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Alkaptonuria is a metabolic disorder characterized by homogentisic acid accumulation in connective tissue. Ochronotic arthropathy, a rare condition reported in alkaptonuria, mostly affects the knee joint. In this study we reported a 57-year-old male patient presented with bilateral hip pain. During the operation, black bone tissue and tendons were observed. We examined the patient for alkaptonuria after the operation and the diagnosis was confirmed. In fact, alkaptonuria was not detected until the operation. Therefore, our study suggests that orthopedic surgeons be suspicious of atypical arthropathy in order to avoid being overwhelmed by the appearance of black cartilage during surgery.

Schwannoma, the most common primary neural tumor of the upper extremity, arises from schwann cells of nerve sheet. The tumor is usually painless and slow growing. Symptomatic masses could be treated through intra- or extra-capsular excision. We aim to evaluate long-term results of surgical treatment of 12 cases of hand Schwannoma. Twelve cases of confirmed schwannoma who were treated in Imam Khomeini university hospital, Tehran, Iran during 2011 to 2022 were included. All operations were done using loupe magnification or under microscope. After incising the tumor capsule, nerve fibres were isolated then the mass resected. Age, sex, location of the mass, size of the tumor, affected nerve, histological diagnosis, and clinical follow-up including neurological status of patients were documented. Twelve patients with a mean age of 44 years were included. Seven (58.3%) were male and five (41.66%) were female. The mean follow-up period was 45 months (range: 6–135). Hand was the most common location of involvement and digital nerve was the most frequent origin of schwannoma. Postoperative evaluation showed no tumor recurrence and pain resolved in all twelve patients (100%). Sensory dysfunction resolved completely in 5 out of 8 patients who reported sensory impairment preoperatively (62.5%) and no motor function improvement was seen in patient with motor deficit. In conclusion, adequate operative techniques can lead to complete tumor removal without neurological loss or recurrence. Neural function improvement in most cases is achieved. New neurologic impairment after excision of schwannoma is rare.

Background:. Lymphedema is common after lymphatic damage in cancer treatment, with negative impacts on function and quality of life. Evidence suggests that blood vessel microvasculature is sensitive to irradiation and trauma; however, despite knowledge regarding dedicated mural blood supply to arteries and veins (vasa vasorum), equivalent blood vessels supplying lymphatics have not been characterized. We studied collecting lymphatics for dedicated mural blood vessels in our series of 500 lymphaticovenous anastomosis procedures for lymphedema, and equivalent controls. Methods:. Microscopic images of lymphatics from lymphedema and control patients were analyzed for lymphatic wall vascular density. Collecting lymphatics from 20 patients with lymphedema and 10 control patients were sampled for more detailed analysis (podoplanin immunostaining, light/confocal microscopy, microcomputed tomography, and transmission electron microscopy) to assess lymphatic wall ultrastructure and blood supply. Results:. Analysis revealed elaborate, dense blood microvessel networks associating with lymphatic walls in lymphedema patients and smaller equivalent vessels in controls. These vasa vasora or “arteria lymphatica” were supplied by regular axial blood vessels, parallel to lymphatic microperforators linking dermal and collecting lymphatics. Lymphatic walls were thicker in lymphedema patients than controls, with immunohistochemistry, computed tomography, transmission electron microscopy, and confocal microscopy characterizing abnormal blood vessels (altered appearance, thickened walls, elastin loss, narrow lumina, and fewer red blood cells) on these lymphatic walls. Conclusions:. Dedicated blood vessels on lymphatics are significantly altered in lymphedema. A better understanding of the role of these vessels may reveal mechanistic clues into lymphedema pathophysiology and technical aspects of lymphedema microsurgery, and suggest potential novel therapeutic targets.

Background: Familial synovial hypertrophy is a rare condition presenting as the flexion contracture of the small joints of the hands and feet, in addition to the large joint effusion and range of motion (ROM) restriction. Case Report: Herein, we introduce a 14-year-old boy with a long history of deformities in the hand and foot joints. Painless swelling and limited motion of big joints were present since birth. There were no similar diseases in paternal or maternal relatives, while his 9-year-old brother also had a lifelong history of same deformities. Conclusion: Involvement of the hands and feet can severely restrict young patients’ function in daily tasks, raising the importance of early diagnosis and treatment in familial synovial hypertrophy.

Background: The occurrence of radioulnar shaft fracture and elbow dislocation simultaneously is not a usual event, and it has only been reported in a few studies. This study aimed to report a case with posterior ulno-humeral joint dislocation and concomitant radioulnar shaft fracture. Furthermore, in a literature review, we summarized other studies that reported this kind of fracture-dislocation and the treatment chosen in each study. Case Report: A 12-year-old boy was admitted to the emergency department due to high-energy trauma following a car accident while cycling. Open fracture of the left radioulnar shaft and posterior dislocation of the left elbow were detected. Conclusion: More studies are required to advance our knowledge about this kind of fracture-dislocation, especially its mechanism of injury. Subsequent examinations can help us design an efficient classification system and determine the best treatment option for radioulnar shaft fracture with elbow dislocation.

Background: Complex regional pain syndrome (CRPS) is an important common complication after surgical treatment for distal radius fracture. Recognition of the related factors is important to reduce the burden of the problem. Herein, the contributing factors for CRPS after distal radius fracture surgery are studied. Methods: In this cross-sectional comparative study, 250 patients admitted to the orthopedics ward in Sina Hospital in Tehran, Iran, from 2017 to 2020, were enrolled. The contributing factors for CRPS after distal radius fracture surgery were determined in them. Results: The CRPS was seen in 17 cases (6.8%). 9 percent of male and 1.9 percent of female patients were diagnosed with CRPS. This showed a significant difference in the Fisher test (P = 0.028). The mean pain severity by Visual Analogue Scale (VAS) was higher in CRPS cases, that showed a significant difference by the Mann-Whitney test (P = 0.001). Conclusion: According to the obtained results, it may be concluded that CRPS was seen in seven percent of patients under surgery for distal radius fracture and was related to the male gender and higher pain severity.

Introduction: Surgery and radiotherapy are key cancer treatments and the leading causes of damage to the lymphatics, a vascular network critical to fluid homeostasis and immunity. The clinical manifestation of this damage constitutes a devastating side-effect of cancer treatment, known as lymphoedema. Lymphoedema is a chronic condition evolving from the accumulation of interstitial fluid due to impaired drainage via the lymphatics and is recognised to contribute significant morbidity to patients who survive their cancer. Nevertheless, the molecular mechanisms underlying the damage inflicted on lymphatic vessels, and particularly the lymphatic endothelial cells (LEC) that constitute them, by these treatment modalities, remain poorly understood.Methods: We used a combination of cell based assays, biochemistry and animal models of lymphatic injury to examine the molecular mechanisms behind LEC injury and the subsequent effects on lymphatic vessels, particularly the role of the VEGF-C/VEGF-D/VEGFR-3 lymphangiogenic signalling pathway, in lymphatic injury underpinning the development of lymphoedema.Results: We demonstrate that radiotherapy selectively impairs key LEC functions needed for new lymphatic vessel growth (lymphangiogenesis). This effect is mediated by attenuation of VEGFR-3 signalling and downstream signalling cascades. VEGFR-3 protein levels were downregulated in LEC that were exposed to radiation, and LEC were therefore selectively less responsive to VEGF-C and VEGF-D. These findings were validated in our animal models of radiation and surgical injury.Discussion: Our data provide mechanistic insight into injury sustained by LEC and lymphatics during surgical and radiotherapy cancer treatments and underscore the need for alternative non-VEGF-C/VEGFR-3-based therapies to treat lymphoedema.

**Objective**: This study aimed to gather and present systemic data about current fat grafting practice in Australia. We knew prior to the study that data for Australian fat grafting is limited, so we sought information from distinct sources. Part 1 aimed to present fat grafting data available from the Australian Breast Device Registry (ABDR). Part 2 aimed to present the details of current fat grafting practice by Australian plastic and reconstructive surgeons. **Methods**: In part 1, fat grafting data from the ABDR from its inception in 2012 to 2020 was collected and summarised. In part 2, a comprehensive survey about all aspects of fat grafting practice was distributed to surgeon members of the Australian Society of Plastic Surgeons (ASPS). **Results**: Part 1. The ABDR recorded an 8.4 per cent and 6.0 per cent increase in fat grafting at the time of breast device insertion surgery from 2012 to 2020 for reconstructive and aesthetic procedures respectively. Fat grafting with breast device insertion, in previously irradiated breast tissue, increased from 0 per cent to 17.4 per cent in the same period. Part 2. One in five of all surgeons of the Australian Society of Plastic Surgeons completed the survey. Our survey demonstrated that fat grafting is highly heterogeneous with respect to donor site selection, harvest technique, processing technique, number of sessions required and volumetric follow-up. **Conclusion**: Our study is the first attempt to present national data on fat grafting. It demonstrates clearly that uptake of autologous fat grafting for breast reconstruction and aesthetic procedures is rapidly increasing Australia-wide. It demonstrates that procedural variables of fat grafting are not standardised among Australian plastic surgeons. This indicates that further clinical data relating to patient demographics, procedural variables and outcomes are vital to ensure patient safety, health resource management and to inform best practice guidelines.

Radiotherapy injury to cells of the skin and subcutaneous tissue is an inevitable consequence of external beam radiation for treatment of cancer. This sublethal injury to normal tissues plays a significant role in the development of fibrosis, lymphedema, impaired wound healing, and recurrent infections. To elucidate the transcriptional changes that occur in cells of the skin and soft tissues after radiotherapy injury, we performed genome-wide RNA-sequencing comparing irradiated cells (10Gy) with non-irradiated (0Gy) controls in normal human dermal fibroblasts, normal human keratinocytes, human microvascular endothelial cells, human dermal lymphatic endothelial cells, pericytes and adipose derived stem cell populations. These data are publicly available from the Gene Expression Omnibus database (accession number GSE184119). Further insights can be gained by comparing the mRNA signatures arising from radiation injury derived from these data to publicly available signatures from other studies involving similar or different tissue types. These global targets hold potential for manipulation to mitigate radiotherapy soft tissue injury.

# Introduction Truncal and head and neck head and neck melanomas have a greater propensity to drain to multiple lymph node basins (MLNB) compared to extremity melanomas, which drain predominantly to a single lymph node basin (SLNB). The objective of this study was to compare the lymphatic drainage patterns and characteristics of truncal and head and neck melanoma, to assess their clinical usefulness in areas of unpredictable drainage. # Methods A retrospective review of 143 patients with head and neck or truncal melanoma from 2014–2018 treated at the Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia. Patients scheduled for a wide local excision (WLE) and SeNBx, and those whose initial biopsy results stated melanoma type, cell type and BT, were included. Patients were excluded if they underwent nodal biopsy alone. # Results We identified 95 patients with truncal and 48 with head and neck melanoma. Drainage to MLNB was significantly higher in the truncal melanoma group (36.8%) compared to the head and neck group (10.4%) (_p_ = 0.001). Patients with drainage to MLNB had a higher positive sentinel node biopsy (SeNBx) rate compared to those with SLNB (40.0% verus. 12.6%, _p_