Trigeminal trophic syndrome (TTS) is a rare neurocutaneous disorder defined by trigeminal anesthesia, facial paresthesia, and crescentic ulceration of the nasal ala. We describe an 86-year-old woman with long-standing trigeminal neuralgia who developed a suspicious ulcerated lesion on the left nasal ala. Although the initial biopsy showed atypical squamous cells suggestive of squamous cell carcinoma, the combined histopathologic, radiologic, and clinical findings supported a diagnosis of TTS. This case underscores the need to distinguish TTS from malignancy, particularly in elderly patients with neurologic comorbidities. Early recognition may prevent unnecessary invasive procedures and improve outcomes.

In the era of supermicrosurgery, clinicians need more precise imaging modalities to know the exact microvascular and lymphatic anatomy of the patient. The goal of this review is to answer the research question “What are the state-of-the-art medical imaging modalities supporting supermicrosurgery?”This study is a scoping review and case report.Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are well-known current standard imaging modalities in flap surgery. In lymphatic surgery, lymphoscintigraphy is the gold standard. (Ultra)high-frequency ultrasound (UHFUS) has taken a major role in preoperative planning of flap surgery and lymphatic surgery. Practical guidelines on the use of UHFUS in flap planning and lymphatic surgery are described in this review article. Indocyanine green angiography and near-infrared fluorescent lymphography have also become key elements in modern flap surgery and lymphatic surgery. Moreover, contrast-enhanced magnetic resonance lymphography produces high-resolution imaging of superficial as well as deep lymphatic vessels. Laser tomography and photoacoustic imaging are promising experimental imaging techniques in lymphatic surgery.This review article describes and compares possible imaging modalities for preoperative planning and intraoperative guidance with the aims of enhancing surgical outcomes, reducing operative time, and preventing complications in supermicrosurgery. Moreover, a case report is described in order to illustrate the practical imaging work-up in daily practice.

Abstract Chronic compartment syndrome (CCS), though often described in athletes, can occur in patients with long-standing lymphedema due to chronic fibrotic changes in the skin, subcutaneous tissue, and deep fascia. We present a unique case of CCS in a patient with advanced secondary lymphedema of the left lower limb. She underwent multiple sittings of vascularized lymph node transfers and lymphovenous anastomoses. Her final lymph node transfer, combined with bariatric surgery, led to dramatic weight loss and a reduction in lower limb girth. Subsequently, she developed persistent exertional pain and neuropathic symptoms in the left calf, raising suspicion for CCS. Intracompartmental pressure (normal range of 0–10 mm Hg) analysis by manometry confirmed CCS with preoperative readings of 22, 25.2, 17.9, and 29.5 mm Hg in anterior, lateral, superficial, and deep compartments of the leg. Surgical decompression and debulking resulted in postdecompression pressures of 6.5, 6, 4.6, and 4.6 mm Hg, respectively, with good symptomatic relief. This case emphasizes the importance of considering CCS in chronic lymphedema with limb pain and neuropathy unexplained by surgical outcomes.

Acquired unilateral proptosis is a clinically significant condition with diverse etiologies, including trauma, inflammation or infection, tumors, and hemodynamic complications. This study aimed to improve recognition by integrating a literature review with illustrative case reports. Four representative cases were described, covering orbital infection, traumatic hematoma, carotid–cavernous fistula, and metastatic tumor. A focused literature review of publications from 2020 to 2024 was conducted, identifying 338 relevant studies, of which 171 met the inclusion criteria. Among the 171 eligible studies analyzed, tumors were the most frequent cause (93/171, 54.4%), followed by hemodynamic disorders (24/171, 14.0%), thyroid-related ophthalmopathy (13/171, 7.6%), infection, and inflammation. In tumors, metastatic tumor (n = 10) represented the most common subtype, followed by sarcoma (n = 9), retinoblastoma (n = 7), and lymphoma (n = 7). The four clinical cases aligned with these categories and illustrated a spectrum of outcomes—from irreversible vision loss in infection to visual preservation through timely endovascular intervention. This study provided a more detailed understanding of the diverse etiologies of acquired unilateral proptosis, suggesting the necessity of a multidisciplinary approach. Integrating these findings into clinical practice is expected to enhance early recognition, optimize treatment strategies, and ultimately improve patient outcomes.

Abstract Extramammary Paget disease (EMPD) is a rare cutaneous malignant lesion. Surgical resection is the primary treatment. However, the ideal surgical margin remains uncertain. This study aimed to investigate the correlation between different margins and EMPD recurrence rates. A total of 35 EMPD patients underwent surgical resection between 2008 and 2018. This study considered multiple factors associated with the local recurrence rate, including surgical margin, depth of excision, pathological margin, tumor size, and the time until recurrence occurred. The study demonstrated that a surgical margin of 2 cm signified the outcome of local recurrence, with 20.8% in the <2 cm group and no local recurrence (0.0%) in the ≥2 cm group (p = 0.157). The tumor size statistics significantly affected the local recurrence at 9 cm (p < 0.05). Other managements had no statistical significance to the local recurrence rate. A surgical margin size of more than 2 cm is suggested for the wide excision of EMPD patients, considering the recurrence percentage and outcome in this study. This retrospective study aimed to find the relation of surgical margin and the disease outcome of extramammary Paget disease (EMPD) by considering multiple factors associated with the local recurrence rate, including surgical margin, depth of excision, pathological margin, tumor size, and the time until recurrence occurred. The result showed that a surgical margin of ≥2 cm gave a better outcome of disease, and a tumor larger than 9 cm significantly affected the recurrence rate. The study suggests surgical excision of more than 2 cm around the tumor.

This review highlights current surgical approaches for carpal tunnel syndrome (CTS), the most common compressive neuropathy of the upper extremity. Open, mini-open, endoscopic, and emerging minimally invasive techniques are compared in terms of outcomes, complications, pillar pain, and reoperation rates. Surgical indications, anatomical considerations, and management of recalcitrant CTS-including recurrent, persistent, and new-onset symptoms-are discussed. Adjunct procedures such as opponensplasty and flexor synovectomy are reviewed, with emphasis on patient selection, individualized decision-making, and the importance of thorough anatomical knowledge to ensure safe adoption of novel techniques.

Facial reanimation surgery offers various approaches, with the choice of method influenced by numerous factors. Masseteric nerve transposition (MNT) has become a preferred neural source, often compared with cross-face nerve graft (CFNG) for its respective advantages. This systematic review and meta-analysis aim to compare postoperative outcomes between MNT and CFNG in facial reanimation surgery for patients with facial nerve paralysis sequelae. A comprehensive electronic search was conducted using databases such as PubMed/Medline, Scopus, ScienceDirect, EBSCO, Web of Science, and Cochrane Library, along with gray literature sources like Scopus Preprints and MedRxiv. Statistical analyses were performed using Review Manager version 5.4.1, with the quality of included studies assessed using the Newcastle-Ottawa Scale. Results showed that MNT provided statistically significant improvements in commissural excursion (CE; mean difference [MD] = 2.36 mm) and commissural contraction velocity (CCV; MD = 7.01 mm/s) compared with CFNG. Additionally, MNT had a higher recovery percentage for CE (MD = 26.86%) and CCV (MD = 13.00%). Superior outcomes were also noted for static and dynamic smile symmetry, quality of life, and patient satisfaction. This meta-analysis underscores the advantages of MNT over CFNG in the majority of parameters in the analysis, at once highlighting the need for further research with larger sample sizes for more precise comparisons.

BackgroundFingertip injuries present a challenge for surgeons. Factors such as appearance, sensation, and grip strength influence the choice of procedure. The neurovascular island (NVI) flap is commonly used due to its reliability and favorable results. However, it can lead to reduced sensation and a limited range of motion, which are significant concerns.MethodsThis study analyzed 56 adult patients with 66 finger injuries treated with a modified NVI flap by a single surgeon. The flap is based on branches of the proper digital artery to the volar and dorsal skin, including two nerves in the resected flap. The FIOS score was used to assess long-term flap outcomes at follow-up. Patients with thumb injuries, incomplete records, or loss of follow-up were excluded.ResultsThe study found that NVI flaps had a survival rate of 98%. Post-surgery, the patients' outcomes were assessed using the FIOS score, with 61 cases rated as “excellent,” 4 as “good,” and 1 as “fair.” During long-term follow-up, none of the patients experienced cold intolerance or sensory abnormalities, which is attributed to the inclusion of the dorsal cutaneous nerve in the flap.ConclusionIn conclusion, the NVI flap procedure proved to be a reliable method for reconstructing fingertip pulp loss, offering long-term satisfactory outcomes. It provided good coverage with preserved sensation, dexterity, and preservation of finger length, meeting the patients' cosmetic expectations.

Lymphedema is rare adverse effect of coronavirus disease 2019 (COVID-19) vaccination that has been reported in several studies. We present a case of surgically treated secondary lymphedema after COVID-19 vaccination. The patient presented lymphedema at the upper extremity with no specific history except the COVID-19 vaccination 18 months before the visit. Lymphaticovenous anastomosis and liposuction were performed on the posterolateral aspect of the forearm and the upper arm. The volume of the affected arm was reduced to more than 54% at 8 months postoperatively. With precise surgical planning, secondary lymphedema resulting from COVID-19 vaccination could be successfully treated surgically.