Malignant melanomas sometimes present with nail or periungual pigmentation, as a subungual melanoma. This pigmentation also occurs in nonmelanoma skin disorders. Therefore, biopsy is mandatory for the absolute diagnosis. We present an atypical presentation of subungual melanoma in an 81-year-old female patient with no specific periungual pigmentation. She suffered from a crushing injury in her right thumb 2 years ago and had undergone repetitive stump plasty at a local clinic. Recently, she felt intermittent pain at the thumb tip. During the revisional stump plasty, we unexpectedly noted a spread out of dark colored soft tissues the distal phalanx. Pathological examination revealed subungual malignant melanoma. This unusual form of melanoma has a predilection for an acral location, particularly the paronychial region. Even when small pigments are found on the periungual area, careful examination and identification of a component of melanoma is necessary in order to not miss any malignant finger lesion.
Aged, 80 and over ; Biopsy ; Diagnosis ; Female ; Fingers ; Humans ; Melanoma* ; Pigmentation ; Skin ; Thumb

No abstract available.
Tendons* ; Wrist*

No abstract available.
Tendons* ; Wrist*

PURPOSE: Thumb reconstruction plays most important role in hand injuries because total loss of a thumb constitutes about 40% disability in the hand. The reconstruction can be accomplished by pollicization, free toe-to-thumb transfer, wrap around procedure and lengthening extraction. However, we sometimes need consecutive or double free flaps in the reconstruction of mutilating hand injuries. METHODS: We reconstructed a mutilating hand injury in a 54-years old man. Because of severe crushing injury of right thumb and index fingers, we reconstructed a thumb with pollicization using nearly amputated middle finger. Although it survived completely, the adjacent soft tissues which had been covered by fillet flap from the space past was necrosed on 1 month. We debrided the necrotic tissues and covered it with anteromedial thigh perforator free flap consecutively because he had an anatomical variation in branches of lateral femoral circumflex artery. RESULTS: He had an uneventful postoperative course without any complication such as infection, dehiscence and flap necrosis. Three months later, he had undergone tenolysis and defatting procedure of flap site. He recovered the some amount of grip function and was happy with the result. CONCLUSIONS: In severe hand trauma including thumb amputation, thumb reconstruction using pollicization and perforator free flap could be an alternative option. It provides minimal donor site morbidity and an acceptable functional result.
Amputation ; Fingers ; Free Tissue Flaps ; Hand ; Hand Injuries ; Hand Strength ; Humans ; Necrosis ; Thigh ; Thumb ; Tissue Donors

PURPOSE: Herpes zoster, or shingles is caused by reactivation of varicella zoster virus lying latent in the ganglion of the dorsal root. It is rare in hand and upper extremities. The aim of this study is to report the shingles occurred in the hand, upper extremity along the various dermatome. MATERIALS AND METHODS: Between October of 2006 and August of 2009, patients with herpes zoster infection in hand and upper extremity were reviewed. The mean age of the patients was 61.4 years, and there were four female patients, one male patient. With the appropriate diagnosis, antiviral agent such as acyclovir(Zovirax(R)), Zovirax(R) cream were applied within 72 hours of skin lesions. Analgesics and wet dressing were commonly applied for relief of acute pain. To prevent the secondary infection and postherpetic neuralgia, tricyclic antidepressants, anticonvulsants and opioids were also prescribed. RESULTS: Herpes zoster infection was occurred along the distribution of ulnar nerve in three cases, radial nerve in one case and medial antebrachial cutaneous nerve in one case. Four patients developed unilateral vesicular eruption with dermatomal rash in addition to severe pain. But, one patient did not show any significant signs on physical exam except dysesthesia along the ulnar nerve distribution in hand and forearm. All of the patients were relieved acute pain, skin rash within 1-2 weeks. There were no recurrence and complications during the one year follow-up period. CONCLUSIONS: It is important that hand surgeons should not misdiagnose the possibility of herpes zoster infection even without developed skin rash. Early diagnosis, appropriate treatment can lower the risk of its complications.
Acute Pain ; Acyclovir ; Analgesics ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents, Tricyclic ; Bandages ; Coinfection ; Deception ; Early Diagnosis ; Exanthema ; Female ; Follow-Up Studies ; Forearm ; Ganglion Cysts ; Hand ; Herpes Zoster ; Herpesvirus 3, Human ; Humans ; Male ; Neuralgia, Postherpetic ; Paresthesia ; Radial Nerve ; Recurrence ; Skin ; Spinal Nerve Roots ; Ulnar Nerve ; Upper Extremity

PURPOSE: Trochanteric pressure sores management has been improved through the development of musculocutaneous flaps. But it has many drawbacks such as donor site morbidity and functional muscle sacrifice. With the introduction of perforator flap, it is possible to use in every location where musculocutaneous perforators are present. We have reconstructed trochanteric pressure sores using perforator-based flaps from the ascending branch of lateral circumflex femoral artery. METHODS: Between May of 2006 and April of 2008, we performed six cases of perforator-based flap from the ascending branch of lateral circumflex femoral artery for the coverage of trochanteric pressure sores. For identifying perforators, a line was drawn from the anterior superior iliac spine to the superolateral border of the patella as the vertical axis, from the pubis to the trochanteric prominence as the horizontal axis. In the lateral aspect of the intersection of these two axes, various flap were designed according to its defects. The flap was raised in the subcutaneous plane above the fascia and the pedicle was traced by doppler and identified. The pedicle was meticulously dissected not to injure the periadventitial tissues and transposed to the defect. The donor site was closed primarily. RESULTS: The mean age of patients was 56.2 years. Four male and two female patients were studied. Five patients were paraplegic. The mean defect size was 6 x 4 cm. The largest flap dimension was 14 x 7 cm. Donor sites were closed primarily without any complications. All flaps survived completely without necrosis, hematoma or infection. There were no recurrence during the follow-up period. CONCLUSION: Trochanteric pressure sores using perforator-based flap from the ascending branch of lateral circumflex femoral artery can be performed safely and it would be a reliable option for coverage of trochanteric pressure sores with minimal donor site morbidity.
Axis, Cervical Vertebra ; Fascia ; Female ; Femoral Artery ; Femur ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Muscles ; Necrosis ; Patella ; Perforator Flap ; Pressure Ulcer ; Recurrence ; Spine ; Tissue Donors

Dupuytren's contracture is a condition commonly encountered by hand surgeons, although it is rare in the Asian population. Various surgical procedures for Dupuytren's contracture have been reported, and the outcomes vary according to the treatment modalities. We report the treatment results of segmental fasciectomies with multiple transverse incisions for patients with Dupuytren's contracture. The cases of seven patients who underwent multiple segmental fasciectomies with multiple transverse incisions for Dupuytren's contracture from 2006 to 2011 were reviewed retrospectively. Multiple transverse incisions to the severe contracture sites were performed initially, and additional incisions to the metacarpophalangeal (MCP) joints, and the proximal interphalangeal (PIP) joints were performed if necessary. Segmental fasciectomies by removing the fibromatous nodules or cords between the incision lines were performed and the wound margins were approximated. The mean range of motion of the involved MCP joints and PIP joints was fully recovered. During the follow-up periods, there was no evidence of recurrence or progression of disease. Multiple transverse incisions for Dupuytren's contracture are technically challenging, and require a high skill level of hand surgeons. However, we achieved excellent correction of contractures with no associated complications. Therefore, segmental fasciectomies with multiple transverse incisions can be a good treatment option for Dupuytren's contracture.
Asian Continental Ancestry Group ; Contracture ; Dupuytren Contracture ; Follow-Up Studies ; Hand ; Humans ; Joints ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative

After the use of silicone-filled breast implant was restricted in 1992, PIP Hydrogel (Poly Implant Prosthesis, France) was temporarily used as an alternative which is an organic polymer of polysaccharide and water. This case report draws attention to an unusual presentation following the insertion of a PIP Hydrogel implant for breast augmentation. The first case is about 43-year-old woman who has undergone breast augmentation using PIP Hydrogel implant was admitted to the hospital because of painful swelling in her right breast. On examination, the right breast was larger than the left. At the operation, it was found that the implant on the right side has a large tear in the shell. And the other case is about 47-year-old woman who had capsular contracture on the outer-lower quadrant of both breasts. She came to our institution to replace bigger implants. We removed existing both breast implants (170cc, subglandular), and replaced cohesive gel implant (300cc, submuscular). From 1992 to 2000, the breast implant filled with a polysaccharide gel had been widely used because of its viscoelastic properties and biodegradability. However, there is no long-term safety data that the filler material as a polysaccharide hydrogel is toxic to humans or not. We wish to highlight its unpredictability and unreliability.
Breast ; Breast Implants ; Contracture ; Female ; Humans ; Hydrogel ; Mammaplasty ; Polymers ; Porphyrins ; Prostheses and Implants ; Rupture ; Silicones

No abstract available.
Ganglion Cysts* ; Temporomandibular Joint*

We present a patient who showed a sterile abscess after facial bone fixation with bioabsorbable plates and screws. He had zygomaticomaxillary complex and periorbital fracture due to falling down. The displaced bones were treated by open reduction and internal fixation successfully using bioabsorbable plate system. However, at postoperative 11 months, abrupt painless swelling was noted on the previous operation sites, left lateral eyebrow and lower eyelid. By surgical exploration, pus-like discharge and degraded materials were observed and debrided. The pathologic analysis revealed foreign body reaction with sterile abscess. This complication followed by bioabsorbable device implantation on maxillofacial bone surgery has been rarely reported in which we call attention to the maxillofacial plastic surgeons.
Abscess* ; Absorbable Implants ; Accidental Falls ; Eyebrows ; Eyelids ; Facial Bones ; Foreign-Body Reaction ; Humans ; Plastics ; Surgeons