Peri-prosthetic late hematoma following breast implant procedure is defined as a hematoma presenting longer than 6 months after operation and is a rare complication with sporadic cases reported throughout literature. We present a case of an 85-year-old patient who developed a spontaneous late hematoma nearly 20 years following implant-based breast reconstruction and adjuvant chemotherapy to illustrate the importance of maintaining a wide differential when approaching a chest wall mass that cannot be biopsied in a patient who has previously received breast implants. MRI revealed a peri-implant effusion with a heterogeneous mixed signal partially enhancing mass measuring 3.2 x 4.3 x 1.7 cm, posterior to the left breast implant. The patient had bilateral Mentor smooth, round, silicone, 350 cc implants in the submuscular plane. Ultrasound-guided biopsy was attempted and unsuccessful due to inability to displace the implant and access the mass, indicating the need for an open biopsy. The patient underwent radical left chest wall mass excision of the posterior implant capsule, removal of the left implant, and closure of the anterior capsule. Final pathology confirmed the diagnosis of organized hematoma. Immunophenotyping flow cytometry was utilized to rule out BIA-ALCL or BIA-SCC. Our case is unique in that biopsy was unable to be obtained given retro-implant position of the mass and that the diagnosis and etiology of late hematoma formation following smooth round silicone implants has been infrequently discussed in literature. Providing a comprehensive workup considering patient history, physical exam findings, imaging, and pathology ensures a wide differential optimizing patient outcomes.

Intraoperative use of urokinase is a recognized method for salvaging compromised free flaps. However, protocols for dosage and administration vary, and no consensus exists regarding the optimal technique. Herein, we report a case of postoperative venous thrombosis in a free fibular flap. Despite the unsuccessful intra-arterial administration of urokinase owing to an extensive venous thrombus, we attempted to dissolve the thrombus through direct intravenous infusion using a 27 G needle at multiple sites in the vein where the thrombus had formed. Ten minutes after direct injection into the venous thrombus, venous blood flowed out and successful thrombolysis was achieved. Re-anastomosis was performed, leading to full use of the skin flap without partial necrosis. No hemorrhagic complications were observed. Intra-arterial injection of urokinase is an effective method of thrombolytic therapy for flap salvage. However, when the vein is completely occluded by thrombus, intraflap circulation of the agent via arterial infusion becomes difficult. Direct injection of urokinase into the occluded vein may serve as a potential method for resolving venous obstruction within the limited ischemic time of the flap.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent abscesses, sinus tract formation and extensive scarring. In severe cases, surgical excision and complex reconstruction are often required. This case report aims to highlight the role of modern plastic surgical techniques, including regenerative technologies, in managing severe HS. A 37-year-old Hispanic male with a 17-year history of HS presented with extensive lesions involving the buttocks, groin, genitalia, thighs and perianal region. He underwent staged wide excisions totaling over 2,400 cm2. Reconstruction included split-thickness skin grafts (STSG), NovoSorb® BTM (Biodegradable Temporizing Matrix) and RECELL® autologous skin cell suspension. Postoperative recovery was marked by successful graft take, wound healing and return to normal function, including physical activity and sexual function, by postoperative day 69. This case underscores both the complexity of managing stage III HS and the evolving role of regenerative technologies in improving outcomes. While wide local excision remains the cornerstone of treatment for extensive disease, adjunctive use of BTM and RECELL enhances dermal regeneration, reduces donor-site morbidity and optimizes aesthetic and functional results. These innovations reflect a shift in reconstructive strategy, emphasizing a more tailored, patient-centered approach. The integration of regenerative modalities such as Biodegradable Temporizing Matrix (BTM) and RECELL autologous cell suspension technology into contemporary plastic surgical reconstruction offers significant benefits in treating severe hidradenitis suppurativa. By complementing traditional excisional techniques, these technologies contribute to improved healing, minimized morbidity and restored function, aligning with the goals of modern, multidisciplinary HS management.

Reconstruction of complex facial defects following oncologic resection presents a significant challenge, especially when critical anatomical subunits and nerve branches are involved. The choice of reconstructive technique must prioritize tissue match, reliability, and safety. The cervicothoracic fasciocutaneous flap offers a valuable alternative to microsurgical reconstruction, providing robust vascular supply and favorable aesthetic integration without the need for microsurgical techniques. This report details the case of a 76-year-old male with micronodular basal cell carcinoma of the left cheek. Wide oncologic resection resulted in an 8 × 8 cm defect involving the infraorbital, preauricular, nasogenian, and mandibular units, as well as underlying structures including the SMAS and masseteric fascia. The defect was successfully covered using the cervicothoracic flap, with no complications such as necrosis or local infection. At four-month follow-up, the patient exhibited stable healing, good aesthetic integration, and only mild residual ectropion, with no functional limitations or donor site morbidity. This case highlights the effectiveness of cervicothoracic flaps in comorbid patients, positioning them as a viable alternative to microsurgical reconstruction for complex facial defects.

The thoracodorsal artery perforator (TDAP) flap is established in immediate and early breast reconstruction, but its role in single-stage, hybrid (flap-plus-implant) reconstruction performed ≥12 months after failed implant-based surgery is not well described. Three consecutive patients underwent pedicled TDAP flap reconstruction combined with a subpectoral Becker-35 expandable implant more than one year after failed implant-based reconstruction in scarred fields with poor skin quality. Pre-operative planning included CT angiography (CTA) for perforator mapping, complemented by handheld Doppler; intra-operative indocyanine green (ICG) angiography was unavailable. Mean flap size was 17 × 8 cm, pedicle 13–15 cm, mean operative time 247 min, and estimated blood loss <250 mls. Two patients achieved durable, satisfactory outcomes with no donor-site morbidity at 24 months. One flap failed after inadvertent division of the dominant perforator, underscoring technical risks in fibrotic planes. Key lessons include meticulous intramuscular dissection, preservation of a secondary perforator until inset, creation of a generous tunnel to prevent kinking, and early management of venous congestion. In patients unsuitable for abdominal flaps or latissimus dorsi sacrifice, a pedicled TDAP combined with an expandable implant offers a muscle-sparing, single-stage option for delayed reconstruction after implant failure.

Background Lipomas are common benign tumors, but giant bicompartmental bilobed lipomas in the hand are rare and pose unique diagnostic and surgical challenges due to the hand’s complex anatomy and the proximity of neurovascular structures. Case presentation We report the case of a 67-year-old woman with a slowly enlarging, painless mass in her left hand, located between the second and third metacarpals, with both dorsal and volar extensions. Physical examination revealed a firm, well-defined lesion measuring approximately 5 cm in length, associated with mild paresthesia and decreased range of motion. Magnetic Resonance Imaging (MRI) confirmed a well-encapsulated, hyperintense mass consistent with a benign lipoma, exhibiting bicompartmental extension without signs of malignancy. A dual approach was employed for complete excision: an S-shaped dorsal incision followed by a volar zigzag incision. Intraoperatively, the lesion demonstrated a bilobed hourglass shape crossing through a constriction ring formed by surrounding anatomical structures. Meticulous dissection enabled safe en bloc removal while preserving the extensor tendons and common digital nerves. The postoperative course was uneventful. The patient resumed active motion two weeks postoperatively, with full recovery of hand function and no recurrence at 6-month follow-up. Histopathological examination confirmed a spindle cell lipoma with no malignant features. Conclusion This case highlights the importance of preoperative imaging, surgical planning, and a dual dorsal-volar approach for managing complex lipomas of the hand. Tailoring the surgical strategy to the lesion’s anatomy allows complete excision while minimizing the risk to vital structures and optimizing both functional and cosmetic outcomes.

Reconstruction of the distal radius after en bloc bone tumor resection is challenging. Among various surgical reconstruction methods, ulnar translocation is a simple approach that does not require vascular anastomosis, autograft harvesting, or prosthesis preparation. This report describes the 7-year follow-up of a patient who underwent reconstruction with ulnar translocation following resection of a recurrent giant cell tumor of the bone. A 57-year-old woman was diagnosed with multiple recurrent giant cell tumor of the bone involving the distal radius. The patient underwent en bloc resection of the tumor with osteotomy of the distal radius 5 cm proximal to the wrist joint through a dorsal incision. The distal ulna was osteotomized at the same level and translocated with preservation of the vascularity of the posterior interosseous artery. Then, the translocated ulna was fixed to the carpal bone and distal radius and aligned in the mid-supination and pronation positions; fixation at 10° of wrist dorsiflexion was performed using locking plates. Bone union between the metacarpal bone, grafted bone and proximal radius was achieved at 9 months postoperatively. At the 1-year follow-up examination, the range of motion of the wrist was 90°/65° (supination/pronation), and the grip strength was 9.1 kg. At the final follow-up examination (7 years postoperatively), the range of motion of the wrist was 90°/90° (supination/pronation) and the grip strength was 19 kg (20 kg on the lateral side). The patient’s QuickDASH and Hand 20 scores were 25 and 43, respectively, indicating minor difficulties in daily activities. Ulnar translocation is regarded as a practical alternative to more complex reconstructive procedures for the distal radius following en bloc tumor resection. Its benefits include surgical simplicity, long-term durability, and preservation of forearm rotation.

Primary malignant melanoma of the umbilicus is extremely rare; evidence guiding optimal resection and reconstruction is limited. A 47-year-old man with primary umbilical melanoma underwent full-thickness abdominal wall resection including the peritoneum. The abdominal wall defect was reconstructed using an autologous fascia lata graft. Histopathology confirmed malignant melanoma with a tumor thickness of 18 mm (pT4bN1aM0, Stage IIIC). At 6-month follow-up, no local recurrence or incisional hernia was observed, and at one year after surgery, no evidence of herniation or recurrence was noted. Autologous fascia lata offers a practical option for abdominal wall reconstruction after extensive oncologic resection of the umbilical region, achieving early freedom from recurrence and hernia in this case.

Trapezoid dislocations are extremely uncommon injuries because of the strong intercarpal and carpometacarpal ligaments that provide greater stability to the trapezoid–metacarpal joint compared with the more ulnar carpometacarpal joints. We report a case of trapezoid dislocation, emphasizing the radiographic features essential for diagnosis and the fixation strategy used for management. A 50-year-old woman sustained a sliding fall while riding a scooter, resulting in a trapezoid dislocation from the carpometacarpal joint accompanied by a fracture at the base of the right third metacarpal. The injury was managed with retrograde intramedullary K-wire transfixation of the second metacarpal-trapezoid joint combined with a spanning plate across the thrid metacarpal-capitate joint. The spanning plate maintained the length of the third metacarpal relative to the capitate, thereby indirectly restoring the anatomical alignment of the second metacarpal and stabilizing the reduced trapezoid. The retrograde intramedullary K-wire was easily positioned so that its tip did not extend beyond the trapezoid, thus preventing potential irritation of surrounding vital structures that might result from an obliquely placed K-wire. The ‘missing carpal sign’ serves as an important radiographic clue suggestive of trapezoid dislocation. Given the strong surrounding interosseous ligaments, it is important to recognize the possible occurrence of trapezoid dislocation in association with fractures or dislocations involving structures adjacent to the trapezoid. We present a retrograde intramedullary K-wire fixation technique for stabilizing the trapezoid–metacarpal joint, which can be easily and effectively applied after anatomical reduction of the trapezoid.

The allograft for humeral reconstruction is a widely used technique in oncology but complication rates are high and Free Vascularized Fibula Graft (FVFG) represents a “strategic” solution to preserve satisfactory upper limb function. We treated 3 cancer patients with allograft failures and FVFG was used to reconstruct complex humeral defects.