Abdulaziz Mahdi Alghamdi

Self-inflicted hand injuries in military personnel pose significant diagnostic challenges, often driven by behavioral or psychological motives. Early recognition of suspicious injury patterns is essential to ensure appropriate management and prevent reinforcement of maladaptive behaviors. A 23-year-old soldier presented with a displaced middle phalanx fracture and extensor tendon laceration of the left ring finger. Review of his medical record revealed three prior digital fractures over two years, each involving similar mechanisms and resulting in extended sick leave. The recurring nature, anatomical distribution, and preserved neurovascular function raised concern for intentional self-inflicted injury with suspected malingering motivated by secondary gain. Psychiatric evaluation revealed a stable clinical presentation but a history of substance-related issues and behavioral traits suggestive of secondary gain. A multidisciplinary plan was initiated, including structured psychiatric follow-up and coordination with military medical officers. Recurrent digital injuries in soldiers should prompt consideration of intentional self-inflicted injury and possible malingering, warranting multidisciplinary assessment. Multidisciplinary evaluation is critical for accurate diagnosis and effective management.

Summary: The thumb contributes nearly half of overall hand function, and its loss is profoundly disabling. Bilateral thumb amputation is rare and catastrophic, often necessitating complex reconstruction. Toe-to-thumb transfer is considered the gold standard, whereas index pollicization is a powerful alternative when microsurgical transfer fails. This report describes a rare case of bilateral thumb amputation managed with both techniques, highlighting their complementary roles. A 32-year-old right-handed soldier sustained bilateral thumb amputations from a high-velocity gunshot injury while holding a sniper rifle. On arrival, both thumbs were amputated at the proximal metacarpals with exposed bone, though the remaining fingers and systemic evaluation were intact. He underwent bilateral second toe-to-thumb transfers. The left reconstruction remained viable and fully functional, but the right developed ischemic necrosis. Salvage included repeated debridements, vacuum-assisted closure therapy, free anterolateral thigh flap coverage, and a groin flap with scar revision. Functional restoration was later achieved with index pollicization, followed by flap debulking and liposuction. At the final follow-up, both reconstructions demonstrated a full range of motion and opposition. The patient reported the pollicized right thumb to be subjectively stronger and more reliable than the contralateral toe transfer, enabling independence in daily living with satisfactory functional and aesthetic outcomes. This case illustrates that even when microsurgical toe transfer fails, staged salvage with flap coverage and index pollicization can restore bilateral function. The coexistence of both reconstructions in one patient provided a unique comparison, highlighting their complementary strengths.

Introduction: Thumb polydactyly is a common congenital anomaly that requires reconstruction to restore joint stability, motion, and cosmetic symmetry. Conventional techniques often fail to adequately reestablish radial collateral ligament (RCL) support, contributing to postoperative deviation or instability. This study describes an autologous periosteal-cartilaginous flap technique for RCL reconstruction after an excision of the radial duplicate digit. Methods: A retrospective case series was conducted at Prince Sultan Military Medical City, Riyadh. Patients who underwent thumb polydactyly correction with autologous periosteal-cartilaginous RCL reconstruction were included. Clinical variables, complications, and functional outcomes were recorded. Functional assessment was performed using the Thumb Assessment after Digital Anomaly (TADA) score, evaluating range of motion, joint stability, and alignment (0 to 5 scale). The operating surgeon assessed cosmetic outcomes; these assessments carry inherent observer bias and should be interpreted with caution. Results: Four patients (ages 2 to 22 y) with Wassel types II, IV, VI, and VII met the inclusion criteria. All procedures were completed without intraoperative complications. At 4 months to 2 years of follow-up, TADA scores were 4/5, 3/5, 5/5, and 5/5. Three patients achieved ≥75% of the normal range of motion, and all demonstrated stable MCP joints. Alignment was optimal (<10 degrees deviation) in 3 cases. Cosmetic outcomes were uniformly rated good to excellent, with no postoperative instability, stiffness, or painful scar formation. Conclusions: Autologous periosteal-cartilaginous flap reconstruction demonstrated promising functional and cosmetic outcomes across a heterogeneous patient group; however, given the small sample size and variability in patient characteristics, these findings should be interpreted with caution. This approach represents a potentially viable reconstructive option for restoring RCL stability in thumb polydactyly. Larger prospective studies are needed to validate long-term effectiveness.

Background: Publication timelines in plastic surgery vary across journals and study types, impacting the timely dissemination of research. This study aimed to evaluate the publication timelines and patterns of plastic surgery journals. Methods: A bibliometric analysis of all original articles published in the 7 plastic surgery journals with the highest impact factors in 2024 was conducted. Results: A total of 2033 plastic surgery articles were analyzed. The median total time to publication (TT) was 8.0 months, with significant variation across journals ( P < 0.001). Plastic and Reconstructive Surgery (PRS) had the longest TT (20.1 mo), whereas Plastic and Reconstructive Surgery – Global Open had the shortest (5.2 mo). Regarding study category, hand and peripheral nerve surgery had the longest TT (12.9 mo), and cosmetic surgery had the shortest (7.6 mo) ( P < 0.001). North American articles had the longest TT (8.7 mo), whereas African articles had the shortest (6.5 mo) ( P < 0.001). Studies by nonplastic surgeons, from multiple institutions, or with medical student coauthors had longer TTs (all P < 0.05). Multivariable analysis identified journal, study category, and author continent as independent predictors of a shorter TT (≤8 mo). Articles in Plastic and Reconstructive Surgery – Global Open (odds ratio = 5.7) or Journal of Plastic, Reconstructive, and Aesthetic Surgery (odds ratio = 4.5) were more likely to be published quickly, whereas those on breast surgery or from Africa or Asia were less likely to be published quickly. Conclusions: Publication timelines in plastic surgery journals improved overall from 2018 to 2024, but unevenly across journals. Study category, author continent, and affiliation significantly influenced publication speed.

Summary: Reconstruction of large gluteal and sacral defects after tumor resection is challenging, especially in patients with previous surgery or radiation. Local flaps may be unreliable in such cases. The vertical and oblique rectus abdominis myocutaneous (ORAM) flaps provide well-vascularized tissue with enough reach for coverage. The transabdominal route is also used for deep or high gluteal defects. This article aims to present a complex case of gluteal defect reconstruction using a transabdominal ORAM flap and to review the relevant literature on similar techniques. A 28-year-old man with recurrent left gluteal soft-tissue sarcoma, previously treated with surgery, chemotherapy, and radiotherapy, presented with a recurrence. After evaluation, he underwent wide-margin tumor resection with reconstruction using a transabdominal ORAM flap. The colorectal team created a tunnel through the abdominal floor, and the flap was passed via partial iliac wing bone resection to cover the gluteal defect. The plastic, orthopedic, and colorectal teams worked together to deliver and inset the flap without tension. The donor site was closed with mesh reinforcement, and drains were placed in both the abdomen and gluteal region. Postoperatively, he developed a minor hematoma that was drained successfully. At 4 months, all wounds had healed completely, with no evidence of hernia, infection, or recurrence. The transabdominal vertical rectus abdominis myocutaneous and ORAM flaps are dependable options for gluteal and sacral reconstruction, providing strong coverage and low complication rates. It is especially useful when local tissue is scarred or irradiated, and multidisciplinary collaboration ensures safe and effective results.

Purpose Superior (SCN) and middle cluneal nerve (MCN) entrapments are underdiagnosed causes of chronic low back pain (LBP), accounting for 1.6–14% of cases. Targeted nerve blocks that provide at least 50% pain reduction are used to confirm the diagnosis of cluneal nerve entrapment. This systematic review aims to address the clinicopathological features, diagnosis, surgical management, outcomes, and prognosis of patients with cluneal nerve entrapment. Method This study was a systematic review of the literature. A thorough search of PubMed, MEDLINE, Embase, and CENTRAL was performed. Studies on surgically treated cluneal nerve entrapment were included with the exception of case reports. Descriptive categorical and numerical statistical analyses were used to analyze the data. Result Fourteen articles involving 236 patients met the inclusion criteria. The average age was 64.68 years, with bilateral involvement in 38.98% of the cases and unilateral involvement in 59.75%. Low back pain (LBP) was reported in all 236 patients (100%). In addition, 209 (88.56%) patients experienced radiating pain in the buttocks. The results showed a significant improvement after surgery: the Visual Analog Scale (VAS) score dropped from 73.63 to 33.31, the Roland-Morris Disability Questionnaire (RDQ) score decreased from 12.49 to 2.52, the Japanese Orthopaedic Association (JOA) score increased from 11.62 to 23.39, and the Numerical Rating Scale (NRS) score decreased from 7.61 to 1.06. Surgical complications were not encountered in any patient; however, 11 (4.6%) patients required a second operation. Conclusion Cluneal nerve entrapment is a well-established yet underdiagnosed cause of LBP. In this systematic review, surgical decompression offered effective and safe pain relief and functional improvement, with no reported complications and a low reoperation rate. Choosing the right patient and management plan for each case is necessary. Additional research is required to optimize the surgical procedures and evaluate the long-term outcomes.

BackgroundCerebrospinal fluid (CSF) leak is a known complication of spine surgery, and an effective protocol for prevention, recognition, and treatment of postoperative CSF leak is essential to avoid a cascade of associated adverse outcomes, such as durocutaneous fistula, wound infection, and intracranial hemorrhage. We aim to identify the incidence of CSF leak post spinal surgeries and to obtain the factors that could predict the risks of having a CSF leak following spine surgeries. MethodsThis study was conducted as a retrospective cohort study on patients who had CSF leaks post spinal surgery in King Abdul-Aziz Medical City, Jeddah, from June 2016 to January 2024. ResultsThe occurrence of cerebrospinal fluid (CSF) leak post-surgery was relatively low (2.6%), and more than 97% of the participants studied had no CSF leak. There is a statistically insignificant relation with age, gender, DM, BMI, hypertension, malignancy, and cardiovascular diseases. Still, there is a statistically significant relation with the attempt to watertight closure, and type of surgery (P value ≤ 0.05). ConclusionPostoperative CSF leak following spinal surgery is associated with morbidity and can lead to re-operation and infection. The incidence of CSF leaks among our study participants was about 2.6%, which is relatively low. Identifying predictors for CSF leaks can assist in counseling patients concerning surgical risk and expected postoperative recovery.