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Periungual warts are frequently encountered in the field of dermatology. Here, we describe the case of a 69-year-old individual who presented with hand warts. The wart growth extended to the finger stump, resulting in a soft tissue defect on the fingertip of the right thumb. A treatment approach involving superficial x-ray therapy in combination with tretinoin was employed to address this finding. The warts disappeared after completing 26 days of the treatment regimen. Fingertip soft tissue defects due to periungual warts are a rare occurrence in clinical settings. This report serves as the first documented case of such a problem successfully managed with the treatment approach mentioned above.

BACKGROUND: Choosing the appropriate treatment approach for a multifocal comminuted open fracture of humerus with severe soft tissue defect is a challenging issue, which could be interesting for every orthopedic surgeon especially for those working in the trauma centers.
METHODS: This study described an innovative approach using titanium elastic nailing to treat a multifocal comminuted open fracture of humerus with severe soft tissue defect. In this study, we report a 40-year-old Persian female patient in whom the treatment achieved complete fracture union and skin graft healing by elastic medullary nailing, vacuum dressing, and skin grafting.
CONCLUSIONS: Elastic medullary nailing is a viable option for reconstruction of simultaneous comminuted fracture and soft tissue defect.

The orthoplastic treatment of post-traumatic bone infections is complex and requires a multidisciplinary approach using both orthopedic and plastic surgery principles. Its primary goal is to achieve rapid control of the infection through aggressive debridement of the affected tissue, in order to perform a complete reconstruction of the limb. This allows both its salvage and restoration of function. We present a patient with septic non-union secondary to distal tibia fracture with a bone defect of 7 cm and severe soft tissue injury. The treatment was divided into three stages. First, the infection was controlled by radical debridement, limb shortening, and temporary stabilization. Second, early reconstruction was initiated utilizing the first stage of the Masquelet\'s induced membrane technique (MIMT), and soft tissue coverage with free flap. Third, MIMT was finalized, and bone lengthening with PRECICE nail was performed. We consider this approach effective as it can offer early recovery with optimal functional and aesthetic results in bone defects associated with coverage defects.

UNASSIGNED: Foot and ankle soft-tissue defects constitute a real challenge to reconstructive surgeons because of restricted local soft tissue availability. We report a 28 years old male with a significant soft-tissue defect on the left anteromedial ankle and dorsal foot.
UNASSIGNED: A 28 years old male with soft-tissue necrosis on the left anteromedial ankle and dorsal foot, as well as second - fourth metatarsal fractures with gangrene of the first - third phalanx, presented to our hospital 14 days after a traffic accident. He underwent debridement and amputation of the gangrenous fingers. In the second operation, a pin fixation of the metatarsal fractures and the reverse sural flap was performed. The donor site was covered with a split-thickness skin graft. The wounds began to improve significantly on the tenth day after the surgery, and his wounds were gone entirely in the third week. The pins were removed eight weeks after the surgery with the fractures healed.
UNASSIGNED: Skin grafts are easy and quick to cover open wounds but cannot be applied to cover bare tendons or bone. Local flaps of the distal third of the lower extremity have a limited range of motion and arc of rotation. Free flaps are an acceptable but complex reconstructive surgery that requires long operative time, special instruments, and microsurgical training and are expensive.
UNASSIGNED: The reverse sural flap was considered feasible in reconstructing patients with soft-tissue defects of the distal leg, ankle, and foot, especially in resource constraint scenarios.

Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities.

We herein report a case of intractable flexor tenosynovitis. The inflamed synovium was debrided twice because of suspected infectious tenosynovitis. However, it relapsed and caused a soft tissue defect. Reconstruction with a free temporoparietal fascia (TPF) flap was performed. Recurrence has not been detected in the six years after surgery.

OBJECTIVE: To evaluate the surgical technique and the efficacy of flow-through flap with a wrist epithelial branch of the ulnar artery to repair a finger soft tissue defect.
METHODS: Between June 2015 and December 2017, 12 cases of soft tissue defects of fingers and injured digital artery were repaired by flow-through flap with wrist epithelial branch of the ulnar artery, including 7 males and 5 females (age range: 18-45 years old, average age: 23.6 years old). The causes of injury included electric saw injury in 7 cases, and machine crush injury in 5 cases. 5 cases were combined with tendon injury, 4 cases with fracture, 12 cases with vessel injury and 2 cases with nerve injury. The area range of the flap was 3.0 cm ×1.8 cm to 6.0 cm ×3.0 cm. The length of the pedicles of the flaps ranged from 2.3 cm to 4.7 cm, with an average length of 3.7 cm. The donor sites were sutured directly in 10 cases, and 2 cases were repaired with a full-thickness skin graft from the ilioinguinal region. Flow-through anastomoses of the distal and proximal end of the wrist epithelial branch of the ulnar artery to the distal and proximal end of the digital artery were created, so as to connect the vessels and reach the physiologic state of blood supply.
RESULTS: All flaps and skin grafts survived after operation, and all wounds healed at I phase. All patients were followed up 6-12 months (mean: 9 months). The flaps exhibited smooth appearance and soft texture, similar to that of the normal surrounding skin. At last follow-up, the two-point distance of flaps was 9-15 mm (mean: 11 mm). According to the assessment of upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 10 cases, and good in 2 cases. The ulnar wrist donor areas only had linear scar.
CONCLUSIONS: Flow-through flap with wrist epithelial branch of ulnar artery exhibits strength in a concealed donor site, reliable blood supply, and simple operation. Flow-through method can be used to repair a broken or defective digital artery in I stage. It is a good method to repair a soft tissue defect of fingers.

BACKGROUND: Quadriceps tendon rupture, although uncommon, is associated with knee joint instability and requires surgical repair. A variety of methods including allografts, synthetic grafts and autologous tendons are used for tendon reconstruction. This work is reported in line with the SCARE criteria (Agha et al., 2018) for case report publication.
METHODS: A new method of simultaneous quadriceps tendon reconstruction and soft tissue knee reconstruction in a 38-year-old male patient following trauma to his knee and subsequent multiple surgeries and wound infections. In a single-stage procedure, gastrocnemius muscle fascia was used for quadriceps tendon reconstruction and medial head of the gastrocnemius muscle flap with split-thickness skin graft was used to cover the soft tissue defect on the anterior aspect of the knee following previous post-operative soft tissue infections and subsequent skin necrosis.
CONCLUSIONS: The only way to maintain the vitality of the patella was to reconstruct the defect with well-vascularized tissue so we decided to use the medial gastrocnemius muscle flap. To obtain good quality tissue for the quadriceps tendon reconstruction, we decided to use the gastrocnemius muscle fascia to minimise the morbidity of the donor region and to reduce the duration of surgery.
CONCLUSIONS: Postoperatively, the patient had an excellent cosmetic outcome with full active extension and limited flexion of the knee joint caused by the preoperative condition. To our knowledge, quadriceps tendon reconstruction using the gastrocnemius muscle fascia has never been reported in English literature and is as valuable as already known reconstruction methods using other tendons or fascia.

Treatment of tibial defects with important soft tissue involvement after bilateral lower limb trauma are challenging for both orthopedic and plastic surgeons. Several therapeutic options are described in armamentarium of reconstructive surgeons such as bone grafts, bone substitutes, distractions osteogenesis, limb prosthesis, free flaps, negative pressure therapy and unfortunately amputation. We describe a patient with tibial and soft tissue defect reconstructed using a chimeric flap composed of latissimus dorsi, serratus anterior muscle and two ribs. At the 1-year follow-up the patient is able to walk with a walker and is still enrolled in rehabilitation program.