In this case report, we describe the treatment of burns in a physically disabled individual with a history of bilateral lower-leg amputation due to diabetic foot gangrene. To the best of our knowledge, there have been very few detailed reports of burns in physically disabled individuals. As a result, we felt it necessary to report this at the academic level, to promote collaboration with the respective authorities, and encourage further data gathering and research.

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Connective tissue diseases and vasculitis can cause Raynaud's phenomenon, which reduces the blood flow to the skin. Skin ulcers are a common symptom in patients with scleroderma, but they are less common in cases with dermatomyositis. A 66-year-old woman was diagnosed with dermatomyositis and tested positive for the anti-melanoma differentiation-associated gene 5 antibody. During the treatment for dermatomyositis, the patient developed acute interstitial pneumonia and a skin ulcer on the tip of her left index finger. A skin biopsy revealed vasculopathy, suggesting that the skin ulcer was a complication of dermatomyositis. The patient was treated with pulse steroid therapy, immunosuppressive drugs, and plasma exchange therapy, which improved her respiratory function. However, the skin ulcer progressively worsened until it involved the middle phalanx and eventually led to osteonecrosis. Pain management was difficult because of osteomyelitis of the middle phalanx and the destruction of the distal interphalangeal joint. As gangrene did not progress, the proximal phalanx was amputated. One year and ten months after the surgery, the wound was closed, the ulcer did not reoccur, and the patient was pain-free. Patients with dermatomyositis who are positive for anti-melanoma differentiation-associated gene 5 antibodies rarely present with skin ulcers or osteonecrosis. In some cases, however, amputation is considered to be an acceptable treatment option. (a, b) Photographs after the initial examination during the first visit with the plastic surgeon: The index finger of the left hand was affected by gangrene. (c) The X-ray image shows no discernible bone destruction nor periosteal reaction. (d) The T1-weighted magnetic resonance (MR) image, and (e) the T2-weighted image show the reduced and obscured signal at the tip of the finger. Furthermore, there was a non-uniform and irregular signal within the distal and middle phalanges. Chronic osteomyelitis in the middle phalanx was diagnosed based on the clinical and imaging findings.

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Primary closure after surgical excision of a pilonidal sinus is desirable for rapid healing; however, it necessitates a degree of rest and carries a high risk of wound dehiscence and infection. This report presents two cases in which closed-incision negative-pressure therapy was performed on primary suture wounds after pilonidal sinus surgery. Closed-incision negative pressure therapy was employed in two cases of simple primary suture wounds after pilonidal sinus resection. Following sinus excision, the wounds were sutured and dressed using the PREVENA™ System Kit. Postoperatively, the patient experienced no restrictions in activities of daily living. Closed-incision negative-pressure therapy, in contrast to conventional negative-pressure wound therapy targeted at open wounds, is applied to sutured wounds. Closed-incision negative-pressure therapy facilitates exudate removal and infection source elimination, mitigates subcutaneous hematoma, and aids in preventing wound dehiscence by drawing the wound edges inward, thereby reducing outward tension and stabilizing the suture. Our cases indicate that closed-incision negative-pressure therapy obviates the need for restrictions in daily activities, which is typically associated with a primary closure. A: A fistula with surrounding granulation was found 1.0 cm to the right of the midline. A small fistula was also found on the midline on the caudal side. B: A straight incision was made between the fistulas and the sinus was removed in one block. C: After sinus removal, a subcutaneous tissue defect measuring 3.0 × 5.5 cm remained. D: Primary wound closure was performed using absorbable subcutaneous and nylon epidermal sutures. E: A PREVENA™ PEEL & PLACE™ System Kit 13 cm was used for dressing.

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Necrotizing soft tissue infections are rapidly progressing and life-threatening conditions commonly caused by group A Streptococcus among other bacteria. We herein report a case of necrotizing soft tissue infection caused by group A Streptococcus that was suspected to have occurred within a family and provide a literature review. A 36-year-old male patient presented with swelling and discoloration of the left hand joint area, leading to a diagnosis of necrotizing soft tissue infection. He had been caring for his grandmother-in-law, who had died of necrotizing soft tissue infection two days before visiting the first hospital. Surgical debridement was performed under general anesthesia, followed by tissue removal. The patient recovered favorably and was discharged. Necrotizing soft tissue infections involve infections of the skin and soft tissues that rapidly progress and have a high mortality rate. Familial transmission is rare, suggesting the possibility of contact transmission. Therefore, it is crucial for families and healthcare workers to consider the possibility of necrotizing soft tissue infection transmission and to take appropriate precautions. (a) Initial presentation. There was erythema from the left thumb to the forearm, and a dark purple blister had formed from the left thumb to the wrist. (b) Day of admission. After initial debridement, necrosis was observed in the subcutaneous tissue and dorsal interosseous muscles from the thumb to the ring finger, so this area was excised. (c) Day after admission. After the second debridement, amputation was performed at the metacarpophalangeal joint of the thumb. (d) Day 45 of admission. Integration of artificial dermis (Integra Dermal Regeneration Template®) was confirmed. (e) Day 65 of admission. Thirteen days after split-thickness skin grafting, the graft had completely taken.

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Iliopsoas hematoma is a rare post-traumatic event. While the optimal treatment modalities for this lesion remain unclear owing to its rarity, an early diagnosis may be associated with better outcomes. However, the diagnosis is complicated by a large number of differential diagnoses. We herein report a case of iliopsoas hematoma that was not initially suspected because the patient had paraplegia. During treatment for sacral pressure ulcer, the patient developed sudden swelling and redness in the proximal left thigh. Therefore, an iliopsoas abscess was suspected. However, during surgery, a hematoma was found and drained. A negative bacterial culture of the contents confirmed that it was an iliopsoas hematoma. Plastic surgeons should be aware that such conditions can occur in patients with spinal cord injury, since such patients will not present with compressive symptoms of iliopsoas hematoma. (Left) CT revealed swelling of the muscle with contrast effect from the iliacus muscle to the hip joint (red ellipse). (Right) Spread of inflammation under the skin was seen on the left thigh. CT: computed tomography

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Terminal extensor tendon rupture of the finger results in mallet finger deformity. Although conservative therapy is the primary treatment for tendinous mallets, surgical treatment, such as tendon grafting or tendon transfer, is considered if there is a tendon defect. The external oblique muscle aponeurosis is sheet-like in structure, similar in morphology to the extensor tendons, and can be harvested with perifascial areolar tissue. In the present study, we used the external oblique muscle aponeurosis, including perifascial areolar tissue, as a transplanted tendon for finger zone I extensor tendon rupture with tendon defect. A 23-year-old man cut the extensor tendon of his left middle finger. Although primary tendon suture was attempted, it failed and caused a 20-mm defect after re-suturing several times. Two weeks later, a tendon reconstruction was performed. The external oblique muscle aponeurosis, including the perifascial areolar tissue, was harvested. It was folded in two and sutured between the proximal and distal ends of the extensor tendon. Perifascial areolar tissue was applied to cover the entire circumferential area of the transferred aponeurosis, including the suture area. At 3 months postoperatively, when all rehabilitation was over, the left middle finger distal inter phalangeal joint total active motion was 60° with a 5° angle of insufficient extension. This corresponds to the excellent functional evaluation of the mallet finger reported by Kanie et al. External oblique muscle aponeurosis with perifascial areolar tissue is considered useful for grafting of terminal extensor tendon ruptures. Further case series are warranted.

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