Site Of Previous Trauma Research Articles

Rapidly Growing Congenital Disseminated Pyogenic Granuloma in the Scalp Treated with Staged Embolization and Excision: A Case Report

Pyogenic granulomas are common, acquired vascular lesions that most often arise spontaneously or in sites of previous trauma. However, there are reports of a few cases that describe a rare condition, congenital disseminated pyogenic granuloma (CDPG), in which an infant either is born with or shortly after birth develops multiple pyogenic granulomas. A hallmark of CDPG is negative staining for glucose transporter 1 (GLUT-1) on immunohistochemistry, which helps distinguish it from the more common multifocal infantile hemangiomas. Because few case reports have described CDPG, much is unknown about its characteristics, clinical course, and most effective treatment options. Here, we present a case of an infant with a unique presentation of CDPG with lesions that are atypically large and growing at a rapid pace. We also describe a novel approach to treating large pyogenic granulomas in CDPG via staged glue embolization and surgical excision.

567 - Prognostic factors in pediatric patients with vitiligo

Abstract Introduction Vitiligo is a pigmentary disorder, and its prevalence reaches 2.16% in children.(1) Childhood vitiligo differs from adult vitiligo in clinical characteristics such as higher incidence in females, higher prevalence of segmental presentation and lower association with autoimmune disorders. (2) The course of vitiligo is unpredictable, the disease may regress, stabilize, progress and exacerbate. (3) Few studies of the course of vitiligo have been published. Objectives The aim of this study was to identify the clinical characteristics associated with the progression of vitiligo in children and adolescents and also to describe the epidemiological profile in our patients. Methods We analyzed the clinical records of a cohort of pediatric patients with vitiligo attended at Centro Dermatológico Dr. Ladislao de la Pascua in Mexico City. Vitiligo diagnosis was defined clinically and to classify patients with NSV we used the revised classification of the Vitiligo Global Issues Consensus Conference. The outcome was the progression of vitiligo, and it was defined as an increase in the extent of the disease at the last visit of follow-up of the patient. We extracted the following data: age at onset, presence of halo nevus, Koebner phenomenon, familial medical history of vitiligo, presence of autoimmune and thyroid disorders. The Koebner phenomenon was considered if lesions were present in areas of friction or if the parents reported their occurrence at sites of previous trauma. Statistical analysis was performed using software SPSS v.25. To calculate the follow-up time we calculate the number of days between the last visit to the first visit of the participant to the center. We define four states according to the clinical course of vitiligo: stable, partial remission, complete remission and progressión. Stable means that the affected body surface area (BSA) did not change over the time, partial remission that the BSA decreased, complete remission means a BSA equal to zero and progression an increase in the involved BSA. We made a survival analysis using Kaplan Meier curves. Results Of the 679 participants, 50.2% (341) were males and 49.8% (338) females, giving a male-to-female ratio of 1:1. The average age of onset was 8.6 years (SD 4.4 years). Non-segmental vitiligo (NSV) was more common (55.5%) than segmental vitiligo (44.5). Koebner’s phenomenon was observed in 22.5% of patients and halo nevus was diagnosed in 5% of them. Only 4.1% (28) of the patients had family history of vitiligo; 0.9% had thyroid disorders and 0.3% had been diagnosed with an autoimmune disorder. The mean time of follow up was 11 months. The clinical course of the patients was: stable 44.3%, partial remission 38.7%, complete remission 4.9% and progression in 12.1%. The median time to progression of vitiligo was 71 months equivalent to 5.9 years (95%CI 58.72-83.29 months). The mean time to progression for non-segmental vitiligo was 54.94 months vs. 61.94 patients with segmental vitiligo (p=0.087). Time to progression was different in patients with another skin disease 68.37 months vs. 54.53 months (p=0.015). There were no differences in time to progression for the following variables: treatment, age of onset, gender, family history, Koebner phenomenon, halo nevus and autoimmune disorders. Conclusions In our population childhood vitiligo has a slow progression rate and a low prevalence of family history and Koebner's phenomenon compared to other Latin American populations. (4) The ratio of non-segmental to segmental vitiligo and female to male were lower than other countries. (5) Studies with longer follow-up periods are needed to assess progression in vitiligo.

Cutaneous nodule at the site of previous trauma in a 9-year-old male dog.

Cutaneous nodule at the site of previous trauma in a 9-year-old male dog.

Cancer Metastases to the Hand: A Systematic Review and Meta-analysis.

Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.

Post Traumatic Tuberculous Tenosynovitis in a Patient that Manifests as Soft Tissue Tumor: A Case Report

Mycobacterium tuberculosis infection is one of the oldest diseases of the human race. This bacteriacan attack any organ in the human body. Extra Pulmonary Tuberculosis (EPTB) infection diagnosis arerarely straightforward, and in many cases, delayed due to various reasons. Tuberculous tenosynovitis(inflammation of the tendon and its capsule because of Mycobacterium tuberculosis complex infection)is a rare form of EPTB. Tuberculosis infection at sites of previous trauma have been reported consistentlythough rarely. We present the case of a 48 years old male with complains of lumps on his lower left arm(with prior history of blunt trauma on the location) and progressive inability to flex the fingers of his lefthand. Early examinations suggest the diagnosis to be a soft tissue tumour. However, tissue biopsy latershowed that the patient was actually suffering from tuberculosis infection. The patient later showedsatisfying response to tuberculosis medication on subsequent follow ups.

Dermatofibrosarcoma Protruberans A Locally Aggressive And Recurent Malignant Tumour Of The Skin: Review And Case Report

Dermatofibrosarcoma protuberans (DFSP) is uncommon but represents one of the most common dermal sarcomas, which is said to be a locally aggressive, low grade, and relatively uncommon cutaneous tumour, which has a high propensity for local relapse with low metastatic potential. Over 90% DFSPs are genetically characterized by chromosomal rearrangements (translocation t (17;22) (q22; q13), resulting in the collagen type-1 alpha 1 (COL1A1)-platelet-derived growth factor â (PDGFB) fusion gene with well-known risk factors for developing DFSP, some cases develop at the site of previous trauma and reports have included a burn scar and the site of vaccination. The mainstay mode of treatment of DFSPs is wide local excision with traditionally 3-cm gross margins excision surgery. Mohs Micrographic Surgery (MMS) is highly recommended surgery for DFSP and is very useful treatment choice for recurrent DFSP. This case report discusses two patients with confirmed DFSP and have received adequate therapy. It also reviews salient features of evaluation and prompt management of DFSP and much emphasis on long-term follow-up of patients. Key Messages : Early diagnosis of pediatric DFSP is critical to minimize surgical disfiguration. We emphasize early evaluation of any suspicious skin lesion should not be ignored and should be excised and sent for histopathology. Undertreating a DFSP is even more problematic, as the tumour is locally destructive, can metastasize, and can prove fatal without treatment. A full metastatic workup should be done and patient should be regularly followed up, if it turns out to be malignant.

Dermatofibrosarcoma Protruberans A Locally Aggressive And Recurent Malignant Tumour Of The Skin: Review And Case Report

Dermatofibrosarcoma protuberans (DFSP) is uncommon but represents one of the most common dermal sarcomas, which is said to be a locally aggressive, low grade, and relatively uncommon cutaneous tumour, which has a high propensity for local relapse with low metastatic potential. Over 90% DFSPs are genetically characterized by chromosomal rearrangements (translocation t(17;22) (q22; q13), resulting in the collagen type-1 alpha 1 (COL1A1)-platelet-derived growth factor â (PDGFB) fusion gene with well-known risk factors for developing DFSP, some cases develop at the site of previous trauma and reports have included a burn scar and the site of vaccination. The mainstay mode of treatment of DFSPs is wide local excision with traditionally 3-cm gross margins excision surgery. Mohs Micrographic Surgery (MMS) is highly recommended surgery for DFSP and is very useful treatment choice for recurrent DFSP. This case report discusses two patients with confirmed DFSP and have received adequate therapy. It also reviews salient features of evaluation and prompt management of DFSP and much emphasis on long-term follow-up of patients. Key Messages: Early diagnosis of pediatric DFSP is critical to minimize surgical disfiguration. We emphasize early evaluation of any suspicious skin lesion should not be ignored and should be excised and sent for histopathology. Undertreating a DFSP is even more problematic, as the tumour is locally destructive, can metastasize, and can prove fatal without treatment. A full metastatic workup should be done and patient should be regularly followed up, if it turns out to be malignant.

Dermatofibrosarcoma Protruberans A Locally Aggressive And Recurent Malignant Tumour Of The Skin: Review And Case Report

Dermatofibrosarcoma protuberans (DFSP) is uncommon but represents one of the most common dermal sarcomas, which is said to be a locally aggressive, low grade, and relatively uncommon cutaneous tumour, which has a high propensity for local relapse with low metastatic potential. Over 90% DFSPs are genetically characterized by chromosomal rearrangements (translocation t (17;22) (q22; q13), resulting in the collagen type-1 alpha 1 (COL1A1)-platelet-derived growth factor â (PDGFB) fusion gene with well-known risk factors for developing DFSP, some cases develop at the site of previous trauma and reports have included a burn scar and the site of vaccination.The mainstay mode of treatment of DFSPs is wide local excision with traditionally 3-cm gross margins excision surgery. Mohs Micrographic Surgery (MMS) is highly recommended surgery for DFSP and is very useful treatment choice for recurrent DFSP.This case report discusses two patients with confirmed DFSP and have received adequate therapy. It also reviews salient features of evaluation and prompt management of DFSP and much emphasis on long-term follow-up of patients.Key Messages:Early diagnosis of pediatric DFSP is critical to minimize surgical disfiguration. We emphasize early evaluation of any suspicious skin lesion should not be ignored and should be excised and sent for histopathology. Undertreating a DFSP is even more problematic, as the tumour is locally destructive, can metastasize, and can prove fatal without treatment. A full metastatic workup should be done and patient should be regularly followed up, if it turns out to be malignant.

Extra-pulmonary tuberculosis developing at sites of previous trauma

We describe five individuals in whom extra-pulmonary tuberculosis appeared to localise at a site of previous blunt injury. We review other similar case reports where preceding trauma was blunt and non-penetrating, and discuss a possible mechanism involving transport of mycobacteria in monocytes to sites of injury during "latent" tuberculosis infection. This challenges the conventional model proposed for mycobacteria dissemination in tuberculosis disease.

Insufficient Bone Regenerate after Intramedullary Femoral Lengthening: Risk Factors and Classification System

Control of distraction rate with an intramedullary skeletal kinetic distractor (ISKD) may be problematic and a high distraction rate may result in insufficient bone regenerate. Are distraction problems preventable when using the ISKD, and what are the risk factors for and radiologic types of insufficient bone regenerate during ISKD lengthening? We analyzed 37 consecutive ISKD femoral lengthening procedures in 35 patients with a mean age 33 ± 11 years and minimum followup of 12 months (average, 27 ± 9 months; range, 12-55 months). The average length gain was 42.8 ± 12.9 mm. Eight patients had problems during distraction: seven had "runaway nails" and one had a nondistracting nail. Insufficient bone regenerate developed in eight patients. Important risk factors were a distraction rate greater than 1.5 mm/day (9.1 times higher risk), age 30 years or older, smoking, and lengthening greater than 4 cm. Less important risk factors identified were creation of the osteotomy at the site of previous trauma or surgery and acute correction of associated deformities. We proposed a radiologic classification for failure of bone regeneration: partial regenerate failure (Type I) or complete failure resulting in a segmental defect subdivided according to a length of 3 cm or less (Type IIa) or greater than 3 cm (Type IIb). Distraction problems with the ISKD were related mostly to internal malfunction of the lengthening mechanism. A distraction rate greater than 1.5 mm/day should be avoided in femoral intramedullary lengthening. Smoking should be a contraindication for femoral lengthening. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Basal Cell Carcinoma Presenting Late in a Shotgun Scar

The development of a basal cell carcinoma (BCC) as a late complication of a shotgun injury is a rare clinical entity. We report the case of a 68-year-old Caucasian man who developed a BCC at the site of a scar from a shotgun pellet entry wound that was sustained 14 years previously. We emphasize the importance of excluding malignancy in a non-healing lesion and discuss the possible etiologic factors in the development of a BCC at the site of previous trauma.

Chest wall and intrathoracic desmoid tumors: surgical experience and review of the literature

Desmoid tumors are fibroblastic/myofibroblastic neoplasms, which originate from musculo-aponeurotic structures and are classified as deep fibromatoses. Despite their benign histologic appearance and lack of metastatic potential, desmoid tumors may cause aggressive local infiltrations and compression of surrounding structures. They are often associated with female gender, familial adenomatous polyposis (FAP) and sporadically may occur at sites of previous trauma, scars or irradiation. Molecular studies have demonstrated that these patients are associated with a bi-allelic APC mutation in the affected tissue. Radical tumor resection with free margins remains the first therapy of choice. In cases with anatomical or technical limitations for a wide excision, radiation therapy represents a proven and effective alternative or supplementary treatment.

Post-traumatic soft tissue tumors: Case report and review of the literature a propos a Post-traumatic paraspinal desmoid tumor

BackgroundAntecedent trauma has been implicated in the causation of soft tissue tumors. Several criteria have been established to define a cause-and-effect relationship. We postulate possible mechanisms in the genesis of soft tissue tumors following antecedent traumatic injury.Case presentationWe present a 27-year-old woman with a paraspinal desmoid tumor, diagnosed 3-years following a motor vehicle accident. Literature is reviewed.ConclusionSoft tissue tumors arising at the site of previous trauma may be desmoids, pseudolipomas or rarely, other soft tissue growths. The cause-and-effect issue of desmoid or other soft tissue tumors goes beyond their diagnosis and treatment. Surgeons should be acquainted with this diagnostic entity as it may also involve questions of longer follow-up and compensation and disability privileges.

Fixed drug eruption at sites of ear piercing

Conflict of interest: none declared. Fixed drug eruption (FDE) at the sites of previous trauma or inflammation is a rare finding. We report two patients with FDE located unilaterally at sites of ear piercing and previous allergic contact eczema. Patient 1, a 24‐year‐old Turkish girl, presented with two circular, indurated violaceous plaques, 10 and 15 mm in diameter, on the dorsal and ventral sides of the right earlobe, respectively, exactly at the site of previous ear piercing (Fig. 1). Patient 2, an 18‐year‐old Turkish girl, presented with a similar circular indurated violaceous plaque, 10 mm in diameter, on the ventral side of the left earlobe exactly at the site of ear piercing. In both patients, the lesions had developed a few hours after the ingestion of analgesic for dysmenorrhoea; for patient 1, a 275‐mg tablet of naproxen sodium, and for patient 2, 20‐mg tablet of piroxicam or tenoxicam. This was the fourth and the fifth attack, respectively, each time occurring at menstruation. Each time, the lesion cleared within 1 week, leaving residual pigmentation. The earlobes had been pierced at the age of 7 years in patient 1, and in early infancy in patient 2. Both girls had previously experienced attacks of contact eczema when wearing earrings made of metals other than gold, and patch testing at that time had revealed contact sensitivity to nickel sulphate in both. Both had been free of eczema for the last 2–3 years, since they had begun avoiding nickel‐containing earrings. Dermatological examination revealed no keloid or papulonodular infiltration on the earlobes.

Idiopathic post‐traumatic dermatitis at the site of recent joint replacement

Idiopathic dermatitis over the site of previous trauma is a recognized but infrequently reported phenomenon that provides a diagnostic dilemma. Careful investigation is needed in order to exclude other rare and/or treatable causes.

Periocular basal cell carcinoma arising in a site of previous trauma

Case report: We report an incidence of basal cell carcinoma of the lower lid arising in an area of trauma 68 years after the initial injury.Comments: Because patients may disregard the appearance of a wound in the setting of former trauma, medical practitioners need increased suspicion and surveillance of chronic nonhealing wounds.

Pyoderma gangrenosum: a difficult early diagnosis to make

Pyoderma gangrenosum (PG) is a rare, painful, non-infectious, ulcerative, inflammatory skin condition. It is characterised by ulcers that can spread rapidly showing undermined violaceous borders. It may develop at sites of trauma or in surgical wounds. Early diagnosis is not always easy as there is no single diagnostic test and clinical features are often indistinguishable from other more common ulcerative skin conditions. Diagnosis is made on clinical appearance, patient history and exclusion of other conditions. We describe a case of PG, which proved challenging to diagnose, in a man who presented initially with a non-healing leg ulcer at a site of previous trauma and surgery. He subsequently developed further lesions on the contralateral leg with the classical appearance of PG. PG is a condition, which may be encountered by plastic surgeons and should always be considered in the differential diagnosis of any ulcer.

Periocular basal cell carcinoma arising in a site of previous trauma

Periocular basal cell carcinoma arising in a site of previous trauma

The use of percutaneous autologous bone marrow transplantation in nonunion and avascular necrosis of bone

During the development of normal bone in the young child, osteoblasts and then haematopoietic stem cells progressively colonise the cartilaginous matrix, resulting in its ossification to bone matrix.[1][1] It is at this time that red bone marrow appears in the skeleton, starting distally in the foot

Interobserver Reproducibility in the Interpretation of Bone Scans From Patients Suspected of Having Reflex Sympathetic Dystrophy

This work was undertaken to identify scintigraphic patterns obtained in patients suspected of having reflex sympathetic dystrophy (RSD), now often referred to as complex regional pain syndrome, whose interpretations could be difficult. Ten patients had bone scans because of clinical suspicion of RSD in the lower legs. They were selected retrospectively to have a wide sample of scintigraphic patterns. The radionuclide images and a multiple-choice questionnaire were presented as a PowerPoint file that was sent electronically on the Internet to 54 Belgian nuclear medicine physicians. They had to determine whether the images were in favor of the diagnosis of RSD. Twenty-eight answers (52%) were received. There was near-complete interobserver agreement for perfectly normal scans, for scans showing diffuse uptake with enhancement of periarticular activity, and for scans showing only focal hyperactivity at the site of previous trauma. Results were more discordant when the hyperactivity was mild and when there was a diffuse hypoactivity, with or without focal hyperactivity. This study shows that using very simple methodology, it is possible to identify some scintigraphic patterns in which there is disagreement among observers and whose interpretations vary. As the results are returned to the participants, they can compare their own interpretations with those of their peers. This aspect could be useful in continuing education in medical imaging.