OBJECTIVE: To describe, according to the CARE guidelines, an easily reproducible technique using two local muscle flaps to reduce the unsightly retromandibular hollow left by total parotidectomy for cancer.
METHODS: A 40-year-old Caucasian male with T3N1M0 temporal skin melanoma was managed by skin resection, conservative total parotidectomy and ipsilateral level II-IV selective lymph-node dissection. Two rotational muscle flaps were taken from the ipsilateral posterior belly of the digastric and sternocleidomastoid muscles. Postoperative course was uneventful, with 3 days\' hospital stay, without facial or spinal palsy. At 3 days, 3 months and 9 months postoperatively, the appearance of the parotid region was similar to the non-operated contralateral region.
CONCLUSIONS: Easy to perform and without associated scars, the approach described here should be included in the armamentarium available to the head and neck surgeon to avoid an unsightly hollow after total parotidectomy for cancer, in an effort to improve quality of life.

The COVID 19 pandemic has resulted in an increased number of patients requiring intubation and intensive care. This has led to an increased incidence of sacral pressure ulcers requiring surgical management. We report our experience of COVID 19 related sacral pressure ulcers requiring surgical reconstruction.
A case series study was performed with 12 patients who presented grade IV sacral pressure ulcers after hospitalization for COVID-19 in a single institution. The mean age was 49.8 years and the most frequent comorbidities were arterial hypertension, diabetes and obesity, each present in 6 patients. All of them were submitted to surgical reconstruction with fasciocutaneous flaps after improvement of their clinical status. Follow up time was of at least 30 days after reconstruction. Preoperative laboratory tests and surgical outcomes were compared to data available in the literature.
No major dehiscence was observed and minor dehiscence happened in 2 cases (16.7%). Out of the 12 patients, 8 (66.7%) had hemoglobin levels less than 10.0 and 5 (41.7%) had albumin levels less than 3.0, though this did not lead to a higher rate of complications.
This study showed that ambulating patients with grade IV pressure ulcer after COVID- 19 infection may undergo debridement, negative-pressure wound therapy and closure with local flaps with adequate results and minimal complication rate.

Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits and frequently affecting the ring and middle fingers. The incidence is 1 out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as a soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal or metatarsal level, rarely to the distal end of the forearm and lower leg. The malformation is mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert syndrome, Poland\'s syndrome, Pfeiffer syndrome, and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth-affecting the right middle, ring, and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present this surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia.

The radial artery supplies various locoregional flaps used for elbow reconstruction. A reverse lateral arm flap is a reliable choice, despite sacrificing the radial artery in some cases. We describe using a reverse lateral arm flap for elbow soft tissue reconstruction in a patient with a previously harvested radial artery.

Background and Objectives: Vascular variations appear as morphologically distinct patterns of blood diverging from the most commonly observed vessel patterns. The facial artery is considered to be the main vessel for supplying blood to the anterior part of the face. An anatomical understanding of the facial artery, its course, its topography, and its branches is important in medical and dental practice (especially in neck and face surgery), and is also essential for radiologists to be able to interpret vascular imaging in the face following angiography of the region. A profound knowledge of the arteries in the region will aid in minimizing the risks to the patient. Materials and Methods: In our publication a narrative literature review and a case report are presented. Results: A rare case of a facial artery pattern has been described anatomically for the first time with respect to its course and branching. This variation was found on the left side of a 60-year-old male corpse during anatomical dissection. The anterior branch of the facial artery arched in the direction of the labial angle, and there divided into the inferior and superior labial arteries. At the same time, the posterior branch coursed vertically and superficially to the masseter muscle. It here gave off the premasseteric branch, and continued towards the nose, where it ran below the levator labii superioris and the levator labii superioris alaeque nasi muscles and terminated at the dorsum nasi. Conclusions: Our review of the literature and the case report add to knowledge on the facial artery with respect to its topographical anatomy and its branching and termination patterns, as well as the areas of supply. An exact knowledge of individual facial artery anatomy may play an important role in the planning of flaps or tumor excisions due to the differing vascularization and can also help to prevent artery injuries during aesthetic procedures such as filler and botulinum toxin injections.

Severe IV-degree thermal crush injury of limbs involved the subcutaneous fascia, muscle and bone, which may lead to amputation and has a great impact on the patient\'s quality of life. We can repair wounds with pedicle flaps or even free flaps, However, there are still huge challenges in bone defect of extremities and functional reconstruction. In recent years, with the development of functional prostheses, we have reconstructed limb functions in many patients helping them to complete their daily lives. We report a case where the right upper arm was injured by thermal crush, leading severe burns to the skin, fascia, muscle and bone. We applied a pedicled latissimus dorsi flap and a free anterolateral thigh flap to repair the wound, and realized the function of limb salvage and movement of the right upper arm by implanting 3D printed scapula, upper arm and elbow joint prostheses. This case illustrates that IV-degree burns involving bones have new technologies to repair and achieve mobility now.

Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the \"spare parts\" concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the \"spare parts\" concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. Limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting.