Acute carpal tunnel syndrome (ACTS) from an infected source is rare because most cases result from trauma. There are cases of ACTS occurring after feline bites, but none in the reported literature after canine bites. The following is a case report of a 58-year-old woman who presented to the emergency department with progressive median nerve symptoms after a canine bite. In the operating room, a significant mass effect was found within the contents of the carpal tunnel secondary to an abundance of purulence. The patient was treated urgently with irrigation and débridement of the wrist with an extended open carpal tunnel release and flexor tenosynovectomy and discharged with peripheral venous access for long-term antibiotics. At 1-month follow-up, the healed wound showed no signs of infection. A mild sensory deficit remained in the median nerve distribution.

This case report presents a unique clinical dilemma in the treatment of a large full-thickness dorsal hand wound in a 64-year-old Caucasian woman with recently diagnosed acquired hemophilia A. The wound was instigated by nominal blunt force trauma to the dorsal hand and progressed to a large desquamating bulla. Treatment was initiated by careful evacuation of the bulla and daily dressing changes. The resulting necrosis of the skin produced a loose eschar. Subsequent removal of the eschar left the extensor tendons with minimal hypodermis covering the paratenon. The potential for life-threatening hemorrhage limited treatment options. The wound was treated with Integra Dermal Regeneration Template and planned for delayed definitive coverage. Continued concern for hemorrhage and comorbid conditions delayed skin grafting. Wound surveillance demonstrated notable interval healing ultimately resulting in complete regeneration of the skin, providing full coverage of the wound and no functional deficits without surgical intervention or skin grafting. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Full-thickness hand wounds present a challenge for the managing clinician to provide long-term adequate functional results. Larger and deep wounds usually require skin grafting to provide suitable coverage and healing. The use of Integra Dermal Regeneration Template (Plainsboro, NJ) has been implemented in the treatment of wounds related to burns, tumor resection, degloving injuries, traumatic wounds to the extremities, and pedicle donor flaps. 1e5 Integra provides an acellular bilaminate dermal-substitute membrane of collagen and chondroitin-6-sulfate to facilitate the migration of fibroblasts, macrophages, and lymphocytes and stimulation of capillary bed development.Acquired hemophilia is a potentially life-threatening autoimmune bleeding disorder caused by the development of autoantibodies against coagulation factors. Acquired hemophilia A (AHA) is the most common manifestation of this disease produced by autoantibodies against Factor VIII. 6,7 Only about half of AHA cases can be attributed to underlying conditions such as malignancy, other autoimmune disorders, or pregnancy. The rest are idiopathic, but all present with spontaneous hemorrhage into the soft tissues, muscles, and mucosa without a history of abnormal bleeding. 8 This case report presents the challenges of managing a patient with AHA after minimal hand trauma evolved into a full-thickness dorsal hand wound with other limiting comorbid conditions during the treatment course.We followed Strengthening the Reporting of Observational Studies in Epidemiology and Case Report for this case. Case ReportA 64-year-old Caucasian woman presented with an evolving hemorrhage on the dorsum of the left hand. The initial trauma was the result of striking the hand on a table while reaching for a piece of paper. This caused a small abrasion with progression of swelling, extensive ecchymosis, and pain of the hand and f...