The aims of this study were to identify the location of the A1 pulley combining palpation technique with superficial palm landmarks and to determine the efficacy and safety of A1 pulley percutaneous release with a 19-gauge needle. Fourteen fresh frozen cadaveric specimens were used: 56 fingers and 14 thumbs. The location of the A1 pulley was based on anatomical landmarks and was identified in all digits. Complete release of the A1 pulley occurred in 60 of the 70 digits (85.7%). The length of the A1 pulley in thumbs was 5.7 mm and in other fingers 4.5 mm. There were no signs of neurovascular bundle injuries. The mean distance between needle pathway and neurovascular bundle was 4.3 mm in the thumbs and 6.5 mm in the other fingers. There were no total flexor tendon injuries. The location of the A1 pulley can be predicted with success. Percutaneous release of the A1 pulley with a 19-gauge needle shows acceptable results in both safety and efficacy.

Keratoacanthoma is a benign skin tumour caused mainly by ultraviolet A radiation. It affects 150 out of every 100 000 people worldwide. The most common location is the face, neck, and hands. Keratoacanthoma usually affects middle-aged and older men with a fair skin phenotype. More importantly, this disease may be a complication of cutaneous cornification. Keratoacanthoma is described as a circumscribed conical prominent hyperkeratotic lesion in the literature, and the main factor provoking this complication is ultraviolet radiation. Fair skin phenotype, male sex, and older age may contribute to the development of cutaneous horn disease. Another possible complication of keratoacanthoma is squamous cell carcinoma, which is defined as a malignant composed of epidermal keratinocytes skin tumour. Squamous cell carcinoma is very similar to keratoacanthoma, but is prone to metastasis and has unclear tumour borders. Ultraviolet radiation and the treatment of keratoacanthoma by using chemotherapy are some of the main provocative factors. All three of these diseases are treated surgically. The purpose of this article is to discuss the etiopathogenesis, clinic, diagnosis, treatment of kerato­acanthoma, essential complications – skin horn, squamous cell carcinoma, and a clinical case related to these diseases.

The article deals with one of the most complex hand injuries in the practice of plastic and reconstructive surgery – amputation of degloving the upper tissues of the upper limb. The clinical case of a woman who has suffered from this trauma, the course of treatment, remote functional and aesthetic results are presented.