The incidence of skin infections caused by Serratia marcescens is extremely low and such infections are typically observed in immunocompromised patients. The clinical manifestations of these infections include cellulitis, abscesses, fluctuant nodules, or granulomatous lesions. Infections caused by S. marcescens are very difficult to treat due to their resistance to many antibiotics, which often leads to specific and prolonged treatment. Infections after receiving a tattoo are very rare and are caused by unhygienic conditions or the inexperience of the tattooist. In this paper we present the case of a 32-year-old male with no comorbidity, who presented an abscess caused by S. marcescens in a area that was tattooed one month earlier. The case was resolved with surgery and antimicrobial therapy that was based on the antibiogram. To our knowledge, this is the first reported case of a S. marcescens skin infection following a tattoo, in the absence of immunosuppression.

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We present a case of a 58 years old woman who presents a low-anterior dislocation with vascular and total nerve injury secondary to a fall with the shoulder extended and abducted (90º). In this situation, it was fixed with closed reduction. After 6 weeks, the ENG and the EMG showed brachial plexopathy. Disruptions were not detected in NMR. She gradually improved with rehabilitation, not having new vascular symptoms. Age, obesity, the delay until the reduction and associated fractures are risk factors to completed brachial plexus palsy, being more common in low energy traumas. Axilar nerve is the most affected element, followed by radial, ulnar and median, in this order. EMG/ENG is the gold standard technique for the diagnosis after one month. MNR will be essential to check the state of the nerve. Rehabilitation is key in the treatment, and the surgery can be postponed. Neurolysis showed encouraging results in the first semester. Functional recovery is slow (six months - one year), being faster in the EMG results. Acute vascular affection is a traumatology emergency. The third section of the axillar nerve is the most common affected. Suspected diagnosis is important, even when the radial pulse is detected. After closed reduction, ECO-Doppler and CT Angiography are the diagnosis test indicated. Suspecting neurovascular injury is mandatory. Systematic exploration and urgent treatment decrease complications and they can improve the patient prognosis.

Diranzo-García J y cols. www.medigraphic.org.mxworst results in patients with major defects have led to other options being considered.

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