Objectives: Lymphedema is a chronic condition characterized by fluid accumulation and limb swelling, often accompanied by pain. While complete decongestive therapy may reduce pain, some patients experience persistent symptoms. Lymphaticovenous anastomosis (LVA) is a minimally invasive procedure that has shown promise in alleviating pain, but the types of pain most responsive to LVA remain unclear.

Methods: This retrospective study included 14 patients (12 women, 2 men; mean age 55.6 years) with lower limb lymphedema and pain who underwent LVA between August and December 2023. A total of 25 limbs were treated. Pain was assessed using a visual analog scale (VAS, 0-10), and pain characteristics were categorized. Limb circumference was measured at six points and summed. Preoperative and postoperative data were compared using paired t-tests. The mean follow-up duration was 268.4 days.

Results: The mean preoperative VAS score was 3.1, which improved slightly to 2.9 postoperatively (p = 0.23); 5 patients (35.7%) experienced pain reduction, 6 (42.9%) had no change, and 3 (21.4%) reported worsening pain. Limb circumference improved significantly from 205.5 cm to 200.5 cm (p < 0.01). Pain improvement showed moderate correlation with changes in limb circumference (r = 0.42) and postoperative weight loss (r = 0.49). Subgroup analysis revealed greater pain reduction in patients who described their pain as "sharp" or "throbbing," whereas all patients who experienced worsening pain reported "heaviness."

Conclusions: LVA may provide meaningful pain relief in selected patients with lower limb lymphedema, particularly those with sharp or throbbing pain. Limb volume reduction and postoperative weight loss appear to be associated with greater pain improvement.

Objective: The objective of this study was to compare the surgical treatment of gynecomastia using circumareolar excision versus transverse skin excision.

Methods: Thirty-six male patients with unilateral or bilateral gynecomastia participated in this prospective randomized study at our institution. Participants were divided into two groups: Group A received circumareolar skin excision, and group B received transverse skin excision. Patients were evaluated for surgical and postoperative complications, patient satisfaction, and cosmetic outcomes.

Results: There were no intraoperative complications or blood transfusions. The average operative time was 150 minutes for group A and 110 minutes for group B. Hospital stays ranged from one to two days. Both groups had a 5.56% incidence of hemostasis-related issues and wound infections. Seromas appeared in 11.11% of cases and resolved spontaneously. Wound dehiscence was observed in 16.67% of group A and 5.56% of group B, with no statistically significant difference. Hypertrophic scars occurred in 16.67% of group B, while none were reported in group A (p = 0.07).

Conclusions: The circumareolar technique requires longer surgical time and may lead to a less optimal chest contour. However, it provides superior cosmetic results for the nipple-areola complex. Both techniques demonstrate comparable rates of postoperative complications.

Objectives: Necrotizing soft tissue infections (NSTIs) caused by group A streptococcus (GAS) are life-threatening diseases with high morbidity and mortality rates. Early diagnosis is of paramount importance because a delay in diagnosis results in a significant reduction in survival rates. Recent studies have shown that the use of a rapid antigen detection test for GAS (GAS-RADT) at the time of NSTI diagnosis facilitates timely identification and simplifies surgical decision-making through small incision-based interventions. This study aimed to evaluate the accuracy of rapid diagnosis using a puncture method and to describe the associated procedure.

Methods: We evaluated the accuracy and reproducibility of GAS-RADT performed using a less invasive and simpler puncture method compared to conventional sampling from small incision wounds and outlined the diagnostic procedure. The study population included 19 patients who underwent GAS-RADT using the puncture method at our hospital between 2019 and 2023.

Results: The concordance rate between GAS-RADT and wound culture was 100%; Cohen's kappa coefficient was 1.0, indicating extremely high concordance.

Conclusions: As GAS-RADT performed with puncture sampling is a minimally invasive and rapid testing method that helps determine treatment strategies, it can be considered an extremely useful diagnostic method for detecting GAS-NSTI, which has been on the rise in recent years.

Hemifacial microsomia has been reported as the second most common congenital craniofacial malformation. The aim is to present a representative case of a patient who underwent both surgical procedures for the integrated care of hemifacial microsomia. The surgical technique for dynamic facial reanimation was a two-stage procedure due to masseter function impairment. The first one consisted of a cross-facial nerve graft, which was coapted to the masseteric nerve on the contralateral side, and the second stage consisted of a gracilis muscle transfer, in which the obturator nerve was coapted to the masseteric nerve on the ipsilateral side (a dual-innervated free functional gracilis flap). Mandibular distraction was performed a year after the second stage of facial reanimation. At the five-year follow-up, the patient had sustained a satisfactory, aesthetic, and pleasant result. No further secondary or revision procedures have been needed. Objectively, we observed bite-force enhancement, as demonstrated by electromyography. In our experience, we recommend performing microsurgical facial reanimation first, followed by mandibular distraction, and finally, autologous ear reconstruction.

The palm is prone to skin contractures due to Dupuytren's contractures or trauma. To cover skin defects after contracture release and prevent re-contracture, surgeons prefer flaps to skin grafts. The perforator propeller flap is one of the best local flaps; however, there are few reports on this method. In a perforator mapping study in healthy volunteers, color Doppler ultrasonography showed that the perforator vessels were located around the metacarpophalangeal joints. Five patients with Dupuytren's contracture and one with post-traumatic scar contracture underwent novel perforator propeller flap reconstruction using perforator vessels around the metacarpophalangeal joint in the second, third, or fourth intermetacarpal spaces. Flap sizes ranged from 11 × 22 to 16 × 50 mm², and all flaps survived completely. Our propeller flap is useful for the reconstruction of distal palmar skin defects, especially those less than 16 mm in width.

Electrical injury refers to sustained trauma to the skin or internal organs caused by direct contact with an electric current. Progressive necrosis caused by vascular endothelial damage is a defining feature of electrical injuries. Given this endothelial damage, careful attention is required during reconstruction after such injuries. We present a case of upper extremity reconstruction following an ultra-high-voltage electrical injury (275,000 volts), using an abdominal distant flap with planned vascular anastomosis. Many cases of electrical injury require extremities amputation; however, we were able to salvage the upper extremity. Therefore, this reconstruction method can be an effective technique for managing high-voltage electrical injuries.

Extensive pelvic resection often results in complications, making flap reconstruction essential for managing pelvic defects. We report a case of successful reconstruction using a pedicled vastus lateralis myocutaneous flap following abdominoperineal resection for anal canal cancer. The flap was transferred through an intermuscular and subcutaneous tunnel into the pelvic cavity. Its anteroposterior extensibility allowed effective filling of the defect. Advancement of the posterior portion of the muscle into the deep pelvis compensated for the limited pedicle length. Preservation of the motor nerve may have helped maintain muscle volume, particularly on the intrapelvic side, with minimal postoperative atrophy observed. These technical strategies demonstrate that the pedicled vastus lateralis myocutaneous flap provides adequate volume, reach, and durability, and may represent a valuable option for extensive pelvic floor reconstruction, especially when motor innervation is preserved.

The upper eyelid fistula caused by intracranial infection is rare. We present a rare case of an upper eyelid fistula caused by a chronic infection of the artificial dura mater, the bone flap, and the absorbable fixation materials following epilepsy surgery in a 13-year-old male. After surgery for left frontal lobe epilepsy, the patient developed a purulent discharge from the left upper eyelid. Imaging studies revealed a bone defect in the cranial bone flap, with the infection extending to the upper eyelid. Pseudomonas aeruginosa was identified as the causative agent. Surgical intervention, including removal of the infected artificial dura mater, bone flap, and fixation materials, was performed, followed by reconstruction of the dura mater using fascia lata. Postoperatively, the upper eyelid fistula healed completely without recurrence. This case underscores the importance of considering cranial bone and dura mater infections as potential causes of upper eyelid fistulas, especially in patients with a history of neurosurgery.

Minocycline has caused hyperpigmentation on various body parts, including the skin and mucosa, as a side effect. This is the first report of hyperpigmentation in transplanted free flaps. We present three head and neck reconstruction cases in two males and one female. The primary diseases were two cases of tongue cancer and one case of buccal mucosa cancer. Two anterolateral thigh flaps and one rectus abdominis musculocutaneous flap were transplanted after tumor resection with skin paddles placed intraorally. Minocycline was administered to prevent acneiform rash, which is a side effect of cetuximab during postoperative chemotherapy. The intraoral skin paddles turned blue 2 weeks to 1 month after administration. Minocycline causes hyperpigmentation by chelating the hemosiderin deposited in the skin due to capillary hemorrhage. Intraorally transplanted free flaps may be susceptible to minocycline-induced hyperpigmentation owing to vascular congestion, inflammation, and the intraoral environment.

Neonatal purpura fulminans, often caused by congenital protein C deficiency, presents with rapid onset of skin necrosis and microvascular thrombosis and can progress to disseminated intravascular coagulation. Therefore, early diagnosis and intervention are crucial for patient survival. We report a case of a neonate who developed purpura fulminans within hours after birth and presented with skin lesions on the right lower leg and abnormal coagulation markers. Treatment with fresh frozen plasma and heparin was promptly initiated, leading to significant improvement. Conservative management with ointments and wound dressings was also administered to treat the skin lesions. Genetic testing confirmed a compound heterozygous PROC mutation. Despite severe ocular complications that resulted in blindness, limb function was preserved. This case highlights the importance of early recognition, genetic testing, and aggressive treatment in managing neonatal purpura fulminans caused by congenital protein C deficiency to improve outcomes and prevent severe sequelae.

An external dental fistula is a skin perforation caused by spontaneous drainage of pus from odontogenic lesions and is often misdiagnosed due to its resemblance to other conditions. This report describes an 84-year-old man who presented with left cheek swelling and pus drainage. Although an external dental fistula was initially suspected, the diagnosis was delayed due to the edentulous state of the left maxilla. After multiple referrals to various specialties and several misdiagnoses, a computed tomography scan revealed a fistulous tract linked to a retained tooth fragment. The dental fragment was surgically removed, leading to resolution of the abscess and closure of the fistula. This case highlights the importance of considering external dental fistulas even in edentulous patients, as a retained tooth fragment can be the underlying cause.

Smith-Magenis syndrome (SMS) is caused by a deletion in the 17p11.2 region or abnormalities in the RAI1 gene. Clinically, it is characterized by distinctive facial features, sleep disturbances, and neurobehavioral traits such as self-injurious behaviors and developmental delays. It may also be accompanied by ophthalmologic, ear, nose, and throat (ENT), and cardiovascular abnormalities. The prevalence of cleft lip and palate in SMS is reported to range from 0% to 25%; however, there are no detailed reports on speech therapy or speech evaluations following surgery in such patients. Given the significant individual variability in developmental delays among patients with SMS, careful consideration is necessary when determining surgical indications for cleft palate. We conducted regular language assessments, including evaluations of mental development, with a speech therapist, and determined that the patient was a candidate for cleft palate surgery when pre-linguistic speech with meaningful elements was confirmed. Herein, we report a case of SMS in which palatoplasty was performed.

Breast cancer remains a leading public health issue in low- and middle-income countries (LMICs), where 5-year survival rates range from 12% to 53%. Although post-mastectomy breast reconstruction is a key part of cancer care, its uptake remains low in LMICs. This review identifies the main barriers limiting reconstruction access to inform potential interventions. We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases were searched for English-language, peer-reviewed articles published between January 2013 and October 2023 on challenges to post-mastectomy breast reconstruction. Eligible studies were original research. Two reviewers extracted and categorized findings into socio-cultural, structural, and financial themes, summarized through descriptive analysis. The search identified 15 papers from 11 countries across four continents. Of the included studies, 73% (n = 11) mentioned barriers under two or more categories; 20% (n = 3) mentioned only structural barriers, and 7% (n = 1) mentioned only socio-cultural factors. Ten studies (67%) described socio-cultural barriers, with the most prevalent themes being the perception of reconstruction as purely aesthetic (47%), fear of anesthesia and recovery time (33%). Thirteen studies (87%) described structural barriers, with the most prevalent structural barrier being a lack of patient awareness, especially before mastectomy (47%). Limited numbers of practicing plastic surgeons (40%), urban-clustered tertiary treatment facilities (33%), and low surgeon referral rates (27%) reduced reconstruction utilization. Twelve studies (80%) described financial barriers with self-payment cited as the most significant limitation to reconstruction and the most significant barrier overall (60%). Reconstruction in LMICs faces intertwined socio-cultural, structural, and financial barriers that limit access and patient willingness.