Infantile haemangiomas (IHs) are caused by dysregulated vasculogenesis and angiogenesis, and can be superficial or deep. Diagnosis is primarily clinical but may include imaging and histology. Treatments include propranolol, laser therapy, and surgery for complications.
Pressure sores are localized skin and tissue injuries over bony prominences, caused by prolonged pressure, shear, friction, and moisture. Treatment varies by stage, from conservative care to debridement, antibiotics, and reconstruction.
Griffiths, Arango, Smith, Wade JPRAS 2022. PMID: 34955395.
Also: The Sunday quiz, podcast feedback, & nerve articles.
Penile reconstruction addresses tissue loss from trauma, fibrosis, cancer, and infection. The primary goal is to construct a phallus with a neo-urethra for standing urination and sufficient bulk for a prosthesis. Techniques include glans, shaft, and scrotal reconstruction.
Wound dressings vary from non-occlusive to occlusive, with antimicrobial options like silver dressings. Dressing choice depends on wound factors, and adjuncts like NPWT can enhance healing.
Also: The Sunday quiz, pressure sores illustration, & osteomyelitis article feature.
Osteomyelitis is a bone infection caused by bacteria or fungi, often due to trauma, surgery, or local soft tissue infection. Acute cases present with pain, fever, and swelling, while chronic cases involve persistent pain and reduced mobility. Management includes antibiotics and surgical debridement.
A paraplegic male presents with a chronic, infected Grade 4 pressure ulcer over the right ischial tuberosity, with exposed bone and possible osteomyelitis. Management is multidisciplinary with infection control, pressure relief, nutritional support, debridement, and flap reconstruction.
Also: New podcast episode, the Sunday quiz, & calculating burn depth.
A patient with a prior tibial fracture plating presents with suspected post-traumatic osteomyelitis. Management includes imaging, bone biopsy, and the orthoplastic approach — early debridement, soft tissue coverage, and antibiotics.
Also: Reverse anterolateral thigh flap illustration, bilobed flap design technique, & evidence on the scalp rotation flap.
Apert syndrome presents with craniosynostosis, midface hypoplasia, and complex syndactyly affecting the upper limbs. The Upton classification helps guide surgery for hand anomalies, with staged interventions to improve function and appearance.
A 97-year-old diabetic woman with a 3-month-old foot wound. History includes wound duration, diabetes control, and treatments. Exam focuses on wound depth, vascular status, and sensation. Chemical debridement, NPWT, and silver-impregnated foam dressing promote healing and infection control.
A 51-year-old woman has persistent pain and sweating asymmetry one year after ORIF for a distal radius fracture, suggesting CRPS. The Budapest criteria support the diagnosis. Treatment includes physical therapy, medications, and interventions like sympathetic blocks.
Also: Sunday quiz winner, inhalation injury illustration, & chemical burns feature.
De Quervain's disease (stenosing tenosynovitis) involves thickening of the APL and EPB tendon sheaths in the first dorsal wrist compartment, causing pain with thumb movements. Diagnosis is clinical, with provocative tests. Treatment begins conservatively, with surgery as a last resort.
A patient with a growing sternal mass, initially thought to be a lipoma, is diagnosed with undifferentiated pleomorphic sarcoma. Management includes staging, wide local excision, and possible radiotherapy. Reconstruction options involve pectoralis major or free ALT flap for the sternal defect.
An infant presents with a large erythematous lesion on the face. Diagnosis of infantile hemangioma is confirmed with GLUT-1 positive immunohistochemistry. First-line treatment is propranolol (2mg/kg/day). Surgery may be indicated for visual obstruction, airway issues, or ulceration.
A patient presents with trigger finger in the right middle finger. Initial treatment includes activity modification, splinting, NSAIDs, and a corticosteroid injection. Due to persistent symptoms, A1 pulley release surgery is planned, ensuring the A2 pulley is preserved to prevent bowstringing.
A patient with a mallet finger injury is unable to extend his fingertip. X-rays show a small bony avulsion fragment. This is a closed, bony mallet injury classified as Doyle Type I. Management includes continuous splinting of the DIP joint in extension for 6–8 weeks.
A postpartum woman presents with radial wrist pain. Diagnosis of De Quervain's is confirmed with a positive Finkelstein test. Initial treatment includes rest, splinting, NSAIDs, and corticosteroid injections. Surgery is considered if symptoms persist after conservative management.
Also: The Sunday quiz, evidence on LA use, & tissue expansion article.
A patient with a history of mastectomy and axillary lymph node dissection presents with progressive swelling in her left arm. Lymphoedema is suspected, classified as Stage II. Treatment includes complete decongestive therapy, and surgical options like Vascularized Lymph Node Transfer (VLNT).
