1/3. Surgical excision of pedunculated supernumerary digits prevents traumatic amputation neuromas.Nine patients divided into two groups were treated for pedunculated supernumerary digits or their sequelae. The first group consisted of three patients who had among them five traumatic amputation neuromas. In each case these lesions resulted from primary suture ligation of accessory digits in infancy. Secondary surgical excision of the vestigial digit with high ligation and retraction of the accompanying nerve tissue was required in all cases. The second group consisted of six patients who had 12 pedunculated supernumerary digits. Primary surgical excision of these digits was performed with high transection and retraction of the accompanying accessory digital nerve. All patients in this group had excellent cosmetic results with no postoperative neuroma formation. adult family members who had undergone suture ligation of similar supernumerary digits in infancy accompanied seven of the nine patients in this series. On careful examination, each of these family members had signs and symptoms attributable to traumatic amputation neuromas. We feel identification and high transection of the accessory digital nerve is essential in the treatment of pedunculated supernumerary digits. This treatment prevents traumatic amputation neuromas and yields a better cosmetic result than the traditional method of suture ligation in infancy.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/3. The development of a Marjolin's cancer in a human immunodeficiency virus-positive hemophilic man and review of the literature.BACKGROUND: The malignant potential of chronic ulcers and scars secondary to a variety of injuries is well characterized in the medical literature. Furthermore, it has been reported that human immunodeficiency virus (hiv)-positive patients have a higher incidence of basal cell carcinoma (BCC) than the general population. OBJECTIVE: To describe a case of an unusually aggressive morpheaform BCC that developed in a 28-year-old hiv-positive patient. The tumor developed in a scar 25 years after the initial trauma (Marjolin's ulcer). methods: Description of a case and review of the literature of Marjolins ulcer. RESULTS: The tumor was removed in a seven-stage, 21-section, micrographically controlled excision. Intraoperatively, perineural invasion of the infraorbital nerve was observed. The postoperative defect was repaired using a full-thickness skin graft. CONCLUSION: Although most malignancies arising within chronic scars are SCCs, BCCs and a number of other tumors have been described. Mohs micrographic surgery was effective in treating this aggressive morpheaform BCC. A high degree of suspicion in any changing healed scar is recommended.- - - - - - - - - - ranking = 0.33333333333333keywords = nerve (Clic here for more details about this article) |
3/3. Traumatic neuromas of the head and neck.An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma. The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |