ResearchPad - case-reports-and-short-communication Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Breast reconstruction in a patient with an implanted deep brain stimulator]]> Deep brain stimulators (DBSs) are sometimes used to treat refractory movement disorders such as Parkinson's disease. When DBSs are implanted in a subcutaneous pocket in the chest region, breast reconstruction becomes a challenge because monopolar electrocautery can lead to DBS dysfunction or brain tissue damage caused by heat. We report a patient with a DBS who underwent one-stage implant-based breast reconstruction. We switched off the DBS before surgery and used monopolar electromagnetic cautery with minimum power settings to undermine the subcutaneous pocket for the breast implant. The DBS was switched back on immediately after completion of the surgery. The patient's postoperative recovery was uneventful with the DBS fully functional.

<![CDATA[Aggressive digital papillary adenocarcinoma and sentinel node biopsy: A case report and literature review]]> Aggressive digital papillary adenocarcinomas (ADPA) are malignant tumours of the sweat gland. Due to the high tendency to recur and metastasise, wide local resection of the lesion is recommended. However, there are a limited number of cases reporting the use of sentinel node biopsy in the management of ADPA, thus its effectiveness remains unclear. We present a case of ADPA of the right middle finger treated with digital amputation and sentinel node biopsy, and review the current literature focusing on the usefulness of sentinel node biopsy.

<![CDATA[Combination of negative pressure wound therapy (NPWT) and integra dermal regeneration template (IDRT) in the lower extremity wound; Our experience with 4 cases]]>

The treatment of de-gloving injuries in the lower limb with exposed tendons, bone, and/or nerve is a challenging reconstruction problem. The standard management of de-gloving injuries involve either direct closure if the skin is viable or immediate grafting with the avulsed skin or full- or split-thickness graft when the skin flap is not viable. Alternative methods are flap coverage especially when the underlying structures are not suitable for grafting such as extensive loss of paratenon and/or exposed bone or open joints The use of negative pressure wound therapy (NPWT) followed by use of Integra dermal regeneration template (IDRT) and subsequent split-thickness skin grafting (STSG) as an alternative to the previously mentioned surgical options has been described. In this series we describe the successful management of four patients with exposed tendons, bones, and joints of the distal lower extremity following road traffic accidents (RTA) using NPWT, Integra and thin split-thickness skin grafts.

<![CDATA[Anatomically accurate 3D modelling and printing in a case of obstetric brachial plexus injury]]>

Obstetric brachial plexus injury is reported in 0.42 per 1000 births in UK and Ireland and are associated with a reduction in quality of life for the patient and their carers. In this report we describe the first use of a patient specific, anatomically accurate 3D model as a communication tool in the treatment of a complex case of posterior shoulder subluxation secondary to glenohumeral deformity resulting from obstetric brachial plexus injury.

The use of 3D models for surgical planning is associated with decreased operating time and reduction of intra-operative blood loss, whilst their use in patient education increases patient understanding. In this case all surgeons surveyed agreed that it was useful and will use 3D modelling to improve consent processes and to conceptualise novel techniques for complex cases in future. This highly reproducible, low cost technique may be adapted to a variety of upper limb reconstructive surgeries, and as the resolution of image acquisition and additive manufacturing capabilities increase so too do the potential applications of this precise 3D printed surgical adjunct.

<![CDATA[Ameloblastic fibrosarcoma – A rarity?]]>

Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumour classified by the WHO (1992) as an odontogenic sarcoma and defined as “a neoplasm with a similar structure to ameloblastic fibroma (AF) but in which the ectomesenchymal component shows the features of a sarcoma.” The first report of AFS was published by Heath in 1887. AFS and related lesions are less frequently diagnosed than odontogenic carcinomas. Approximately two-thirds of AFSs seem to arise de novo, but others have developed in recurrent AF, in which the ectomesenchymal cells retain their embryonic appearance and develop malignant characteristics. We report a rare case of an aggressive odontogenic neoplasm, the incisional biopsy of which showed the features of AF, while the excisional biopsy revealed the features of malignancy, suggestive of AFS.

The purpose of this report is to discuss the diagnostic difficulties, whether AFS is truly an extremely rare tumour as reported earlier and, lastly, should the treatment protocols of AFs be revised, as 44% of AFSs arise from recurrent AFs.

<![CDATA[Film dressing – A versatile no-mess operative field around the head and neck]]> ]]> <![CDATA[Acute symptomatic hyponatremia following elective rhinoplasty: A case report]]>

We present the first reported case of symptomatic hyponatremia after elective rhinoplasty. A 42-year old female underwent cosmetic rhinoplasty without complication and was discharged home after an uneventful recovery from general anesthesia. Just prior to midnight on the day of surgery, she reported nausea, which was treated with supportive care. Four hours later, she developed emesis, altered mental status, and seizure-like activity prompting medical transport to the emergency department. Upon arrival, she was hypotensive (BP 78/54), tachycardic (HR 112 bpm), hyponatremic (116 mmol/L), hypoosmotic (239 mOsm/kg), and had decreased consciousness (GCS = 10). She was admitted to the intensive care unit and had a central line placed for hypertonic saline infusion. Urinalysis was suggestive of SIADH (UrNa 111 mmol/L, UrOsm 546 mOsm/kg) and Nephrology was consulted. Her serum sodium was corrected over three days and her mental status improved. Surgeons should maintain a low threshold for further evaluation in patients who deviate from the expected postoperative recovery pathway. This report demonstrates that normal postoperative symptoms may mask underlying physiological abnormalities that can progress to acute life-threatening illness and underscores the importance of direct patient observation in the immediate postoperative period.

<![CDATA[Dermatofibrosarcoma protuberans (DFSP) arising from a keloid scar – A case report]]>

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma with an indolent early course that may be misdiagnosed for benign skin pathology. In this case-report we highlight an instance of DFSP arising from a keloid scar de novo and present a reconstruction with a local pedicled LD flap. We subsequently appraise the related literature and discuss the diagnostic challenges.

<![CDATA[Successful repair of a full upper eyelid defect following traumatic amputation by simply suturing it back in place]]>

There is a general belief that a full-thickness eyelid defect is best repaired using a vascularized flap in combination with a free graft, and that a free full-thickness eyelid graft would not survive due to poor blood perfusion. However, we describe a case in which an upper eyelid was traumatically amputated. The eyelid was sutured in place and healed well in situ. The long-term outcome was good regarding motility and function. This raises the question of whether a blood-supplying pedicle is necessary for the survival of the graft when repairing large eyelid defects.

<![CDATA[Complex facial reconstruction with invasive and non-invasive conventional interventions]]>



Despite the obvious advantages, face transplantation requires strict patient selection to guarantee optimal outcomes. Therefore, it is not suitable for all patients with severe facial disfigurements. Simultaneously, conventional plastic and reconstructive surgery techniques, as well as medical spa techniques, have evolved, offering minimally invasive treatment of complex deformities.


The entire face of a young woman was severely disfigured because of a mistreated juvenile acne, with severe ectropions, oral incompetence and substantial midfacial tissue defect. We are describing the reconstruction with a combination of conventional reconstructive methods, such as scar release, skin transplantation, local flaps, medical needling and lipofilling.


Oral competence, unhindered breathing and adequate lid closure was achieved. Previously unable to participate in social life in any meaningful way, our patient was able to reintegrate fully and take a job.


For selected patients, combined, invasive and non-invasive conventional techniques can provide satisfying outcomes in complex facial reconstruction. Modern regenerative approaches such as lipofilling and medical needling should be considered as integral parts of treatment strategies.