Sophia R., 8

Sophia is an 8 year old girl child living with her parents and 2 siblings. She is a primary school pupil. They struggle financially in the family. They stay in a 2 rooms apartment, having a pit toilet with access to electricity. They use borehole water, and her family income is 15000. She was born with right hand swelling involving the fingers and dorsum of the hand as well as distal part of the palm. She has had two debulking surgery and histology confirmed microcystic lymphatic malformation. No other medical condition. Patient complained of fever last night. There is associated history of purulent discharge from the swelling on one of the fingers. Gross swelling of the distal palmar area of the right hand, multiple scars on the dorsum which has flat normal skin but skin of the palmar surfaces of the digits and webspace shows hyperkeratosis. Diagnosis shows Right hand microcystic lymphatic malformation with skin changes was made. Patient is being planned undergo two debulking surgeries. The family are poor and in seek of help from Helpster Charity.

8 years old Sophia Robert has a congenital microcystic lymphatic malformation of the right hand, which had previously required two debulking procedures. During the current admission, she underwent a third-stage debulking surgery to further reduce the abnormal tissue and improve the contour and function of the affected hand and digits. She remained on admission for 14 days and received appropriate antibiotic and analgesic treatment, together with regular postoperative wound care and monitoring. Her recovery was complicated by a wound infection, which was treated with antibiotics and continued wound care. The infection responded to treatment and has now been controlled. The child is currently clinically stable and undergoing outpatient follow-up. The wound is receiving continued care, and compression dressing is being applied to the affected digits to assist with controlling residual swelling and moulding the digits. Further follow-up is required to monitor wound healing, hand function and the long-term outcome of the surgical treatment.

The prognosis of right hand microcystic lymphatic malformation with skin changes is variable and depends on the extent of involvement and response to treatment. Although the condition is benign, it may be chronic with recurrent swelling, skin breakdown, lymph leakage, or infection. With appropriate multidisciplinary management, symptoms can be controlled and hand function preserved, but complete cure is often challenging.