The first web space of the hand plays a fundamental role in daily hand function, facilitating crucial movements, such as pinching, grasping, and opposition. The structural anomalies of acquired defects of this anatomical region, whether secondary to trauma, burns, or post-oncological surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced microsurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limitations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplantation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.

Summary: This case report addresses the discovery, surgical management, histology, and postoperative outcomes of an incidentaloma during the preoperative evaluation of a 58-year-old woman planning to undergo abdominoplasty and hernia correction after bariatric surgery. The patient’s computed tomography scan revealed a large pelvic mass in addition to an enlarged uterus and an umbilical hernia. Subsequent surgical intervention included umbilical hernia repair, subtotal omental excision, and en-bloc removal of the uterine and ovarian structures. Histological analysis confirmed the mass as a high-grade utero-ovarian leiomyosarcoma. The patient received adjuvant chemotherapy and demonstrated a positive response in follow-up imaging at 6 months, with reduced mass size and no significant lymphadenopathy. Both aesthetic and morpho-functional outcomes were satisfactory. The report highlights the challenges of diagnosing and treating incidentalomas, emphasizing the need for individualized management. It discusses the rarity of primary ovarian leiomyosarcoma and the surgical approach used. The case ultimately emphasizes the importance of multidisciplinary clinical evaluations in ensuring comprehensive care for patients with unexpected radiological findings, such as utero-ovarian leiomyosarcoma.

Introduction: Pilomatricoma, also known as benign calcifying epithelioma of Malherbe, is a follicular tumor originating from cells in the hair follicle matrix. It usually manifests as a firm subcutaneous mass up to 3 cm in size. Less commonly, it may measure >5 cm and in such cases is called giant pilomatricoma. We herein present a case of a subcutaneous lesion that was characterized by aggressive biological behavior and initially thought to be malignant but subsequently found to be a rare angiomyxoid variant of giant pilomatricoma. Case presentation: This case involved a young, healthy woman with a rapidly growing subcutaneous lesion on the distal lateral side of her right arm. An incisional biopsy was performed, and the lesion was diagnosed as hyperplasia of the epidermis and subcutaneous tissue, likely of reactive nature. After radical excision, analysis of the entire specimen led the pathologist to diagnose a rare variant of giant pilomatricoma with angiomyxoid stroma. Discussion: Classic pilomatricoma is an indolent, slow-growing lesion that is well defined and not fixed to the underlying tissue planes. However, after showing no signs of enlargement for 6 months, the lesion in the present case began to grow in a very unusual and concerning manner, suggesting a skin malignancy. The patient’s young age and the rapid development and large dimensions of the lesion led us to suspect a sarcoma. Conclusion: This case highlights the importance of cooperation between the dermatosurgeon and the pathologist to ensure thorough evaluation of such misleading cases. Such cooperation will guide appropriate management decisions and avoid overtreatment of benign lesions.

The first web space of the hand plays a fundamental role in daily hand function, facili-tating crucial movements such as pinching, grasping, and opposition. Structural anom-alies and acquired defects of this anatomical region, whether congenital or secondary to trauma, burns, or surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced mi-crosurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limi-tations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplan-tation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.