An anatomically normal first web space is essential for optimal prehensile movements of the thumb and hand. A 28-year-old woman presented with severe scarring and contractures of the first web space of both hands, following a flame burn injury sustained 25 years prior to presentation. First web space contracture may occur secondary to severe injuries, burns (as observed in our patient), or congenital hand anomalies. A significant amount of additional skin is required to release a severe first web space contracture. Reconstruction of wide areas of contractures using only local flaps is challenging. Among other free flaps used in clinical practice, the thinned lateral arm free flap provides flexible vascularized tissue for reconstruction of the skin after severe first web space contracture release. Reconstruction using lateral arm free flaps facilitated thumb abduction and opposition (which were initially difficult) and improved hand function in our patient.

Purpose: Hand skin defects and following scar contractures are common injuries and sequelae of home or industrial accidents. Glabrous skin defects should be replaced with similar skin to achieve functional recovery and cosmesis. However, donor sites for full-thickness glabrous skin are insufficient. Methods: From 2008 to 2018, we performed graft surgeries from the hypothenar area to cover the palmar skin defects after postburn scar contracture release. All 62 patients were treated with full-thickness composite grafts including skin and subcutaneous tissue. Results: Follow-up periods ranged from 13 to 65 months. All glabrous composite grafts demonstrated good uptake rates, resembling the surrounding skin in appearance, texture, and color. Among the 62 patients, there were only three cases of partial graft loss. There were no reported complications such as significant color change, hypertrophic scar, or donor site complications. The grafted skin showed an average 5.8 mm static two-point discrimination in sensory recovery. Conclusion Our results indicate that use of glabrous full-thickness composite graft is a reliable method for hand palmar skin resurfacing. With low donor-site morbidity, the graft restores the functional and aesthetic properties of glabrous skin.

Neurofibromas are benign neoplasms originating from neural tissues that rarely transform into malignancies. Approximately 25% to 45% of neurofibromas are located in the head and neck; the most common sites are the lateral cervical region and mouth. A 27-year-old female patient visited our hospital complaining of a painful brownish mass in the right elbow that had recently increased in size. She had no history of cancer and was otherwise in excellent health. This mass accounted for 80% of the total elbow circumference. Genetic mutation testing resulted in a diagnosis of neurofibromatosis type 1. A wide surgical excision was performed, and the area was repaired using a bilateral large superficial circumflex iliac artery perforator free flap. The flap survived well, with no partial necrosis. Histological findings showed a plexiform neurofibroma measuring 14×12×1.5 cm3. The patient’s postoperative course was uneventful; at an 18-month follow-up, she had good cosmetic and functional outcomes with no signs of relapse.

Large defects in the buttock region are uncommon and pose significant challenges for reconstruction. The skin in this area adheres firmly to the subcutaneous tissue, making mobilization difficult. Attempts to use local or regional flaps to cover defects in this region often result in flap necrosis, leading to an elevated risk of infection and unstable wounds. In addition to these intrinsic challenges, factors such as fecal contamination, difficulty in patient positioning, and suboptimal underlying patient conditions further complicate the reconstruction process. Furthermore, the lack of suitable recipient vessels often hinders free tissue transfer for complex wound coverage in the buttock area. Here, we present a case involving sequential latissimus dorsi and omental free flap coverage to address a large gluteal skin and soft-tissue defect. Our experience highlights the importance of meticulous reconstructive planning and the appropriate selection of recipient vessels for successful buttock reconstruction.

Neurofibromas are benign neoplasms originating from neural tissues that rarely transform into malignancies. Approximately 25% to 45% of neurofibromas are located in the head and neck; the most common sites are the lateral cervical region and mouth. A 27-year-old female patient visited our hospital complaining of a painful brownish mass in the right elbow that had recently increased in size. She had no history of cancer and was otherwise in excellent health. This mass accounted for 80% of the total elbow circumference. Genetic mutation testing resulted in a diagnosis of neurofibromatosis type 1. A wide surgical excision was performed, and the area was repaired using a bilateral large superficial circumflex iliac artery perforator free flap. The flap survived well, with no partial necrosis. Histological findings showed a plexiform neurofibroma measuring 14×12×1.5 cm3. The patient’s postoperative course was uneventful; at an 18-month follow-up, she had good cosmetic and functional outcomes with no signs of relapse.

Large defects in the buttock region are uncommon and pose significant challenges for reconstruction. The skin in this area adheres firmly to the subcutaneous tissue, making mobilization difficult. Attempts to use local or regional flaps to cover defects in this region often result in flap necrosis, leading to an elevated risk of infection and unstable wounds. In addition to these intrinsic challenges, factors such as fecal contamination, difficulty in patient positioning, and suboptimal underlying patient conditions further complicate the reconstruction process. Furthermore, the lack of suitable recipient vessels often hinders free tissue transfer for complex wound coverage in the buttock area. Here, we present a case involving sequential latissimus dorsi and omental free flap coverage to address a large gluteal skin and soft-tissue defect. Our experience highlights the importance of meticulous reconstructive planning and the appropriate selection of recipient vessels for successful buttock reconstruction.

Neurofibromas are benign neoplasms originating from neural tissues that rarely transform into malignancies. Approximately 25% to 45% of neurofibromas are located in the head and neck; the most common sites are the lateral cervical region and mouth. A 27-year-old female patient visited our hospital complaining of a painful brownish mass in the right elbow that had recently increased in size. She had no history of cancer and was otherwise in excellent health. This mass accounted for 80% of the total elbow circumference. Genetic mutation testing resulted in a diagnosis of neurofibromatosis type 1. A wide surgical excision was performed, and the area was repaired using a bilateral large superficial circumflex iliac artery perforator free flap. The flap survived well, with no partial necrosis. Histological findings showed a plexiform neurofibroma measuring 14×12×1.5 cm3. The patient’s postoperative course was uneventful; at an 18-month follow-up, she had good cosmetic and functional outcomes with no signs of relapse.

Large defects in the buttock region are uncommon and pose significant challenges for reconstruction. The skin in this area adheres firmly to the subcutaneous tissue, making mobilization difficult. Attempts to use local or regional flaps to cover defects in this region often result in flap necrosis, leading to an elevated risk of infection and unstable wounds. In addition to these intrinsic challenges, factors such as fecal contamination, difficulty in patient positioning, and suboptimal underlying patient conditions further complicate the reconstruction process. Furthermore, the lack of suitable recipient vessels often hinders free tissue transfer for complex wound coverage in the buttock area. Here, we present a case involving sequential latissimus dorsi and omental free flap coverage to address a large gluteal skin and soft-tissue defect. Our experience highlights the importance of meticulous reconstructive planning and the appropriate selection of recipient vessels for successful buttock reconstruction.

Primary cutaneous anaplastic large cell lymphoma (C-ALCL) is rare among skin malignancies. C-ALCL usually manifests as reddish or violet nodules. Surgical excision or radiation therapy is generally considered as first-line therapy, but a clinically aggressive disease may require multiagent chemotherapy. Establishing a proper diagnosis of C-ALCL is challenging but should be made to avoid inappropriate treatment and its consequences. The authors report a case of medically resolved C-ALCL in an 81-year-old man presented with well-defined nodular lesions on the forehead.
Aged, 80 and over ; Diagnosis ; Drug Therapy ; Forehead ; Humans ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, Primary Cutaneous Anaplastic Large Cell ; Lymphoma, T-Cell ; Skin ; Viola

Reconstruction of subtotal maxillectomy defects with columella deficit is challenging. We report a unique case of facial reconstruction using a free radial forearm flap and a free preauricular flap for the maxillectomy and columella deficit. A 73-year-old woman was diagnosed with recurrent sebaceous carcinoma of the nose. We performed wide excision, including areas of the right cheek, nose, upper lip, maxilla, and columella. The resultant subtotal maxillectomy defect was reconstructed using a three-dimensional flap. First, a free radial forearm flap was transfered to resurface the nasal, oral, and external facial side. Second, a preauricular flap was positioned into the columella defect and anastomosed with the distal portion of the radial forearm flap pedicle. The two flaps survived, and the patient recovered uneventfully. We believe the radial forearm and preauricular double free flaps with the pedicle connection method were effective in reconstructing the present case of subtotal maxillectomy defect.