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).
Lymphedema is a chronic condition caused by impaired lymphatic drainage, leading to swelling, typically in the limbs. It can be primary (congenital) or secondary (from surgery, radiation, or infection). Treatment focuses on complete decongestive therapy, with surgery reserved for severe cases.
Also: The Sunday quiz, operating on Enchondromas, & glomus tumours - clinical scenario.
Also: Macrodactyly, Sunday Quiz and 3 recommended reads.
Also: The Sunday quiz, cervical lymph nodes of the neck illustration, & mandibular defects feature.
In this week's edition 1. ✍️ Letter from P'Fella How We Hit 100: The Journey of ThePlasticsPaper
This guide provides four key tips, along with practical examples, to help you approach the FRCS Plastic Surgery Oral Exam with confidence and clarity.
Also: Anatomy illustration of the week, macrodactyly feature, & 3 recommended articles.
Soft tissue sarcomas are rare, malignant tumors of mesenchymal origin. They are classified into over 70 subtypes, with risk factors including environmental exposures and genetic predispositions. Management involves surgery, radiotherapy, and sometimes chemotherapy, tailored to the sarcoma type.
Median nerve tendon transfers restore thumb opposition, flexion of the index and middle fingers, and thumb flexion. The procedure involves relocating functional tendons to compensate for lost function due to nerve injury.
A patient seeks NAC reconstruction post-DIEP flap. NAC reconstruction is indicated post-mastectomy, breast reduction, congenital absence, trauma, or gender-affirming surgery.
Also: Sunday quiz winners, tuberous breast deformity, & nipple flap recon options.
A patient with bilateral arm paraesthesia and heaviness, along with a history of sciatic nerve injury and crutch use, is diagnosed with thoracic outlet syndrome (TOS) through clinical examination and imaging. Treatment includes physiotherapy, pain management, and surgical decompression.
