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Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()

We present a case describing a technique for the surgical management and aesthetico-functional reconstruction of a shoulder in an adult with unilateral upper limb phocomelia (ULP).(1)⁠ A 25 year old male patient was presented to our clinic with upper left limb non-syndromic phocomelia. His main conc...

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Autores principales: Miralles, Marc, Videc, Patricia, Žic, Rado
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407286/
https://www.ncbi.nlm.nih.gov/pubmed/37560485
http://dx.doi.org/10.1016/j.jpra.2023.06.006
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author Miralles, Marc
Videc, Patricia
Žic, Rado
author_facet Miralles, Marc
Videc, Patricia
Žic, Rado
author_sort Miralles, Marc
collection PubMed
description We present a case describing a technique for the surgical management and aesthetico-functional reconstruction of a shoulder in an adult with unilateral upper limb phocomelia (ULP).(1)⁠ A 25 year old male patient was presented to our clinic with upper left limb non-syndromic phocomelia. His main concerns was an aesthetically unpleasant limb and shoulder shape. Few older publications describe available options for pediatric patients, such as clavicle transposition or limb amputation, but nowadays ULP treatment options focus on prosthetic rehabilitation (PR) and targeted muscle reinnervation (TMR). Our patient refused any prosthesis, and TMR is expensive, requires an experienced rehabilitation team and has limited availability. We aim to describe a non-expensive, simple and effective option for selected adult patients with limited shoulder functionality wishes.(2–5) We used the existent hypoplastic limb for shoulder mound reconstruction, providing the patient with a more anatomical shoulder shape. The palmar skin of the hypoplastic hand and three existing fingers were excised. Also, distal phalanges were amputated. Then, the hand was rotated and positioned under the coracoid process, creating a shoulder-like mound. Six months later, there has been a loss of shoulder volume compared to early postoperative weeks, but the patient is satisfied with the results. Nevertheless, we found some limitations to our approach such as long-lasting postoperative pain, sensory symptomatology, and loss of volume of the reconstructed shoulder. Those could be solved with the complete denervation of the limb and a Latissimus Dorsi (LD) transposition flap in a second stage of reconstructive surgery.
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spelling pubmed-104072862023-08-09 Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report() Miralles, Marc Videc, Patricia Žic, Rado JPRAS Open Case Report We present a case describing a technique for the surgical management and aesthetico-functional reconstruction of a shoulder in an adult with unilateral upper limb phocomelia (ULP).(1)⁠ A 25 year old male patient was presented to our clinic with upper left limb non-syndromic phocomelia. His main concerns was an aesthetically unpleasant limb and shoulder shape. Few older publications describe available options for pediatric patients, such as clavicle transposition or limb amputation, but nowadays ULP treatment options focus on prosthetic rehabilitation (PR) and targeted muscle reinnervation (TMR). Our patient refused any prosthesis, and TMR is expensive, requires an experienced rehabilitation team and has limited availability. We aim to describe a non-expensive, simple and effective option for selected adult patients with limited shoulder functionality wishes.(2–5) We used the existent hypoplastic limb for shoulder mound reconstruction, providing the patient with a more anatomical shoulder shape. The palmar skin of the hypoplastic hand and three existing fingers were excised. Also, distal phalanges were amputated. Then, the hand was rotated and positioned under the coracoid process, creating a shoulder-like mound. Six months later, there has been a loss of shoulder volume compared to early postoperative weeks, but the patient is satisfied with the results. Nevertheless, we found some limitations to our approach such as long-lasting postoperative pain, sensory symptomatology, and loss of volume of the reconstructed shoulder. Those could be solved with the complete denervation of the limb and a Latissimus Dorsi (LD) transposition flap in a second stage of reconstructive surgery. Elsevier 2023-07-01 /pmc/articles/PMC10407286/ /pubmed/37560485 http://dx.doi.org/10.1016/j.jpra.2023.06.006 Text en © 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Miralles, Marc
Videc, Patricia
Žic, Rado
Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title_full Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title_fullStr Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title_full_unstemmed Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title_short Aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – A case report()
title_sort aesthetic shoulder reconstruction using hypoplastic tissue in a patient with phocomelia – a case report()
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10407286/
https://www.ncbi.nlm.nih.gov/pubmed/37560485
http://dx.doi.org/10.1016/j.jpra.2023.06.006
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