title: Invasive macrodystrophia lipomatosa of the hand.
abstract: OBJECTIVE
  The Authors point out the interest of differential diagnosis and conservative surgical treatment of a rare case of digital and ulnar side of the hand gigantism, with massive fatty infiltration of soft tissues and a neurovascular bundle, to be included into Macrodystrophia Lipomatosa with fibrolipomatous hamartomata.
  
  
  METHODS
  Excision of the mass included 4th ray disarticulation (the fifth had been amputated several years ago) as well as microsurgical external and internal neurolysis of the ulnar nerve, the ulnar neurovascular bundle being exposed and covered with dermal substitute INTEGRATM, with a good result both from a cosmetic and functional point of view at three year follow up.
  
  
  RESULTS
  This is the first report of INTEGRATM covering of a neurovascular bundle. Samples taken from the dermal substitute matrix interface at day 6 and day 25 were examined with transmission Electron Microscopy: a newly formed tissue, rich in precursor cells, was detected.
  
  
  CONCLUSIONS
  Conservative surgery, requiring particular microsurgical skills and use of dermal templates, plays an outstanding role in treatment of these rare but aggressive soft tissues masses of the upper limb.
authors.affiliation: Department of Medical and Surgical Specialties and Odontostomatology, Department of Social Territorial Medicine, Section of Dermatology, Department of Human Pathology, University of Messina, Gazzi, Messina, Italy. mrcolonna1@libero.it.
authors.forename: M R
authors.initials: MR
authors.lastname: Colonna
authors.forename: C
authors.initials: C
authors.lastname: Guarneri
authors.forename: F
authors.initials: F
authors.lastname: do Stagno d'Alcontres
authors.forename: G
authors.initials: G
authors.lastname: Risitano
authors.forename: V
authors.initials: V
authors.lastname: Cavallari
authors.forename: D
authors.initials: D
authors.lastname: Ribuffo
mesh_terms: D003937:Diagnosis, Differential; D005877:Gigantism / Q000175:diagnosis* / Q000628:therapy*; D006225:Hand / Q000473:pathology / Q000601:surgery; D006226:Hand Deformities / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008068:Lipomatosis / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged