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.

Soft tissue reconstruction around the elbow is challenging due to the need for durable yet pliable coverage that preserves joint mobility and function. We present the case of a 56-year-old gentleman with a chronic elbow wound secondary to osteomyelitis. Following debridement, the defect was reconstructed using a posterior ulnar recurrent artery perforator (PURAP) flap designed in a propeller style. Unlike previous reports that have described PURAP flaps based on arm perforators, this case uniquely utilised perforators arising from the forearm. This forearm-based approach offers several advantages, including reduced donor-site morbidity, and avoidance of dissection near the ulnar nerve. This case highlights the versatility and safety of the forearm-based PURAP flap for elbow reconstruction. Level of evidence: Level 5.

We describe a singular case in which the patient underwent wide surgical excision of the primary lesion (Pleomorphic Dermal Sarcoma) and reconstruction with a skin graft. After seventy-five days, total clinical and radiological regression of the ipsilateral parotid and neck localizations was observed without the need for adjuvant therapy.

Facial aging causes skin laxity, volume loss, and wrinkles. This study examines the effects of combining Polydioxanone (PDO) thread lifts and Botulinum Toxin A for non-surgical facial rejuvenation in 10 patients. After four months, 90% reported improved skin texture and brightness. Mild, transient swelling occurred, with no major complications.

Although less commonly in the hand, gouty tenosynovitis may present with symptoms resembling infection. Only a few case reports document such presentations, and reports of coexisting infection and gouty tenosynovitis are even more uncommon. A 32-year-old male with polyarticular tophaceous gout, noncompliant with medications, presented with a one-day history of right index finger swelling and redness. Investigations were suggestive of infectiousious tophus. Despite broad-spectrum antibiotics and rheumatologic interventions (colchicine, allopurinol, and corticosteroids), his condition deteriorated. Multiple incisions and drainages were performed without improvement. Persistent infection, confirmed to be methicillin-resistant Staphylococcus aureus (MRSA), complicated the underlying gouty inflammation. Standard therapies for infective tenosynovitis did not yield clinical resolution, presumably due to ongoing crystal-induced inflammation and compromised tissue. Ultimately, finger amputation was performed to control disease progression after all other salvage options failed. This case underscores the aggressive and destructive potential of gout when complicated by infection. Normal or relatively low serum uric acid levels do not exclude gout, and synovial fluid crystal analysis can be pivotal. Coexisting infection and gouty tenosynovitis in the hand can lead to severe tissue damage if misdiagnosed or inadequately treated. A high index of suspicion, multidisciplinary collaboration, and timely surgical intervention are crucial in preventing further morbidity. This case demonstrates that amputation may be necessary when infection remains unresponsive to standard treatments, emphasizing the importance of early diagnosis and aggressive management.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous tumor predominantly affecting young to middle-aged adults, characterized by a slow-growing, indurated plaque or nodule. The diagnosis and treatment of DFSP can be challenging due to its rarity, growth pattern and variable clinical presentation. A 40-year-old male presented with a firm lump of 8 mm on his forehead for one year. It was initially suspected to be a benign lipoma or atheroma and removed accordingly by a private plastic surgeon. However, histopathological examination revealed dermatofibrosarcoma protuberans (DFSP) that was not radically removed, prompting referral for removal at our department. Here, he presented with a scar of 10 mm with no visible or palpable residual tumor. A planned excision of 20 mm and reconstruction with split thickness skin graft (STSG) was performed. Histopathology showed tumor activity at several margins, with perineural and periosteal invasion. MRI was inconclusive, and therefore PET-CT was added, which showed possible residual tumor. Re-excision including mapping biopsies was performed. Wide re-excision was performed three times to achieve clear surgical margins, yielding a tumor size of approximately 8x10 cm and a final defect measuring 10x12 cm. The defect was reconstructed with a dermal template (Integra®) and STSG. Our case underscores the propensity of DFSP for significant subclinical extension, including potential perineural and periosteal invasion. Despite the aesthetically challenging location, a satisfactory cosmetic result was achieved, and there was no recurrence during the two-year follow-up.

Titanium miniplates, though biocompatible, often require removal due to infections (3–18%), primarily from Staphylococcus aureus. Biofilms, which resist antibiotics, drive persistent infections. We analyzed 10 infected miniplates via SEM, revealing dense polymicrobial biofilms, especially near screw holes. These structured microbial communities underscore the need for biofilm-targeted treatments to improve outcomes.

In postoperative scenarios, arterial embolisms, while not rare, can profoundly affect flap viability. This case study elucidates a distinctive occurrence of embolism a week after surgery, underscoring the importance of examining areas beyond anastomotic sites. Surgeons must scrutinize distal vessel segments for discoloration to ensure successful flap rescue.

A 42-year-old mother underwent a combined abdominal cosmetic procedure with fat grafting to the rectus muscle. Twenty-four days post-surgery, she developed a voluminous abdominal mass corresponding to cytosteatonecrosis. Ultrasound-guided fluid aspirations failed to treat her, and surgical drainage was necessary. The limits of combined procedures need to be discussed.

Wiskott-Aldrich Syndrome presents unique diagnostic and therapeutic challenges. Our case highlights a rare clinical complication associated with WAS and emphasizes the importance of prompt recognition and management. Dissemination of such rare presentations is crucial for enhancing clinical awareness and optimizing patient outcomes.