Cutaneous melanoma is a highly aggressive form of skin cancer, responsible for >90 % of deaths related to skin tumors, despite accounting for only a small proportion of total cutaneous tumors.Cutaneous melanoma is the fifth most commonly diagnosed cancer in both females and males and there is an annual increase of around 3–7 %.In recent years, survival rates have improved due to health education campaigns, prevention strategies and the development of new treatments for advanced disease.Melanoma patients have an increased risk of developing a new melanoma, although the risk is still low. Most new melanomas are diagnosed within 5 years of the first melanoma. A small fraction of patients are diagnosed with more than one melanoma within 3 months of the first melanoma, referred to as synchronous melanomas. As this is a rare phenomenon, the available literature remains limited. Some studies have shown improved survival in this group and that the subsequent melanoma was significantly thinner; however further research is needed to fully understand this phenomenon.Here we present a case with a patient with six synchronous melanomas diagnosed within 19 days. The patient underwent genetic screening but no pathogenic gene variants were found.This case highlights the importance of thorough skin examination at the time of melanoma diagnosis.To our knowledge, this is the first reported case of six synchronous melanomas in the absence of identifiable genetic predisposition. The case demonstrates the need for further research.

We present the case of a female patient who underwent polyacrylamide hydrogel (PAAG) injection for breast augmentation 21 years ago and developed bilateral breast pain 2 years prior to evaluation. Preoperative magnetic resonance imaging (MRI) did not reveal any hematoma formation. However, intraoperative findings included multiple mural masses composed of dark red, fibrous clots, which were subsequently diagnosed as chronic organized hematomas. This case illustrates that organized hematoma may represent a distinct subtype of PAAG-related complications, likely resulting from long-term interactions between the physicochemical properties of PAAG and the local tissue microenvironment. It also highlights the diagnostic limitations of imaging in complex PAAG-associated pathology, suggesting that imaging should serve as an adjunct rather than a sole determinant in surgical decision-making. For patients with persistent pain or morphological changes of the breast, surgical exploration should be considered even in the absence of characteristic imaging findings. For asymptomatic patients, surgical intervention may also represent a beneficial option.

BackgroundBuried free flaps monitoring cannot rely on clinical evaluation, which remains the gold standard in flaps with a skin paddle. A reliable way to monitor buried free flaps is through implantable dopplers, which provide a continuous and direct signal of anastomotic flow. Since the only way to ascertain a suspicion of vascular impairment in buried free flaps is through reoperative exploration, a high specificity is required together with a high sensitivity to avoid unnecessary theatre take-backsMethodsA systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) and using the following keywords: “Cook Swartz” AND “doppler” AND “flap” AND “monitoring” and “Synovis” AND “Flow Coupler” AND “flap” AND “monitoring”. The indicators of efficacy and effectiveness of the two available implantable dopplers were analyzed and compared to our casistics.ResultsThe search using Cook Swartz thesaurus identified 116 articles while that of Synovis Flow Coupler 25 articles, of which only 26 and 6, respectively, fully satisfied our inclusion criteria.ConclusionThe literature search seems to confirm our current practice, with Cook Swartz (Cook Medical, Bloomington, IN) arterial placement preferred for head and neck buried free flaps and Synovis Flow Coupler (Synovis Life Technologies, Inc., St. Paul, MN) for buried DIEP flaps. This preferential placement reflects the higher rate of false positives when a vein is monitored in the head and neck, which is high mobile and prone to respiratory oscillations leading to probe dislocation or missing signal.

BackgroundFor subungual, malignant skin tumors of the thumb, ultimate treatment has mostly been the amputation, a procedure that comes with a significant functional loss. We propose reconstruction of the defect with the reverse, homodigital, dorsoulnar, pedicled (RHDU) flap, if no osseous infiltration is present.MethodsWe present the cosmetic and functional results in five patients treated for subungual tumors of the thumb between May 2020 and September 2023. Range of motion in the metacarpo—and interphalangeal joints, the widening angle of the first web, Kapandji score, grip and pinch strength, outcome scores including the disability of the arm, shoulder and hand (DASH) and Michigan Hand Score (MHQ) were assessed at final follow up.ResultsRange for follow up was 1–5 years. Function was comparable to the contralateral side. Patient reported outcome showed satisfactory function with an average DASH score of 12.82 and MHQ score of 84.8. The cosmetic result was rated with an average of 90 points on the visual analogue scale for cosmesis. No recurrence of the tumor has been reported in any case.ConclusionReconstruction of the defect with a RHDU flap after excision of subungual tumors and proof of no osseous invasion, is a reliable and a promising alternative to an amputation, resulting in satisfactory functional and cosmetic outcomes.

Breast lymphoma associated with implants is an uncommon condition, with B-cell lymphomas representing a small subset. Among these, diffuse large B-cell lymphoma (DLBCL), particularly Epstein-Barr Virus (EBV)-positive, is extremely rare and poorly characterized. This lymphoma subtype differs from the more prevalent implant-associated anaplastic large-cell lymphoma. Chronic inflammation caused by prolonged contact between the implant and surrounding tissues is believed to create a microenvironment favorable for lymphoid proliferation and malignancy, though the underlying mechanisms remain speculative and require further exploration. We report the case of a female patient with Poland syndrome, a congenital anomaly involving chest wall deformities, who underwent left-sided breast reconstruction with an implant. She presented with implant rupture and capsular contracture, necessitating surgical removal of the implant and surrounding capsule. A total capsulectomy was performed, and reconstruction utilized the “no-touch” technique to reduce contamination. Intraoperative abnormalities of the periprosthetic capsule led to its submission for pathological analysis. Histopathological and immunohistochemical studies confirmed EBV-positive DLBCL. A PET/CT scan showed no hypermetabolic activity or extramammary involvement. Multidisciplinary evaluation concluded that conservative management with regular follow-up was appropriate, given the favorable prognosis. The patient remains under observation with no signs of recurrence. This case highlights the importance of considering lymphoma in patients with implants presenting with capsular changes or unexplained symptoms. Early diagnosis, involving thorough histopathological analysis and advanced imaging, is critical to guide management. Although EBV-positive implant-associated B-cell lymphomas generally have a good prognosis and rarely require aggressive treatment, their rarity underscores the need for continued documentation and research. Expanding our understanding of their pathogenesis and clinical behavior will help refine diagnostic and therapeutic approaches, improving patient outcomes.Section categoryReconstructive.

Ulnar artery thrombosis from hypothenar trauma is an uncommon cause of digital ischaemia, most often associated with Hypothenar hammer syndrome (HHS). Standard treatment includes segmental excision and autologous vein grafting along the Guyon's canal, but this may be suboptimal in patients with occupational risk factors. We report a case where the vein graft was rerouted through the carpal tunnel to avoid subsequent compression at Guyon’s canal. To our knowledge, this is the first report of this anatomical approach. The patient achieved excellent graft patency and functional recovery at 6 months, suggesting a promising surgical alternative in select cases.

A 22-year-old female patient presented to the emergency department with fever, confusion, and right hip pain. Four years prior, the patient had undergone buttock augmentation with copolymer polyamide gel fillers (BIOTRH s.r.o., Prague, Czech Republic) for the aesthetic correction of hip dips, with early filler dislocation occurring only 6 months after injection. Clinical examination revealed erythema and calor in the right inguinal and gluteal regions. Given the septic presentation and suspicion of abscess formation, surgical intervention was performed, resulting in the release of putrid fluid. Satisfactory healing necessitated a total of three surgeries, alongside antibiotics, radical debridement, and vacuum therapy. This case illustrates the severe early and late complications that can arise following the injection of polyamide gels for buttock augmentation.

In current pain management practices, multimodal analgesia strategies centered on regional nerve blocks, combined with low-dose opioids and adequate nonsteroidal anti-inflammatory drugs, are considered the standard approach. However, the short-lived effectiveness of conventional local anesthetics leads to inadequate postoperative pain management, which substantially diminishes patient comfort and satisfaction during recovery periods. Prolonging the duration of local anesthetics has become a core focus of regional anesthesia research, with liposomal bupivacaine gaining attention due to its ultra-long-acting properties. This article aims to systematically explore the mechanism of action, safety, potential adverse reactions, and clinical applications of liposomal bupivacaine in nerve blocks and surgical procedures, providing a scientific basis for optimizing clinical analgesia strategies.

Breast augmentation remains one of the most common cosmetic surgical procedures globally yet implant surface preference (textured versus smooth) remains a key area of debate. Whilst textured implants have traditionally been favoured in the UK and Europe, concerns around breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and the absence of formal guidelines have contributed to wide variations in practice. This study therefore examines current UK practice among plastic surgeons, focusing on surgeon preferences and the factors guiding decision-making. An anonymised online survey was distributed to UK consultant plastic surgeons performing cosmetic breast augmentation. Data collected included implant surface, brand, incision, pocket, case volume, and ranked decision-making factors. Free-text responses were analysed thematically. Descriptive statistics and chi-square testing were used to explore associations. Seventy-five consultant plastic surgeons responded (response rate = 31.3 %). Textured implants were most commonly used (82.7 %), although smooth implants were more frequently selected by high-volume surgeons (>50 cases/year, χ²(5) = 11.79, p = 0.038, Cramér's V = 0.37). Mentor was the preferred brand (53.3 %), while Motiva was more commonly selected by smooth implant users (χ²(5) = 58.3, p = 0.011, Cramér's V = 0.29). All surgeons preferentially used inframammary incisions; subglandular placement was most common (54.7 %). The top four decision-making factors in implant surface selection were patient preference, cosmetic outcome, risk of capsular contracture and BIA-ALCL possibility. Qualitative themes highlighted the influence of patient expectations, safety concerns, and institutional policy. UK practice in cosmetic breast augmentation remains varied. Although most surgeons preferred textured implants, a shift towards smooth implants appears to be emerging among high-volume operators.