Background: Van der Woude syndrome (VWS) may display varied clinical features. We aimed to determine cleft types, lower lip pits, and lip pit surgeries in a large VWS cohort in Finland. Materials and methods: This is a single-center retrospective, observational patient record study performed at national centralized cleft center that evaluated 151 individuals with VWS born between 1946 and 2019. Information regarding sex, cleft type, lip pit presence, and the number of lip pit surgeries were gathered from patient records. Results: Sixty per cent of the individuals with VWS were female and 40% were male (p < 0.01). The majority (105/151; 70%) of the individuals with VWS presented with clefts in the palate region (p < 0.01). Cleft lip (CL) occurred in 7.3% and cleft lip and palate (CLP) in 21.5% and no cleft in 2.6% of individuals with VWS. Information on lip pits was available for 127/151 patients. Lip pits were present in 93% of patients. Lip pits were surgically removed more frequently in unilateral cleft lip and palate (UCLP) (84.6%) and bilateral cleft lip and palate (BCLP) (66.7%) compared with cleft palate (CP) (8.8%) (p < 0.001). Recurrent surgery for lip pits occurred more often in BCLP (46.4%) than in UCLP (6.7%) and CP (1.3%). Conclusions: In Finland, cleft palate is the predominant cleft type in VWS. Cleft type distribution in VWS reflects the frequencies of non-syndromic clefts in Finland, deviating from trends observed in other countries. Lip pits are more commonly removed in UCLP or BCLP than in CP only. Furthermore, recurrent surgeries for lip pits occur more frequently in individuals with BCLP.
Background: The Wassel classification for thumb polydactyly relies on radiographs; however, invisible unossified cartilage in young children can lead to misclassification and suboptimal surgical planning. This study evaluated whether ultrasound improves the accuracy of polydactyly classification compared with radiographs. Materials and methods: This prospective study included 31 cases of radial polydactyly initially classified as Wassel type IV or type II based on radiographs. All patients underwent preoperative ultrasound to identify potential cartilaginous connections between the proximal and distal phalanges. The ultrasound findings were compared against intraoperative exploration, which served as the gold standard for final classification. Results: Ultrasound correctly identified cartilaginous connections in the majority of cases, achieving an overall diagnostic accuracy of 93.5%. Thirty eight per cent of radiologic type IV cases were reclassified as type III, and 10% of radiologic type II cases were reclassified as type I after ultrasound detection of hidden connections. The accuracy was 100% for types IV-C and II, whereas type IV-D presented a diagnostic challenge with 75% accuracy. Overall diagnostic accuracy of ultrasound for polydactyly classification was high, with only a small number of misclassifications. Conclusions: Radiograph-based Wassel classification may misclassify thumb polydactyly in children due to unossified cartilage. Ultrasound allows direct visualization of cartilaginous connections and improves preoperative classification accuracy. Combined use of ultrasound and radiographs provides a more reliable anatomical assessment and may help optimize surgical planning and outcomes.
Background: Implant malposition is a leading cause of reoperation after orbital floor reconstruction. Intraoperative computed tomography (CT) enables immediate assessment and correction, however its impact on implant positioning accuracy and outcomes remains insufficiently studied. Materials and Methods: This retrospective study included 86 patients with isolated orbital floor fractures treated with radiopaque implants between 2011 and 2023 at Uppsala University Hospital. Sixty-five patients underwent postoperative CT and 21 intraoperative CT. Eight senior surgeons from all Swedish university hospitals independently reviewed anonymized scans under hypothetical intraoperative and postoperative conditions, indicating whether they would adjust the implant intraoperatively or recommend reoperation postoperatively. In the intraoperative group, implant position was assessed on final CT obtained after any CT-guided adjustment. Actual re-intervention rates were recorded. Results: Recommendations for implant adjustment were significantly more frequent in the postoperative CT group than in the intraoperative CT group (45% vs. 19%, p = 0.042). Unanimous agreement that no adjustment was required occurred more often in the intraoperative CT group (48% vs. 22%). Consensus among ≥3 experts favoring reoperation was observed in 20% of postoperative cases and in none of the intraoperative cases. The perceived need for reoperation was lower in the intraoperative than in the postoperative CT group (5% vs. 15%, p = 0.45), as were actual reoperation rates (5% vs. 11%, p = 0.68). Conclusions: Intraoperative CT was associated with improved expert-assessed implant positioning. Although reoperation rates were lower in the intraoperative CT group, these differences did not reach statistical significance.
Aim: The venous flaps provide a versatile, easy flap choice to repair the dorsal skin defects of the fingers and web spaces. Its thin and pliable nature provides natural coverage for the important delicate structures of the hand such as bone, tendon, joint or neurovascular bundle. Material and methods: From 2010 to 2025, we used the venous flaps to cover exposed bone, tendon and joint located on the distal phalanx, proximal phalanx, web space and dorsum of the hand in 10 patients. Flaps were unipedicled distally based in nine cases. It was a free venous flap in one case. During the flap elevation, the pedicle of the flap included one superficial vein of the hand and its perivenous areolar tissue. Results: The size of the flaps ranged from 4 cm2 to 9 cm2. The mean length of the vascular pedicles was 3.1 cm (min: 2 cm, max: 10 cm). In all cases, the flaps survived completely. The donor sites were on the dorsal surface of the hand in nine cases, the volar surface of the wrist in one case. The donor sites were closed primarily in eight cases; skin graft was used in two cases. Conclusion: The aim of this study was to share our experience regarding the venous flap usage in the hand. Another aim is to remind us of this useful flap, which was not popularized enough despite its versatility and being described 40 years ago.
Introduction: Scaphoid fractures still have high rate of nonunion, mainly due to the tenuous blood supply and only primary bone healing. Rigid fixation facilitates this kind of bone healing and is considered as vital as protection of the blood supply. The optimal implant (screw) location should meet the requirements for researcher’s biomechanical findings on fracture stability. Materials and methods: Raw CT-scanned data of eight volunteers’ wrists were imported into Mimics. The 3D scaphoid was segmented out and calculated, then opened in Geomagic Studio. Four fracture planes (proximal, oblique waist, horizontal waist and distal) simulating common broken scaphoid were created. Mimicking scaphoid implants (screws), the longest, the sub-longest, and central and eccentric cylinders perpendicular to each fracture plane were created. Whole and inside-fragmental length, and the relative location of each cylinder were measured and analyzed. Results: The longest (28.5 ± 1.6 mm) cylinder was significantly longer than the sub-longest (25.4 ± 1.4 mm). Several eccentric perpendicular cylinders (so short or cutting out of the scaphoid) couldn’t be created. Some proximal inside-fragmental lengths ranged from 3.0 to 5.1 mm. Several central perpendicular cylinders intersected with the longest one. Several central and eccentric perpendicular cylinders were outside of the proximal scaphoid non-contact region. Conclusion: The results of this study showed that scaphoid fracture images from CT scan can be calculated and yield the optimal implant location.
BACKGROUND:Autologous breast reconstruction continues to be a cornerstone of post-mastectomy reconstruction, with abdominally based flaps providing reliable aesthetic and functional outcomes. Of these approaches, the deep inferior epigastric perforator (DIEP) flap and the transverse rectus abdominis myocutaneous (TRAM) flap are the most commonly used. However, controversy exists surrounding their relative effectiveness, complication profile, donor-site morbidity, and reported outcomes. METHODS:A systematic review and meta-analysis were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A search was conducted across PubMed, Scopus, Embase, and Web of Science for comparative studies published between January 2000 and December 2025 that assessed DIEP and TRAM flap breast reconstruction. Outcomes included total flap loss, fat necrosis, donor-site morbidity, abdominal wall complications, and patient-reported outcomes. Random-effects meta-analyses were performed employing pooled odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was evaluated by Cochran's Q and Higgins' I² statistics. An exploratory network meta-analysis was also performed to compare DIEP with other autologous reconstructive techniques, such as transverse upper gracilis (TUG), transverse myocutaneous gracilis (TMG), profunda artery perforator (PAP), and inferior gluteal artery perforator (IGAP) flaps. RESULTS:Ten studies met the inclusion criteria for the qualitative synthesis, yet five also provided quantitative data that were included in the meta-analysis. Pooled analysis showed no significant difference in fat necrosis between reconstructive techniques (OR: 0.86; 95% CI: 0.54-1.36; I² = 34.6%). Likewise, the total flap loss rates were similar between DIEP and TRAM flaps (OR: 0.79; 95% CI: 0.39-1.61; I² = 7.2%). DIEP reconstruction was consistently associated with fewer donor-site morbidities and significantly better maintenance of abdominal wall health than the TRAM flap. Among exploratory network meta-analysis studies, the TUG flap showed clear superiority in reduced total flap loss, while DIEP flaps ranked favorably in donor-site outcomes and patient satisfaction. CONCLUSIONS:DIEP and TRAM flaps have comparable flap survival and overall reconstructive efficacy in post-mastectomy breast reconstruction. DIEP reconstruction appears to offer the best performance in reducing donor-site morbidity while preserving abdominal wall integrity. There was no single reconstruction technique that consistently outperformed all other reconstructive approaches across all outcomes, reinforcing an individualized surgical approach based on patient anatomy, comorbidities, reconstruction goals, and surgeon expertise.
This study presents a wedge osteotomy technique for correcting metacarpal adduction in the treatment of Wassel types V and VI thumb polydactyly, evaluating its clinical efficacy and reporting intraoperative anatomical abnormalities. A retrospective analysis of 37 thumbs treated between January 2016 and June 2023 was performed. Preoperatively, the median inter-metacarpal angle (IMA) was 0°, and the median radial deviation angle of the metacarpophalangeal (MCP) joint of the ulnar thumb was 30°. All cases underwent excision of the hypoplastic radial thumb, thenar muscle relocation, and a radial closing wedge osteotomy at the base of the ulnar thumb metacarpal to achieve a corrected IMA exceeding 40°. The ulnar capsule and collateral ligament were reinforced, and one or two Z-plasties were performed to enlarge the first web space in most cases. Mean follow-up was 51.4 months (range, 12–120). Postoperative IMA and MCP joint angle improved significantly to a median of 40° (IQR: 35–42°) and 0° (IQR: 0–10°),respectively. Mean range of motion at the MCP and interphalangeal joints was 40° (IQR: 30–45°) and 60° (IQR: 45–75°). According to the modified Tada score, 31 thumbs were rated good, 5 fair, and 1 poor. In conclusion, wedge osteotomy to correct metacarpal adduction deformity in type V/VI thumb duplication yields encouraging results, with good functional outcomes and a low reoperation rate.
National quality registries provide valuable opportunities for prospective, standardised follow-up of clinical outcomes over long periods. In cleft care, such long-term data remain limited internationally, particularly beyond childhood. The Swedish National Cleft Lip and Palate (CL/P) Registry, established in 1999 with predefined variables and standardised follow-ups, enables longitudinal evaluation of treatment outcomes across centres. The primary aim was to demonstrate the long-term usability of the Swedish National CL/P Registry for outcome assessment. As a clinical example, long-term outcomes after secondary alveolar bone grafting (SABG) from a single centre with complete historical registry coverage were analysed. National analyses of SABG outcomes are currently constrained as the first complete nationwide cohorts became available in 2025. To enable a longer observation period, data from a centre with consistent documentation since the registry’s initiation were therefore examined. Since April 2006, 167 patients had documented SABG outcomes at a standardised 16-year follow-up. Outcomes were assessed using a nationally agreed bone height scoring system based on two-dimensional dental radiographs, where a bone height of ≥ 3/4 of the root length was considered successful. Successful grafting was observed in 84% of unilateral and 71% of bilateral clefts. Higher age at first SABG and the need for complementary grafting were associated with poorer outcomes. This study illustrates how a national quality registry with predefined variables and long-term follow-up can identify clinically relevant patterns and challenges. The presented SABG outcomes exemplify registry-based quality evaluation and provide a structured basis for continuous discussion, adjustment and improvement of cleft care.
BACKGROUND:After tumour control, facial nerve preservation is a primary objective in vestibular schwannoma surgery. Predicting long-term recovery remains challenging, and the prognostic value of the Koos grade is unclear. OBJECTIVE:The primary outcome was facial palsy at 12 months (partial or severe). Secondary outcomes included Day 1 function, recovery trajectory, intraoperative signal status, Koos grade, complications and difference in surgical approaches. METHODS:Retrospective cohort study at Sahlgrenska University Hospital (2006-2024). Two reviewers independently extracted clinical data and assigned blinded Koos grades. Predictors were assessed using multivariable logistic regression. RESULTS:Of 293 surgically treated patients, 213 with complete follow-up formed the study cohort (retrosigmoid 121, translabyrinthine 92). Sixty-four (30.0%) had any palsy at 12 months: 50 (23.5%) partial and 14 (6.6%) severe. Day 1 facial function dominated all models: severe palsy at Day 1 carried an adjusted odds ratio (OR) of 222.08 (95% CI 26.45-1864.44; Firth-corrected OR 128, 21-762), while partial function had an OR of 8.83 (3.93-19.83). Female sex was independently associated with palsy (OR 2.87, p = 0.013); surgical approach was not (OR 0.77, p = 0.550). Koos grade showed no association (OR 1.19, p = 0.730). Among patients with normal Day 1 function, 90% remained palsy free at 1 year; among those with severe palsy, only 4.5% recovered. CONCLUSIONS:A single bedside examination on post-operative Day 1 predicts long-term facial nerve outcome more powerfully than any variable tested, including Koos grade; comparison of surgical approaches remained inconclusive owing to era confounding. Three recovery trajectories provide a framework for tailored post-operative management.
Background: This study aimed to compare the incidence and long-term progression of breast cancer-related lymphedema (BCRL) following autologous or implant-based breast reconstruction, with subgroup analysis based on prepectoral versus subpectoral implant placement. Methods: A retrospective review was conducted of 228 patients who underwent mastectomy and immediate breast reconstruction by a single surgeon between 2017 and 2020, using either a deep inferior epigastric perforator (DIEP) flap or a tissue expander. Arm circumference was measured at standardized proximal and distal points. BCRL was diagnosed clinically and confirmed by lymphoscintigraphy demonstrating dermal backflow and/or delayed axillary nodal uptake. Soft-tissue compliance was assessed using ultrasonography to evaluate differences in tissue response with and without compression. Results: The overall incidence of BCRL showed no significant difference among groups (DIEP 8.9%, prepectoral 14.8%, subpectoral 15.6%). However, during 2-year follow-up, the subpectoral group demonstrated faster progression and greater limb volume increase compared with the DIEP and prepectoral groups. Improvements in soft-tissue compliance were greatest in the DIEP group, followed by the prepectoral group, while the subpectoral group showed the least improvement. Conclusions: Autologous reconstruction demonstrated the most favorable lymphatic outcomes, supporting prior literature. Among implant-based approaches, prepectoral placement was associated with a milder course of BCRL than subpectoral placement, possibly due to decreased postoperative pain and shoulder restriction. These findings suggest that reconstruction type and implant placement plane may influence BCRL severity and should be considered when planning surgery to reduce complications and optimize long-term outcomes.
75th Anniversary Congress of the Scandinavian Association of Plastic Surgeons (SCAPLAS) June 3-5th, 2026 Oslo, Norway
Rupture of the extensor pollicis longus (EPL) tendon is a recognised complication after distal radius fracture (DRF) that leads to loss of active thumb extension. Transfer of the extensor indicis proprius (EIP) tendon to the EPL is one of the most common reconstructive procedures, but prospective outcome data are limited. This study evaluated functional and patient-reported outcomes after EIP-to-EPL tendon transfer exclusively in patients with EPL rupture secondary to DRF. Thirty consecutive patients (26 women, 4 men; median age 65 years, range 17-80) underwent EIP-to-EPL tendon transfer between 2021 and 2025 for EPL rupture secondary to DRF. Thumb motion, grip and pinch strength and QuickDASH scores were recorded at 3 and 6 months postoperatively. All motion parameters improved between 3 and 6 months. At 6 months, lift-off height recovered to approximately two-thirds, total thumb flexion to > 80% and radial/palmar abduction to about 90% of the contralateral side. Grip and pinch strength reached 79-85% of the uninjured hand. Mean QuickDASH score improved from 29 to 21 points (p = 0.015). In conclusion, EIP-to-EPL tendon transfer restores satisfactory thumb motion, strength and patient-rated function following EPL rupture associated with DRF. Functional recovery at 6 months is comparable to that of patients with uncomplicated DRFs. Clinical Trials registry no. NCT05264675.
Background: Cosmetic surgery has increased during recent decades, both domestically and through cosmetic tourism. Patients who develop postoperative complications frequently seek care in the public healthcare system. The extent to which these complications generate healthcare workload and costs within Swedish public hospitals remains poorly described. Methods: This retrospective cohort study includes patients presenting with acute complications after cosmetic surgery to the three hospitals in Region Örebro County, Sweden, between 2018 and 2024. Patients were identified through medical records and administrative systems. Cosmetic procedures performed locally, elsewhere in Sweden, or abroad were included. The primary outcome was direct hospital cost per patient estimated using diagnosis-related group weights. Secondary outcomes included emergency department attendance, hospital admission, length of stay (LOS), diagnostic investigations, surgical interventions and outpatient follow-up. Statistical comparisons between groups were performed using chi-square tests, independent sample t-tests and non-parametric tests where appropriate. Results: A total of 53 patients were included. The majority were female (88.7%) with a mean age of 42.1 years. The most common procedures associated with complications were abdominoplasty, breast augmentation and reduction mammoplasty. Infection with or without abscess was the most frequent complication. Patients operated in Sweden had a higher rate of hospital admission compared with patients operated abroad (48.0% vs 13.6%, p = 0.01), while LOS was similar between groups. In contrast, patients operated abroad required more outpatient physician follow-up. The mean estimated healthcare cost per patient was 45,956 SEK, Swedish crowns (€3890). Patients operated in Sweden generated higher average costs compared with patients operated abroad (58,460 SEK vs 28,688 SEK). The total estimated cost for managing complications in the cohort was approximately 2.3 million SEK. Conclusions: Complications after cosmetic surgery generate a measurable workload and cost for the public healthcare system. In this regional Swedish cohort, a substantial proportion of complications originated from procedures performed domestically rather than abroad. These findings challenge the perception that the public healthcare burden from cosmetic surgery complications is primarily driven by cosmetic tourism. Improved coordination between private cosmetic providers and the public healthcare system may help reduce the clinical and economic impact of these complications.
Background: Varied surgical alternatives for treating cubital tunnel syndromes have been used. A trend of endoscopic ulnar nerve release is emerging. The purpose of this study is to introduce a modified technique of endoscopic ulnar nerve decompression in association with anterior transposition of the ulnar nerve and to assess the feasibility and efficacy of the surgery. Materials and Methods: We introduced a modified method of endoscopic release and subfascial anterior transposition of the ulnar nerve. The technique was applied to six patients who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome. The patients were classified according to the Dellon classification preoperatively. The Bishop rating system was used to evaluate the postoperative outcomes. Trial registration number for the study is MR-31-25-090620. Results: Preoperatively, all six patients were classified as severe according to the Dellon classification. The endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition surgeries were performed with no difficulty in all patients. All the patients had improvement in symptoms and scored excellent or good according to the modified Bishop Rating System postoperatively. Conclusions: The modified endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition technique is technically feasible with satisfactory outcomes in six patients in this study.
Background: Congenital craniofacial conditions are a diverse group of rare and complex disorders, leading to significant functional and psychosocial challenges. Their rarity and variability hinder research and clinical standardisation, resulting in substantial practice variation across centres. International collaboration and high-quality evidence are therefore essential to improve and converge care for affected individuals. This article presents the discussion section of a doctoral thesis that addressed these challenges through multiple methodological approaches, the majority of which were conducted within the European Reference Network for Rare and Complex Craniofacial Conditions (ERN CRANIO). Methods: The studies combined systematic reviews, multicentre cohort analyses, expert consensus and registry development to advance understanding and care for three conditions: unilateral cleft lip and palate (UCLP), Treacher Collins syndrome and Miller syndrome. Results: The thesis provides evidence supporting early hard palate closure in UCLP, contributing to improved speech outcomes and fewer oronasal fistulas without increasing surgical burden. For facial dysostosis syndromes, the European clinical consensus statement and the establishment of the first international registry provide a foundation for more standardised multidisciplinary care and collaborative research. The systematic review on Miller syndrome clarifies its phenotypic spectrum and aids differential diagnosis with other syndromes. Conclusions: Through its comprehensive and collaborative approach, this thesis promotes the convergence of care for congenital craniofacial conditions in Europe. It highlights the importance of methodological rigour, standardisation and international collaboration to achieve evidence-based and equitable care for these rare and complex disorders.
Purpose: This study aimed to (1) introduce a simple and reproducible method to assess severe radial translation of distal radius fractures (DRF) which is a potential cause of distal radioulnar joint (DRUJ) instability, and (2) to construct a treatment-oriented classification. Materials and methods: From 2018 to 2023, stress test (ballottement test) was performed to detect DRUJ instability associated with DRF after treatment with locking plate fixation. Potential radiographic predictors of DRUJ instability focus on radial translation were accessed. The severity of radial translation was described by a readily and easily technique as ‘point- baseline’ method. According to this method, radial translation was categorized into three grades: no translation (the marking points not moved), moderate translation (the marking points moved, but were located on the ulnar side of the baseline), and severe translation (the marking points moved and reached the baseline position, or even completely moved to the radial side of the baseline). All these fractures were divided into two groups, namely Group A (cases with no translation or moderate translation) and Group B (cases with severe translation). Relationships between DRUJ instability and the radiographic parameter of radial translation were analyzed. To investigate the causes of DRUJ instability, all of the cases with DRUJ instability were further divided into two subgroups: subgroup A (cases with DRUJ instability in Group A) and subgroup B (cases with DRUJ instability in Group B). Practices to address DRUJ instability at the time of DRF fixation were explored. Results: There were 226 patients enrolled in this study. According to ‘point- baseline’ method, there were 174 wrists in Group A and 52 wrists in Group B. There were 34 cases (19.54%) diagnosed as having DRUJ instability intraoperatively via manual stress testing in Group A, while 36 cases (69.23%) in Group B. There was significant difference in the incidence of DRUJ instability between the two groups (p < 0.0001). Of the 70 cases with DRUJ instability, 18 cases regained stability by ulnar styloid fracture fixation, 12 cases by dorsal ulnar corner fragment (sigmoid notch fracture) fixation, and 40 cases by arthroscopy-assisted triangular fibrocartilage complex (TFCC) repair. To investigate the causes of DRUJ instability, there were 34 wrists in subgroup A, while 36 wrists in subgroup B. There were no significant differences between the two subgroups regarding the causes of DRUJ instability including ulnar styloid process fracture, dorsal ulnar corner fragment (sigmoid notch fracture), and traumatic TFCC injury. Conclusions: This study helped establish a ‘point- baseline’ method which can be readily and easily used to identify the severity of radial translation, which was a significant predictor of DRUJ instability. On the other hand, whether or not severe radial translation, treatment of DRUJ instability by the three major ways: (1) the ulnar styloid fracture fixation; (2) the dorsal ulnar corner fragment fixation; and (3) traumatic TFCC injuries repairing.
Background: Autologous fat grafting faces the clinical challenge of unstable absorption rates, and the regulatory mechanisms of macrophages need to be elucidated. Objectives: It aimed to investigate the infiltration levels and phenotypic dynamics of macrophages and explore their impact on graft retention rate (RR). Methods: A total of 180 C57BL/6J mice were randomly divided into experimental (AG, fat grafting), sham (BG, no grafting), and intervention (CG, macrophage depletion followed by grafting) groups. Graft RR was assessed, and macrophage status was analyzed by flow cytometry and immunofluorescence postoperatively. Levels of inflammatory, pro-fibrotic, and angiogenic factors were also detected. Results: Macrophage infiltration in the AG peaked at week 2 (21.3 ± 1.5%) and then shifted from M1 to M2 phenotype. The graft RR in the AG was visibly higher as against the CG (p < 0.05). M2 macrophages were strongly positively correlated with RR (based on the aggregated data of all time points, r = 0.821, p < 0.0001), while pro-inflammatory factors suggested negative correlation. The AG had visibly elevated levels of angiogenic factors, which were strongly positively correlated with RR (p < 0.05). Conclusion: Macrophages (especially the M2 subtype) play a key role in fat graft survival by modulating inflammatory responses and promoting angiogenesis. Targeting macrophage polarization may be a novel strategy to improve fat grafting outcomes.
The successful treatment of forearm non-unions, which occur as a complication in 2-10% of all forearm fractures, poses a significant challenge in reconstructive surgery. Current treatment often involves revision fixation with non-vascularized bone grafts for atrophic non-unions. Large bony defects in both forearm bones, however, necessitate advanced reconstructive techniques. In isolated reconstructions of the radius or ulna, the vascularized medial femoral condyle (MFC) flap has gained popularity, achieving 98-100% union rate. Allogenic bone grafts have also been described for reconstruction of large bone defects, potentially reducing donor site morbidity and operation time. This two-case report investigates the performance of vascularized MFC cortico-cancellous flap for ulna reconstruction and tricortical allogenic bone graft of the iliac crest for radius reconstruction in excessive, post-traumatic, atrophic non-union of the forearm diaphysis. In May and June 2021, a 62-year-old and a 56-year-old male received reconstruction surgery 9 and 13 months after initial plate osteosynthesis after a motorcycle accident. The MFC flap showed successful bony union of the ulna after 3 months as well as consecutive remodeling. However, the reconstruction of the radius showed a recurrent non-union, which even led to plate breakage in one case. In both cases, ulnar reconstruction with a vascularized MFC flap achieved successful union. However, radial reconstruction using structural allograft did not achieve union, causing recurrent non-union, likely reflecting limited biological incorporation. Level of Evidence: V (Therapeutic).
Background: Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin’s ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis. Methods: We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools. Results: A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively. Conclusion: Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.
Background: With the widespread popularity and development of aesthetic treatments, the focus has extended from facial aging to include the aging of hands. The primary aim of this study is to review the current materials, methods of injection, and testing procedures employed in cosmetic hand injections. Methods: PubMed database (from 1971 to April 2024) was searched to identify relevant studies on materials, injection techniques, and evaluation methods associated with aesthetic hand injections, excluding systematic reviews and medical record reports. Results: A total of 1815 articles were identified, of which 41 articles were included. This study summarizes the current materials, injection techniques, and outcome evaluation methods used for cosmetic hand injections, while discussing observations and making recommendations. Conclusion: Hand skin conditions tend to receive less attention than cosmetic facial injections. In existing studies of injected substances, hydroxyapatite remains the main material used for cosmetic hand injections. Poly-L-lactic acid (PLLA), platelet-rich plasma (PRP), and polycaprolactone injections were significantly more effective than other substances in the hand. In commonly used injection techniques, catheter-based injection methods are more accurate than needle positioning and dose. The most commonly used assessment methods remain ultrasound and the Merz hand partial scale. At present, there is still a relative lack of research on aesthetic hand injections, and extensive and in-depth research, such as randomized studies comparing hyaluronic acid and calcium hydroxylapatite and longitudinal data on the results of PLLA or PRP, is recommended to further develop hand injection techniques with lasting aesthetic results. Increased public awareness of hand injections derives from more reliable and valid studies. And we need standardized outcome measures and long-term follow-up data in future studies.
