Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: This study compared the outcomes of three commonly used reconstructive techniques—the thenar flap, partial toe pulp free flap, and radial artery superficial palmar (RASP) flap—for the reconstruction of fingertip and pulp defects, in order to provide guidance for surgeons in selecting the appropriate method based on defect size and patient characteristics. Methods: A retrospective chart review was conducted on 50 patients who underwent fingertip or pulp reconstruction. Nine patients received thenar flaps, 26 received partial toe pulp free flaps, and 15 received RASP flaps. Patient demographics, defect size, flap survival, donor site morbidity, and patient satisfaction were analyzed. Results: All flaps survived. In the RASP flap group, three cases of partial necrosis were successfully managed without additional surgical interventions. The thenar flap group had donor site pain and joint stiffness, while the partial toe pulp free flap group exhibited no donor site complications. The RASP flap group experienced hypertrophic scarring in five cases. Patient satisfaction was high across all groups, with the partial toe pulp free flap yielding the most positive outcomes. Conclusion The thenar flap is a reliable option for small defects, especially those with exposed bone, but is associated with donor site morbidity and joint stiffness. The partial toe pulp free flap provides superior functional and aesthetic results for moderate defects, though it requires more surgical expertise and has a longer recovery time. The RASP flap is optimal for larger defects, offering good cosmetic results but requiring careful donor site management to avoid hypertrophic scarring.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: This study compared the outcomes of three commonly used reconstructive techniques—the thenar flap, partial toe pulp free flap, and radial artery superficial palmar (RASP) flap—for the reconstruction of fingertip and pulp defects, in order to provide guidance for surgeons in selecting the appropriate method based on defect size and patient characteristics. Methods: A retrospective chart review was conducted on 50 patients who underwent fingertip or pulp reconstruction. Nine patients received thenar flaps, 26 received partial toe pulp free flaps, and 15 received RASP flaps. Patient demographics, defect size, flap survival, donor site morbidity, and patient satisfaction were analyzed. Results: All flaps survived. In the RASP flap group, three cases of partial necrosis were successfully managed without additional surgical interventions. The thenar flap group had donor site pain and joint stiffness, while the partial toe pulp free flap group exhibited no donor site complications. The RASP flap group experienced hypertrophic scarring in five cases. Patient satisfaction was high across all groups, with the partial toe pulp free flap yielding the most positive outcomes. Conclusion The thenar flap is a reliable option for small defects, especially those with exposed bone, but is associated with donor site morbidity and joint stiffness. The partial toe pulp free flap provides superior functional and aesthetic results for moderate defects, though it requires more surgical expertise and has a longer recovery time. The RASP flap is optimal for larger defects, offering good cosmetic results but requiring careful donor site management to avoid hypertrophic scarring.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.