Complex dorsal dislocations of the metacarpophalangeal joint are usually a complication of hyperextension injury and are irreducible to closed maneuvers. The volar plate displaced between the dorsum of the metacarpal head and the volar base of the proximal phalanx is the obstacle that prevents reduction. While the pathophysiology of complexity is relatively clear, such injuries are uncommon and reduction requires experience. We describe a case of complex fracture dislocation of the index metacarpophalangeal joint with a review of the literature on relative anatomy and treatment armamentarium.

(1) Background: Orbital wall fractures are common in maxillofacial trauma, and artificial implants are often used for reconstruction. However, there has always been concern about infection because implants are directly exposed to the airway. This study was conducted to determine the effectiveness of a combination of resorbable plates and antibiotic-impregnated collagen sheets in reconstructions of orbital fractures and to determine whether it had an effect in reducing postoperative antibiotic use. (2) Methods: The retrospective study was conducted on 195 patients who underwent orbital wall reconstruction from March 2019 to August 2022. The 176 patients in the control group underwent reconstruction using only resorbable plates and were administered postoperative antibiotics for 5 to 7 days. On the other hand, the 19 patients in the experimental group underwent reconstruction using a combination of resorbable plates and antibiotic-impregnated collagen sheets and only received antibiotics once before surgery. The occurrence of ocular complications, the length of hospitalization, the infection incidence rate, and the adverse effects of antibiotics were investigated. (3) Results: significant ocular complications were observed in the experimental group during a follow-up period of more than 1 year. Regarding postoperative infections, there were two cases of infection in the control group (infection rate: 1.14%), while no infection was found in the experimental group. The hospitalization period of the experimental group was significantly shorter than that of the control group (p < 0.01), and the incidence of total adverse effects of antibiotics, especially nausea, was lower in the experimental group (p = 0.02). (4) Conclusions: The combined use of resorbable plates and antibiotic-impregnated collagen sheets allows effective orbital wall reconstruction without infection, with a shorter hospital stay, and with fewer antibiotic adverse effects.

Pedicle coverage during free flap reconstruction of the digit commonly presents complicated issues. As the finger is a cylindrical unit with small volume, it is difficult to secure ample soft tissue for relaxed coverage of the pedicle. We have applied full-thickness skin grafts (FTSGs) to loosely cover the pedicle of the free flap of the fingertip and report preliminary results. Seven patients who received free toe pulp flap and FTSG for soft tissue coverage of the pedicle were analyzed. Intraoperative parameters collected were defect, flap and graft area size and donor site. Patients were observed postoperatively for up to 2 months for graft take, necrosis, digit contour, and donor site complications. The average area of the free flap was 2.39±1.03 cm2 and the average graft area was 1.37±1.06 cm2. The FTSG survived without sloughing or necrosis in six patients. Early epithelial sloughing with dermis take was noted in one patient who healed with dressings. The pedicle and graft portion showed bulging immediately after the operation but decreased to normal contour by 4 weeks. FTSG is an option that can be safely used as a method of pedicle coverage during free flap reconstruction of digits.

Autonomic denervative dermatitis (ADD) is a rare skin condition caused by autonomic nerve injury, often after surgery. It typically presents as erythematous or excoriated lesions in areas with sensory loss. While cases in the lower limbs are documented, facial involvement after mandibuloplasty has not been reported. The authors describe a 27-year-old woman who developed ADD 1 year after angle-body reduction mandibuloplasty. She presented with pruritic, erythematous papules on the chin and sensory deficits. The lesions resolved spontaneously, leaving scarring and contour irregularities. Diagnosis was based on clinical history and exclusion of other conditions such as contact dermatitis and seborrheic dermatitis. Autonomic denervative dermatitis arises from sudomotor dysfunction and immune dysregulation due to autonomic nerve damage. Surgeons should be aware of this potential complication, especially involving the mandibular canal. Early recognition and treatment with emollients, corticosteroids, and antihistamines may prevent permanent sequelae. This case underscores the need for awareness to avoid underdiagnosis.

Morel–Lavallée lesions (MLLs) of the lower extremities frequently progress to large, encapsulated fluid collections, where persistent dead space becomes the principal driver of recurrence and wound-related complications. Although extensive open debridement can achieve durable cavity obliteration, it may compromise residual perforators and increase soft-tissue morbidity. We describe a minimally invasive technical strategy that combines internal closed-suction drainage with external negative-pressure wound therapy (NPWT) over the dead-space footprint. Following limited incisional evacuation, strategically positioned internal drains provide continuous intracavitary fluid removal, while external NPWT delivers uniform pressure-mediated tissue apposition to facilitate sustained cavity collapse. This coordinated pressure configuration enables effective dead-space control without routine pseudocapsule excision or wide soft-tissue dissection. In two illustrative cases, stable wound healing was achieved without recurrence during the available follow-up period. This dual negative-pressure approach may offer a reproducible and minimally invasive option for managing extensive or encapsulated MLLs by integrating internal evacuation with external compression to promote durable dead-space obliteration, while also potentially reducing procedure-related morbidity.

The lower eyelid is essential for tear film maintenance, globe protection, and facial aesthetics. Reconstruction after cancer excision must restore both function and appearance. We report a 67-year-old man with Bowen disease located 0.5 cm below the left lower eyelid margin and lateral to mid-pupil line. Mohs surgery yielded a 1.5×1.3 cm anterior lamellar defect with intact orbicularis oculi muscle (OOM). Reconstruction was performed via a subciliary incision, dissection between suborbicularis oculi fat (SOOF) and periosteal fat, division of the orbicularis retaining ligament, and preservation of the premaxillary space and zygomaticocutaneous ligament (ZCL). A mid-cheek lift was achieved by suspending SOOF to the arcus marginalis, followed by OOM suspension and skin trimming. At 6 months, the patient showed excellent functional and aesthetic outcomes without ectropion. For anterior lamellar defects situated lateral to the mid-pupil line, satisfactory reconstruction can be achieved with a mid-cheek lift while preserving both the premaxillary space and the ZCL.