Introduction: Avascular necrosis of the sesamoid bones in the hand is a very rare and painful condition that is often associated to overuse or circulatory disturbances. The literature on its etiology, cause, and frequency remains sparse. This condition is more commonly observed in the femoral head or metacarpal head, while sesamoid necrosis of the hand is less frequently to not at all discussed. This study explores the causes, symptoms, diagnosis, and treatment options for this rare condition, presenting a case of a 76-year-old woman diagnosed with avascular necrosis of the sesamoid bone in the index finger. Material and methods: An extensive literature review was conducted using PubMed and Google Scholar, yielding 82 publications from 1990 to 2024. Of these, 80 were excluded due to being related to the foot. A retrospective analysis of the remaining two articles focused on the conservative and surgical treatments for sesamoid necrosis in the hand. The data include demographic information, diagnosis, and treatment outcomes. Results: Over the past 35 years, only two cases of avascular necrosis of the sesamoid bones in the hand have been documented. Both previous reports involved female patients presenting with symptoms of grip weakness and progressive pain at the metacarpophalangeal (MCP) joint. In the two reported cases, conservative treatments such as Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and physical therapy were initially applied but ultimately proved ineffective. Surgical intervention, including sesamoidectomy, was required to alleviate symptoms, with all diagnoses confirmed through pathological examination. Conclusion: Avascular necrosis of the sesamoid bones in the hand, though rare, can lead to significant pain and functional impairment. Conservative treatments can provide short-term symptom relief, but they have been insufficient for long-term pain management or functional restoration in the few cases reported worldwide. Surgical intervention, specifically sesamoidectomy, remains the definitive treatment for achieving lasting relief. Early intervention is recommended to prevent long-term disability, chronic pain and resulting infection.
Background: Microvascular tissue transfer is the method of choice for oncological and trauma reconstruction. Successful free tissue transfer requires technical expertise and management of patients and surgery related factors. However, whether systemic blood pressure (SBP) affects perfusion of free flaps remains unclear. Methods: Photoplethysmography (PPG) is a relatively new technology used in many wearable medical devices to measure blood pressure and heart rate. It is a simple optical technique that detects changes in blood volume within the underlying microvascular bed of tissue. This study aimed to evaluate the relationship between systemic blood pressure (SBP) and free flap perfusion using PPG. Results: Twenty-five patients who underwent free flap reconstruction for head-neck cancers or traumatic soft tissue defects were enrolled in this study. All patients were clinically normotensive without needing postoperative vasopressors. The study did not find a statistically significant correlation between systolic or mean blood pressure and free flap perfusion. Conclusion: Beyond a critical threshold of mean arterial pressure (MAP), free flap perfusion is not directly correlated with blood pressure. In clinically normovolemic patients, elevations of BP above MAP ~65 mm Hg did not enhance flap perfusion.
Objective:As the number of elective hand surgeries has increased across the board, this systematic review aims to elucidate the effectiveness of extracorporeal shockwave therapy (ESWT) in hand surgery. Of interest are Dupuytren's disease (DD), trigger finger (TF), De Quervain's tenosynovitis, osteonecrosis of the lunate (ONL), and carpal tunnel syndrome (CTS). Methods:Qualitative analysis of the current evidence according to the Cochrane Handbook for systematic reviews of interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement using electronic databases, and quality assessment of the included studies using the Cochrane risk of bias in non-randomized Studies - of Interventions assessment tool, the Cochrane risk-of-bias tool for randomized trials and the measurement tool to assess systematic reviews 2 were performed. Results:ESWT with ≥5 sessions in DD improved functional status and symptom severity significantly and consistently, especially pain, in the short- and mid-term. In TF ESWT alleviated pain in the short-, mid- and long-term. Also, functional status and severity of triggering improved consistently in the mid- and long-term. Three sessions of ESWT are the optimal number in TF patients. In DQT ESWT improved pain and functional status in the short- and mid-term. One study showed LCI and ESWT to be equally effective in DQT patients. Another study showed ESWT as an effective treatment of the pain and progression of ONL. ESWT improved pain and functional status in CTS in the short- and mid-term, especially if ≥4 sessions of ESWT are performed. The long-term effectiveness of ESWT has been suggested but not sufficiently proven. Conclusions:ESWT is an effective and recommended treatment in DD, TF, and CTS to improve pain and functional status, especially, rESWT regarding CTS and likely also TF. It represents an equally effective option as local corticosteroid injections in TF, DD and CTS with fewer and less severe adverse effects. In the treatment of DQT, ESWT should be considered an option in the clinical setting. Further research is necessary to develop normed protocols and expand its scope of application. Trial registration:The review and search protocol were registered at PROSPERO (National Institute for Health and Care Research) - CRD42024598627.
Background: The authors report a case of a 42-year-old male patient who presented with a relapse of penile acne inversa five years after a split-thickness skin graft without use of collagen-elastin-matrix (CEM). After unsatisfactory pharmacological treatment, resection of the affected skin, negative pressure wound therapy (NPWT), CEM application, and split-thickness skin graft (STSG) were performed in several steps. Methods: We performed initial debridement and consecutive NPWT. After achieving a clean wound bed, a CEM (1 mm MatriDerm®; MedSkin Solutions Dr. Suwelack AG, Germany) was applied, followed by split-thickness skin grafting. Results: During a 19-month follow-up, the patient presented with a very good functional and cosmetic outcome. Under intravenous antibiotic therapy and intensive wound care, we achieved complete recurrence-free status in the genital area at the 19-month follow-up. The subjective quality of life almost tripled from 3.2 to 9.3 on the numeric analog scale (NAS). Conclusion: Complex reconstruction procedures of penile defects in acne inversa can be avoided if there is a well-perfused wound bed. Coverage of the defect with MatriDerm® and split-thickness skin grafting may lead to long-term aesthetically satisfactory results with high patient satisfaction. We have monitored one patient over 19 months, who presented with stable penile soft tissue coverage and no signs of relapse. We anticipate that coverage of penile defects using MatriDerm® and split-thickness skin grafts may prevent or at least delay the need for complex reconstruction in cases of recurrence.
Arthroplasty in managing tumors of the extremities is a challenging surgery. Careful planning and the expertise of the surgical team are of utmost importance, especially when managing unpredictable intraoperative complications. In this study, we report on the surgical management of a pathological femoral neck fracture with multiple metastases with carcinoma of an unknown primary origin. Primary total hip replacement was planned. However, due to the presence of multiple metastases in the lower limb with intraoperative fracture of the distal femur, a total femoral replacement with a push-through endoprosthesis was carried out primarily. The duration for the surgical intervention was three hours and 56 minutes. Following surgery, initial intensive care was necessary due to the multimorbidity of the patient. Two days after surgery, the patient could be mobilized with full weight bearing and no restriction of range of motion of the entire left lower limb supervised by physiotherapists at ward level, which she tolerated well. The pain was significantly relieved during hospital stay. Mega-endoprostheses with push-through stems are a reliable option in cases with multiple metastases.
