Postprocedural hyperpigmentation is a rare but concerning complication after botulinum toxin type A injections. In 2024, 3 patients developed persistent facial hyperpigmentation following Coretox administration in the glabellar and forehead regions. This case series characterizes the clinical course, imaging findings, and hypothesized mechanisms underlying this reaction. Three female patients received Coretox injections using standard aesthetic techniques, including subdermal injections in the forehead and periorbital regions and intramuscular injections in the glabellar region. Serial clinical photographs and QuantifiCare LifeViz imaging-including cross-polarized, ultraviolet-filtered, and hemoglobin-filtered modes-were performed from baseline through follow-up. Medical histories, sun exposure, skincare routines, and concurrent medications were reviewed. No patients reported recent use of photosensitizers, active dermatitis, or excessive ultraviolet exposure. All 3 cases exhibited localized hyperpigmented macules at injection sites, appearing 2-3 weeks postprocedure. QuantifiCare imaging demonstrated elevated melanin and hemoglobin signal intensity in affected areas. Although pigmentation lightened slightly over 2-3 months, the discoloration persisted beyond 1 year in all cases as of October 2025. Exosome-based treatment, Rejuran injection, and laser therapies were attempted without significant improvement. Approximately 1,400 vials of Coretox have been used by the author since 2019, with all three pigmentation events linked to batch E622080A (June 28, 2024). This is the first report to document persistent facial hyperpigmentation following Coretox injection, using serial imaging analysis. Although the pathogenesis remains unclear, polysorbate 20-a stabilizer replacing human serum albumin-may act as a trigger in susceptible individuals. Early recognition, patient counseling, and photoprotection are recommended. Further investigation into excipient-induced pigmentary changes is warranted.

The great toe is crucial in weight-bearing and gait propulsion, making reconstruction of its composite defects particularly challenging in high-risk patients. We present a case of a 59-year-old man with poorly controlled diabetes and osteomyelitis of the left distal phalanx. Thorough debridement revealed complete loss of the distal phalanx, full-thickness dorsal soft tissue, and exposed extensor tendon. We used a chimeric flap based on the superficial and deep branches of the superficial circumflex iliac artery (SCIA) as an improved alternative to the traditional deep circumflex iliac artery flap, which was particularly effective in this patient. The flap provided a vascularized iliac bone segment and a thin skin paddle based on the deep branch of the SCIA. The harvested pedicle provided sufficient length for straightforward microanastomoses to the dorsalis pedis vessels. The bone segment was securely fixed to the residual proximal phalanx using a headless compression screw. The postoperative course was uneventful with complete flap survival. At the 6-month follow-up, the patient's excellent functional outcome was confirmed by the Japanese Society for Surgery of the Foot score of 92 out of 100, achieving painless full weight-bearing ambulation. This case suggests that the chimeric flap based on the SCIA is a valuable technique for small composite defects, including those of the distal phalanx, providing effective reconstruction with minimal donor-site morbidity compared with traditional options. The technique is advantageous in patients who are compromised, in whom donor-site complications and recipient-site requirements for thin, pliable coverage must be carefully balanced.

Chronic genital wounds following oncological surgery and radiation are uncommon and challenging to reconstruct because of scarred, poorly vascularized tissues and proximity to the urethra and testes. We report a 73-year-old man with a 2-year nonhealing wound at the base of the penis and right hemiscrotum after orchiectomy and adjuvant therapy. He presented for operative excision, skin substitute placement, and negative-pressure wound therapy. His early course was complicated by persistent venous oozing requiring ongoing hemostatic measures and subsequent operative debridement. Final pathology showed no malignancy recurrence. Given the extent of tissue loss and failed prior grafting, definitive coverage was achieved with a pedicled superficial circumflex iliac artery perforator (SCIP) fasciocutaneous flap with indocyanine green-confirmed perfusion and 2 Blake drains. The flap remained viable with excellent capillary refill. Postoperatively, he developed acute blood-loss anemia, transient acute kidney injury that resolved with medical optimization, and a medication-associated hypoxic event after prophylactic antibiotics, all managed without flap compromise. This case highlights decision-making for staged wound bed optimization, selection of a pedicled SCIP flap in a radiated field after skin grafting failure, and perioperative management considerations in an older patient with cardiovascular comorbidities. The SCIP flap provided durable, sensate coverage with favorable early outcomes, supporting its role as a versatile option for complex genital reconstruction when skin grafting is unlikely to succeed.

Nasolabial flaps are a reliable option for oral commissure reconstruction due to their robust vascularity and minimal donor site morbidity. However, conventional methods that involve folding of the flap into the oral cavity usually lead to bulky commissures and restricted mouth opening. Here, we report a case of bilateral oral commissure defects in an older patient with suspected verrucous carcinoma. Bilateral inferiorly pedicled nasolabial tunnel flaps were used for reconstruction after tumor resection. The flaps were transferred intraorally via subcutaneous tunnels to preserve oral function and prevent microstomia, and their thinned distal portions were used to restore the commissures. This approach enabled a single-stage reconstruction without the need for secondary flap division. The patient experienced favorable long-term outcomes, including preserved mouth opening, stable denture use, and no tumor recurrence. Only minimal lip incompetence was observed, without leakage of saliva or food. This case highlights the effectiveness of nasolabial tunnel flaps for simultaneous bilateral commissure reconstruction, providing reliable single-stage repair with functional and aesthetic benefits while minimizing the risks of bulkiness, restricted mouth opening, and microstomia.

Dynamic compression of the common peroneal nerve (CPN) at the knee remains underdiagnosed because static investigations, including electromyography and magnetic resonance imaging, may fail to detect positional nerve entrapment. The orthogonal kinesiotaping test (OKT), adapted from the Lacertus Antagonist Test for dynamic median nerve compression, uses kinesiotape applied perpendicular to the nerve to provide temporary decompression. This prospective monocentric study evaluates OKT for diagnosing dynamic CPN compression. Patients meeting the Hagert triad-tenderness over the fibular tunnel, selective dorsiflexion or eversion weakness varying with limb position, and a positive Scratch Collapse Test-were included. Ultrasound or magnetic resonance imaging excluded extrinsic causes. A 5-cm kinesiotape strip was applied perpendicular to the CPN at the fibular neck with approximately 20% tension. A positive test required improvement of at least 1 Medical Research Council grade, patient-reported functional improvement, and examiner-confirmed increased resistance. OKT was performed on 124 knees in 111 patients, including 55 men, 56 women, and 13 bilateral cases. Immediate strength improvement occurred in all patients except 4 with complete paralysis. Pain decreased in all patients, and fatigability improved in 96.4% of patients. Benefits disappeared after tape removal. OKT is a simple, reproducible, noninvasive test demonstrating immediate, reversible functional improvement consistent with dynamic mechanical compression. It may constitute a fourth clinical sign within the Hagert diagnostic framework and could be applicable to other dynamic nerve entrapments.