Summary: Vascular occlusion is a rare but serious complication following hyaluronic acid filler injections, especially when it affects functionally critical areas such as the tongue. A 27-year-old Caucasian woman, a Dutch national, underwent a chin augmentation procedure with 1 mL of hyaluronic acid filler at a clinic in Bali, Indonesia. Within 5 minutes, she experienced discomfort, speech difficulties, and swelling on the right side of her tongue, with discomfort extending to the right side of her throat, ear, and posterior neck. Physical examination revealed discoloration of the surface of the tongue on the right side, delayed capillary refill time, and tenderness in the affected area. Vascular occlusion was suspected, and high-dose hyaluronidase therapy was promptly initiated, totaling 9000 IU of hyaluronidase injected across affected areas. The patient experienced a rapid improvement within minutes, achieving a full recovery with no long-term sequelae. This case highlights the potential for vascular compromise of the lingual artery following the injection of chin filler. Early recognition, aggressive hyaluronidase therapy, and supportive measures can prevent necrosis and preserve tissue integrity in critical vascular territories.
Summary: Fingertip injuries represent approximately 25% of hand trauma presenting to emergency departments. The thenar flap is a well-established technique with excellent outcomes for single- or 2-digit reconstruction; however, its application to 3 adjacent fingertip injuries has not been previously described. This study presents a technical modification extending the application of the thenar flap for simultaneous reconstruction of three adjacent digits. The approach is based on the robust vascular network of the thenar eminence and glabrous skin that closely matches native fingertip texture while preserving sensibility. Careful preoperative planning was performed to ensure adequate tissue availability without excessive tension. Flap elevation was carried out in the subcutaneous plane to preserve vascular integrity, followed by sequential insetting of the injured fingers with attention to spatial configuration to prevent pedicle compromise. Reconstruction was completed in two stages: flap elevation and insetting followed by pedicle division at three weeks. The technique was applied in a 21-year-old patient with crush injuries to the index, middle, and ring fingers of the dominant hand, each involving soft-tissue avulsion of approximately one-fourth of the distal phalanx length (Ishikawa zone 1). At 3-year follow-up, complete flap survival was achieved. The patient demonstrated full range of motion, protective sensibility with a mean 2-point discrimination of 5 mm, and excellent aesthetic outcomes without donor-site complications. This technical innovation expands reconstructive options for complex multidigit fingertip trauma while preserving the established functional and aesthetic advantages of thenar flap coverage.
Summary: The hand remains the most injured body part, with the burden of these injuries well recognized. Hand rehabilitation remains crucial to recovery after injury, yet challenges remain in patient access, adherence to therapy, and limited feedback outside of supervised sessions. An opportunity exists to augment hand rehabilitation outcomes by integrating telemedicine and audio sensation, using sound to guide therapy. The authors introduce movement sonification in plastic surgery, the conversion of human movement data into audible sound. A web-based interface was developed using MediaPipe Hands, an open-source machine learning tool. Through a standard webcam on a computer or smartphone, a user can visualize their hand in real-time on screen, with each digit’s joint landmarks tracked live. As a user moves their fingers, the bending angle at each joint is continuously calculated and mapped to a sound parameter (pitch, volume, on/off cue, and change in instrument). The sound changes dynamically as the joint moves, guiding the user toward a prescribed target position. This provides immediate auditory and visual feedback, helping users self-correct and recognize when they are underperforming, compensating, or successfully reaching the end target. Building on preliminary research in proximal upper-limb neurorehabilitation, this is the first application of movement sonification at the digit level. The aim of this study was to build a proof-of-concept rehabilitation tool for validation studies and future clinical trials. Plastic surgery applications may include improving patient engagement in therapy, supporting home-based and hybrid telerehabilitation, and giving therapists an additional way to individualize and monitor prescribed hand rehabilitation.
Summary: Despite advancements in brachial plexus surgery and outcomes with nerve and free functional muscle transfer, there exists a subset of patients where contemporary reconstruction is unsuccessful resulting in poor distal function and persistent pain. Targeted muscle reinnervation is a technique that has been shown to improve intuitive control of a myoelectric prosthesis and improve pain in amputees. We present the innovative, successful application of elective amputation and targeted muscle reinnervation in the setting of a severe brachial plexus palsy. The Disabilities of the Arm, Shoulder and Hand score improved from 30.75 preoperatively to 18.33 at 20 months of follow-up, demonstrating the potential for this approach in optimizing function, pain, and cosmesis.
Summary: Cryolipolysis is a popular noninvasive procedure for localized fat reduction with a generally favorable safety profile, although rare complications have been reported. We present the case of a 67-year-old woman who developed erythemato-violaceous patches 2 weeks after cryolipolysis on the flanks, later extending to the thighs. Skin biopsy showed dermal sclerosis and inflammatory infiltrates consistent with morphea, with changes suggestive of early lichen sclerosus. Treatment with oral methotrexate and topical clobetasol was initiated, whereas phototherapy and systemic corticosteroids were avoided due to comorbidities. The strict localization of lesions to treated areas, along with a previously reported case, suggests that cold-induced trauma may act as a trigger for morphea in predisposed individuals. This report underscores the need for vigilance and documentation of rare adverse effects to refine the safety profile of cryolipolysis.
