We report our experience of using tissue expansion where we deal particularly with complications and their management. Forty patients had tissue expanded during a 5-year period (2005-2010). Indications included reconstruction of a scar (after a burn, after injury, or postoperative), congenital naevi, microtia, and breast reconstruction after mastecomy. Of the 50 expanders inserted, complications occurred in 12 (10 patients). Exposure and perforation of the expander were the most common complications, followed by infection, seroma, and local pain. In all cases, complications were managed successfully either by conservative treatment or by a single procedure. The reconstructive plan ended in an acceptable aesthetic result in 9 of the 10 complicated areas. The insertion of multiple expanders over extensive scar tissue and particularly over the lower limb, is associated with high morbidity. Selection of patients, identification of high-risk sites, and suggestions for treatment are important. When complications occur, immediate management usually results in a successful outcome.

Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.

Facial penetrating injuries can cause retention of foreign bodies in the frontal sinus. This rare condition can remain underdiagnosed for years, since non-specific symptoms, such as headaches and nasal obstruction, can be developed. So far, removal by an endoscopic approach is the most preferred treatment option because it is less invasive with a short recovery time. However, removal by an open surgical approach remains the method of choice for large foreign bodies, especially in cases of coexistent non-reducible fractures of the anterior table of the frontal bone. We present a case where a combined approach - open and endoscopic - was necessary to successfully remove a retained foreign body from a frontal sinus. With the assistance of a transnasal endoscope, the retained stone was mobilized and removed from the open frontal sinus followed by osteosynthesis of the anterior table. Therefore, in special circumstances, a combination of both techniques should be considered for the optimal outcome.

Tendon defect reconstruction is a challenging procedure that can be complicated by tendon retraction or tendon gap increase after debridement of interposed scar tissue. Although application of tendon autografts from dispensable tendons is considered the gold standard for bridging the gap, donor-site morbidity cannot be ignored. We use a local sliding tendon autograft which can avoid distant graft harvesting and it is adaptable across all tendon zones for reconstruction of tendon defects. A reverse l-type longitudinal incision of the same length with the measured final gap is made at the midsubstance of the proximal tendon stump and the created intercalary tendon segment is transferred distally to bridge the gap, providing an “elongated” proximal stump of the required length. The Elongation Rail Technique has been applied successfully in four patients with flexor tendon defects with favorable results and functional outcome at 6 months follow-up according to Strickland and Glogovac criteria.

Reverse radial forearm flap is a quick and reliable flap, providing a well-vascularized tissue for coverage of hand defects. It is based on the reverse flow of the radial artery and the only drawback is the proximal ligation of the vessel. Two cases with complex dorsal hand defects were referred with delay to our Hand Unit, due to the CoVid-19 pandemic restrictions. In both cases deep structures of the wrist and fingers were exposed and the wounds were infected. Surgical debridement, skin coverage and reconstruction were decided in a staged approach: The reverse radial forearm flap was first performed, and in subsequent stages, functional restoration with hamstrings tendon grafts and finger joints arthrodesis successfully followed. These two cases highlight the reliability of a traditional pedicled flap in the salvage of complex hand defects, especially when time and resources are limited due to a pandemic.