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Objectives: The aim of this study is to evaluate the outcomes of the reconstruction in emergency of the amputated thumb using isolated or associated homodigital and heterodigital flap techniques in those situations when microsurgical replantation is not possible due to local or general conditions. The[for full text, please go to the a.m. URL], 57. Kongress der Deutschen Gesellschaft für Handchirurgie

Introduction The purpose of this paper is to highlight the rarity of lipoma localization in the hand, especially the ones with big dimensions localized in the palm (giant lipoma), the importance of IRM exam in establishing the positive and differential diagnostics, as well as the importance and the necessity of the surgical treatment regarding the functional rehabilitation of the hand. Material and methods Our study is based on 7 patients with lipomatous lesions in the hand localized as - in 2 cases on the dorsal face of the hand, in 4 cases on the thenar eminence and, in only 1 case, in the palm. In the last case, the lesion occupied the entire surface of the palm, with important functional deficiency and with paresthesia on the thumb and the index. In 3 cases out of 5 lesions localized on the volar face of the hand, the diameter of the lesion was over 5 cm, the inferior limit for the giant tumors. The biggest one was 9.5 5 3.5 cm. The IRM exam established the diagnostic of lipoma and in 1 case raised the questionable diagnostic of well-differentiated liposarcoma, which was confirmed by the pathological exam. In those 6 cases of lipoma, the surgical treatment was the complete removal of the lesion followed by the complete remission of the neurological symptoms and by the complete functional reintegration of the hand. In the liposarcoma case, the surgical treatment was followed by the oncological one, the hand amputation not being accepted by the patient. Discussion Lipoma is a slowly growing, asymptomatic tumor, which explains the large size at diagnosis, especially in cases with deep location. The symptoms are given by hand dysfunctions caused by tumor size and its compression on the neighboring tissues such as nerves or intrinsic muscles. The tumors having more than 5 cm in diameter, rapid growth and deep location can be malignant. MRI exploration is preferred in cases of lipoma for diagnostic specificity. Conclusions In establishing the diagnosis of a hand tumor, the surgeon must consider the possibility of a lipoma, despite its rarity. MRI exam is the most useful exploration in these cases, being able to establish the diagnosis with high accuracy. The differential diagnosis must be taken into account, mainly with the liposarcoma but also with other possible benign tumors of the hand.