Injury
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The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch. ⋯ This new nerve transfer proposal may be an important step in nerve transfer surgery.
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Replantation of lower extremity is a very complex and difficult procedure. There are still a lot of controversies about indications, even numerous scoring systems are now available that can facilitate the surgeon's decision. We present the functional results of a replanted below-knee amputation in an elderly patient, 27 years after the injury and discuss the indication for replantation.
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Case Reports
Facial palsy caused by an intrameatal metastatic disease - Reconstruction with an autologous sural nerve graft.
Dysfunction of the facial nerve is frequently attributed to inflammation, followed by traumatic injury. Knowledge of the complex anatomical course of the facial nerve is critical to localize the site of pathology and for successful management. The multiplicity of etiologies and its complex anatomy often make facial paralysis a diagnostic challenge. ⋯ The final histopathological findings revealed a metastatic breast adenocarcinoma. To our knowledge only seven prior cases of an isolated metastatic CPA lesion have been reported. In patients without a known malignancy, a rapid progression of hearing loss, disequilibrium, and facial palsy might be the first sign of a metastatic CPA lesion.
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Extensive lower limb traumatic injuries are particularly challenging when they associate skin and soft tissue defects, moreover when the patient is a child. In view of more frequent recommendations and reports of negative pressure wound therapy (NPWT) use for severe trauma and extensive soft tissue defects of the lower extremity, we aimed at reviewing the indications and outcomes of this technique in our pediatric plastic surgery department. ⋯ NPWT has proven to be an easy to use, safe and effective therapeutic tool for pediatric patients, with considerable improvement for healing in case of traumatic injuries of foot and ankle, presenting extensive skin and soft tissue defects and bone exposure in children. NPWT is also suitable for children since its use implies less frequent dressing changes, and decreases the level of pain and anxiety, and spares donor areas needed for more complicated procedures and, by creating an optimal grafting bed, it ensures good outcomes, in the short term and long term as well.