vigilant follow-up is essential to promptly identify any recurrences or spreading.

Management of Giant cell tumor occupying the 5th metacarpal bone in 6 years old child.

Giant cell tumor of the bone (GCTOB) is a relatively uncommon tumor of the bone. It is characterized by the presence of multinucleated giant cells. Giant-cell tumor of the bone accounts for 4-5% of primary bone tumors and ∼20% of benign bone tumors. Giant cell tumors of the hand are rare, accounting for only 2-4% of all giant cell tumors. Giant cell tumor (GCT) of the bones of the hand has some special features as compared to GCT at other sites. Because of the aggressive nature of this lesion, adequate assessment of the treatment method is required. The aim is to eradicate the disease but preserve as much hand function as possible. Methods of treatment include curettage with or without bone grafts, local resection possibly combined with reconstruction using homologous or autologous bone, amputation, and resection of one or more rays.

The Use of MartriDerm in Nail Bed Reconstruction of Thumb Injured by a Pellet.

Gunshot injuries to the hand and upper extremity can be divided into low and high-energy injuries. Nonballistic firearms such as pellet guns are generally considered low-energy guns but can be associated with serious morbidity and even mortality. Management is tailored according to the severity and type of injured structures. Here, we present the case of a 21-year-old soldier who accidently shot his thumb with an air gun while on a bird hunting trip, whose case was managed with extraction placement of bone graft and collagen matrix to prevent nail deformity. This case was written to increase the awareness about the need for safe use of such guns and to display the authors preferred way of management.

Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach.

Global brachial plexus injury (GBPI) mainly affects adults and causes severe life-changing consequences that lead to the deterioration of patients' quality of life. Several surgical approaches have been described and reported in the literature to improve patients' functional ability. A literature review is done on PubMed/MEDLINE and Embase using specific keywords to retrieve relevant articles assessing different surgical approaches for GBPI management. Inclusion and exclusion criteria were applied, and eligible articles were included in the review. The literature survey revealed that various surgical options had been used to manage GBPI patients. In this concise review, we discuss and compare the different surgical approaches related to GBPI and its outcome in terms of restoring elbow flexion and extension, shoulder abduction, and wrist and hand function. The primary surgical intervention relies mainly on transferring single or multiple nerves with/without nerve grafts to restore the function of the targeted muscle. Different techniques using a variety of nerve donors and recipients are compared to assess the functional outcomes of each option. Moreover, further options are addressed for delayed GBPI injuries or failed nerve transfer procedures, as in free functional muscle transfer techniques. In addition, information about brachial plexus injury cases faced in our center is presented along with our center's approach to diagnosing and managing partial and GBPI cases.

Diffuse Type Neurofibroma of the Forearm.

Nerve sheath tumors comprise 5% of soft tissue masses of the upper limb in adults. Neurofibromas are divided into three types: localized, diffuse, and plexi- form. The diffuse type is rare and is typically found in the head and neck region. We present a rare case of diffuse type neurofibroma found in the forearm, presented to our clinic as a slowly enlarging mass of the left forearm of 3 years duration. The lesion was suspicious in the magnetic resonance imaging, and biopsy revealed diffuse type neurofibroma. We opted for total excision of the lesion that was found to be not possible due to involvement of the major nerves. The final pathology report showed no malignancy. Nerve tumors of the upper limb can be either benign or malignant. Neurofibroma associated with neurofibromatosis has malignant potential. The diffuse type is rare, and it most commonly occurs in the head and neck region. It has a low malignant transformation rate. Magnetic resonance imaging is the diagnostic modality of choice; however, it can be inconclusive. Biopsy should be taken to confirm the diagnosis and plan for management. Our case was managed by near total excision in order to preserve the major forearm nerves because of high clinical suspicion.

A Rare Presentation of Hand TB Extending to the Space of Parona.

Most cases of hand infections are caused by gram-positive cocci and gram-negative bacilli. Atypical hand infections are rare and are caused by uncommon pathogens like Mycobacterium tuberculosis (TB). Musculoskeletal tuberculosis accounts for 20% of TB cases, and only 2% of these cases involve the hand and foot. In this article, we describe a case of hand TB that had spread from the thenar space to the space of Parona. The patient was treated with a combined surgical and medical approach. A 29-year-old male patient presented to our clinic with the complaint of pain and swelling of the right hand that had been worsening for 4 months before presentation. It was associated with mild weakness and night sweats. On physical examination, he had two separate swellings: one at the thenar eminence and one at the volar side of the wrist. He was taken for incision, which showed caseous material on both sites. It was sent for culture that revealed mycobacterium tuberculosis. The patient was placed on anti-TB medications for a total of 6 months. Tuberculous infection of the hand is a rare condition; the most common musculoskeletal sites are the spine, hip, and knee. Early diagnosis and treatment of TB infection in hand are essential for retaining optimal function. The diagnosis usually depends on the clinical presentation supported by laboratory tests and imaging studies. Treatment consists of medical, surgical, or combined treatment. Surgical intervention should aim to remove all the infected material in addition to debridement of the involved tissues.

A Simple Option Added for Reconstruction of Posterior Neck Defects.

Background: Posterior neck defects are uncommon and are mainly caused by infections or tumors. Consequently, the reconstruction options are limited in the literature. They vary according to the size and type of the defect, and options range from grafts to free flaps. In this article, we present a series of cases where we used a transpositional locoregional flap as a simple and effective way for the coverage of posterior neck defects. Materials and Methods: In a series of 11 patients, we designed locoregional transpositional flaps unilaterally or bilaterally, according to the defect size. Dissection was carried on a subfascial plane. Results: All flaps survived without necrosis. We had two incidents of minimal wound gaping that healed without any intervention. Conclusion: In this series, we introduce a new option and its algorithm to reconstruct moderate-sized posterior neck defects using locoregional transpositional flaps, either unilaterally or bilaterally. It is simple, easy to conduct, and has a better color match and less complication rate than other options mentioned in the literature.

Date Palm Thorn Injury: A Literature Review and a Case Study of Extensive Hand Haematoma.

Date palm thorn injuries require a high level of clinical suspicion and careful management as they can lead to severe complications, such as tissue inflammation, synovitis, and extensive haematoma. Although it is associated with serious injuries, this type of injury is often underdiagnosed and is not sufficiently reported in the literature. We describe a case report of an 18-year-old male patient who presented with significant progressive swelling of the right hand that extended to the distal third of the forearm, having received a date thorn injury the day before. The patient underwent multiple incisions and hand fasciotomy to reduce the haematoma and relieve compartment pressure in his hand.

A Rare Sequela of Constriction Band Syndrome: Case Report.

The patient in this case report is a 19-year-old man who presented with left foot cauliflower lesion. He complained of an inability to wear proper shoes, in addition to an unpleasant appearance of his foot. The lesion was present since his birth. Based on history and physical examination, the top 2 differential diagnoses at this stage were pediatric neurofibroma and constriction band syndrome (CBS). Laboratory investigations and x-ray were ordered for the patient. X-ray showed absence of most of the phalanges of the first, second, and third toes, with swelling of the overlying soft tissues of the foot. CBS was confirmed. Excision of the lesion was done along with skin graft applied on the area. Biopsy showed skin with dermal fibrosis and extensive adipose tissue infiltration without any sign of atypia or malignancy. The patient was discharged with regular follow-up appointments.

A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge.

Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem. METHODS: This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature). RESULTS: None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis. CONCLUSION: FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.