Search

**Introduction** Microsurgical free flap scalp reconstruction is commonly the only reconstructive option in certain challenging patient cohorts. We describe the technical refinements that have streamlined our approach to microsurgical scalp reconstruction and cranioplasty. **Methods** Virtual surgical planning for multiple failed cranioplasty cases involves fashioning an implant with a 3 mm offset. Intramuscular dissection of the latissimus dorsi (LD) vascular pedicle, distal to its bifurcation, is routinely performed, and can increase pedicle length by up to 4 cm without the need for tedious dissection in the axilla. Anastomoses to the superficial temporal vessels distal to their bifurcation in the parietal scalp are reliable and safe. The sequence of surgery is in reverse to the conventional sequence, with the free flap vascularised before craniectomy/cranioplasty is performed to decrease the duration of synthetic implant exposure. **Results** Thirty-nine cases were performed in 35 patients over a five-year period. An LD-based free flap in various permutations was the commonest free flap option (_n_ = 31). The superficial temporal artery and vein were choice recipient vessels in 82 per cent and 74 per cent of cases, respectively, with the former demonstrating higher anatomical consistency. Complications included free flap venous congestion successfully salvaged (_n_ = 1), infected polymethylmethacrylate cranioplasty requiring explantation (_n_ = 1), subdural haematoma requiring craniotomy for evacuation (_n_ = 1) and free flap donor site haematoma (_n_ = 2). **Conclusion** Our technical refinements offer a streamlined and reliable procedure of complex scalp reconstruction and cranioplasty.

Background and Aim: Prevalence of neck pain in nursing professionals (NPs) is much higher than in the general population. However, concrete evidence is not available regarding the efficacy of the therapeutic intervention for treating neck pain among them. The purpose of this study was to compare the efficacy of Mulligan's self-sustained natural apophyseal glides (SNAGs) and conventional physiotherapy in the management of work-related neck pain (WRNP) among the NPs. Materials and Methods: A total of 38 NPs with WRNP were recruited using the simple random sampling (lottery method) to participate in this two group such as pretest–posttest and single-blinded randomized controlled study from recognized tertiary care teaching hospital. Recruited NPs were randomly allocated into two groups such as Group A and Group B. NP in Group A taught self-SNAGs with a towel and instructed to perform 10 repetitions ×1 set/two hour ×4 times/day for 5 days/week ×2 weeks. Whereas in Group B, NPs received conventional physiotherapy treatment, consist of neck isometrics, and performed for 10 s ×10 repetitions ×1 set/day ×5 days/week ×2 weeks. Both groups were asked to use the hot pack for 15 min, before their intervention. Visual Analog Scale (VAS) score, neck disability index (NDI), and cervical range of motion (ROM) were documented at baseline, 2nd-week postintervention, and 4th-week follow-up period and analyzed. Results: Group A revealed statistical significance difference (P < 0.05) in VAS, NDI, and neck ROM when compared to Group B. Conclusion: Mulligan's self-SNAGs have proved to be more beneficial over the conventional physiotherapy in the management of WRNP among the NPs.

Background: The efficacy of ischemic compression, strain/counterstrain, and muscle energy techniques were supported by literatures to relieve myofascial trigger points. However, no high-level research is available regarding the integrated neuromuscular inhibition technique (INIT). Objective: To document the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle over the traditional approach. Methods: Thirty adults in the age group of 18–35 years diagnosed with mechanical neck pain with upper trapezius trigger point were selected by the simple random sampling for two group pretest-posttest design. They were allocated randomly into two equal groups, Group A and Group B, respectively. Group A received hydrocollator pack, INIT, neck strengthening exercises, scapular stabilization exercises, shoulder stabilization exercises, postural correction, and ergonomic advice while Group B received the same treatment except INIT. They were treated for six sessions on alternate days for 2 weeks. Visual analog scale, neck disability index, and tenderness grading scale were noted at baseline, 3rd session, and 6th session after the above treatment on both the groups and analyzed. Results: In all the outcome measures, Group A showed significant (P < 0.05) improvement when compared to Group B. Conclusion: There is a sufficient evidence to prove the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle

Neck pain accounts for 15% of all soft tissue problems seen in general practice and are a common reason for referral to physiotherapy treatment. The prevalence of neck pain in dentists is 74.3%. Musculoskeletal symptoms in dentists are caused due to many reasons for e.g., prolonged static posture, repetitive movements, suboptimal lighting, and genetic predisposition. Since deep cervical muscle activity is required in synergy with superficial muscle activity to stabilize the cervical segments, a study is needed, to compare the effectiveness of deep cervical flexor (DCF) training and posture correction training on neck pain and neck disability index and forward head posture. Aim: To determine and compare the effect of DCF training on forward head posture, neck pain and neck disability index in dentists suffering from chronic non severe neck pain. Material and Methods: Total of 30 subjects were selected, based on inclusion and exclusion criteria, who were further divided into Experimental and Control groups. Baseline information of dependent variables was taken at the beginning of study on day one, for Visual Analogue Scale (VAS) and Neck disability Index (NDI). Forward head posture was measured on day one using digital photograph technique. Then, Experimental group was given DCF training and Control group was given conventional isometrics training (CIT) for 4 weeks under supervision of examiner. All measurements were repeated at end of 4th week, on completion of study. Results: It was observed that pain and disability had reduced in both groups on group analysis. But the forward head posture had improved significantly in experimental group only. Conclusion: DCF training is more effective than CIT in improving forward head posture, decreasing pain and disability in dentists suffering from chronic neck pain.