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Tomac A, Ion AP, Opriș DR, Arbănași EM, Ciucanu CC, Bandici BC, Coșarcă CM, Covalcic DC, Mureșan AV. Ledderhose's Disease: An Up-to-Date Review of a Rare Non-Malignant Disorder. Clin Pract 2023; 13:1182-1195. [PMID: 37887082 PMCID: PMC10605618 DOI: 10.3390/clinpract13050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023] Open
Abstract
Plantar fibromatosis (or Ledderhose's disease) is a rare benign condition, difficult to treat, defined by gradual-growing nodules in the central medial part of the plantar fascia, with the possibility of sclerosis and shrinkage of the entire fascia or, rarely, contractures of the toes. From a histopathological point of view, it is linked to Dupuytren's contracture of the hand and Peyronie's disease of the penis, being part of a large group of fibromatoses, based on a proliferation of collagen and fibroblasts. Its etiology is still not fully understood, even though it has been associated with trauma, diabetes mellitus, use of anticonvulsants, frozen shoulder, alcohol consumption, and liver disease. Typically, ultrasound confirms the diagnosis, and magnetic resonance imaging is used for more aggressive and advanced types. Several conservative treatment techniques, such as steroid injections, verapamil, imatinib, radiation therapy, extracorporeal shock wave therapy, tamoxifen, sorafenib, mitomycin C, and collagenase, have been documented. When non-operative care fails, surgical measures may be considered, even though recurrence is expected. We attempted to provide a better understanding of this disease by covering all of the important aspects: its history, clinical and radiologic findings, diagnosis, pathophysiology features, conservative and surgical treatment, recurrence rate, and prognosis.
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Affiliation(s)
- Alexandru Tomac
- Clinic of Plastic Surgery, Saint Spiridon Emergency Clinical Hospital, 700111 Iasi, Romania;
| | - Alexandru Petru Ion
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Diana Roxana Opriș
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540139 Targu Mures, Romania;
| | - Eliza Mihaela Arbănași
- Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Claudiu Constantin Ciucanu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Bogdan Corneliu Bandici
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Cătălin Mircea Coșarcă
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Diana Carina Covalcic
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
| | - Adrian Vasile Mureșan
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (B.C.B.); (C.M.C.); (D.C.C.); (A.V.M.)
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Starnoni M, Benanti E, Acciaro AL, De Santis G. Upper limb traumatic injuries: A concise overview of reconstructive options. Ann Med Surg (Lond) 2021; 66:102418. [PMID: 34141410 PMCID: PMC8188247 DOI: 10.1016/j.amsu.2021.102418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
Different options for upper limb reconstruction are described in literature: advancement or rotation flaps, regional flaps and free flaps are the most common. Local and regional flaps can represent the reconstructive options for small defects while large wounds require the use of free flaps or distant pedicled flaps. In case of large wound, the use of free flaps rather than distant pedicle flaps is usually preferred. To choose the best reconstructive option, it is essential for the surgeon to have a general overview about the different methods. In this review the Authors will refer to the most commonly used methods to cover soft tissues injuries affecting the dorsum and the palm of the hand and the forearm (excluding fingers). The aim is to show all flap reconstructive options so as to support the inexperienced surgeon during the management of traumatic injuries of the upper limb. Reconstruction of traumatic injuries of the upper limbs can be challenging. Small defects can be covered by local and regional flaps while large wounds need the use of free or distant pedicled flaps. The literature shows different opinions whether to use pedicled flaps (regional or distant) or free flaps. Dermal substitutes can be considered in patients who are not suitable for flaps reconstruction. Patient related factors and surgical background can significantly interfere with the surgical reconstructive solution.
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Affiliation(s)
- Marta Starnoni
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Benanti
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Andrea Leti Acciaro
- Department of Orthopaedics and Traumatology, Division of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
| | - Giorgio De Santis
- Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy
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Extended and unusual indications in jaw reconstruction with the fibula flap: An overview based on our 30-year experience. Ann Med Surg (Lond) 2021; 62:37-42. [PMID: 33489114 PMCID: PMC7806501 DOI: 10.1016/j.amsu.2020.12.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 12/27/2022] Open
Abstract
Since the introduction of fibula flap as a reconstructive technique, an evolution of indications has been observed. Our first report of a traumatic mandibular reconstruction using fibula flap was in 1992. The vast majority of indications for surgery, are: malignant tumors, benign neoplasms, osteoradionecrosis and traumas. Nevertheless, extended indications have been described such as the treatment of dentoalveolar defect without bone discontinuity or reconstruction of maxilla defect up to type III (A and B), according to Cordeiro's classification. Unusual indications include cleft palate malformations with bone discontinuity less than 6 cm. Moreover, a particular attention should be focus on fibula flap harvest with more innovative technologies than traditional use of monopolar or bipolar and their advantages in pre and postoperative management.
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