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Since the onset of the COVID-19 pandemic in 2020, students' right to education has been threatened globally, and medical colleges are not an exception to this. During COVID-19 induced lockdown, medical colleges had to resort to online classes instead of regular academic sessions. Medical colleges and other higher education institutions in India faced a challenge in determining on how to engage their students in the learning process and assess them using reliable, effective and acceptable methods. Now that the COVID pandemic is nearly over, many medical colleges have already started regular sessions. At the same time, some continue to use online lectures and other tools for engaging their learners in addition to regular classes. Medical colleges also used different online tools for formative assessments. But the effectiveness of such online educational activities is yet to be established in India. This article discusses how unsupervised online tests can be used for formative and summative exams in post-COVID medical education.

Background and Aims: Airway management in children with oral cleft surgery carries unique challenges, concerning the proximity of the surgical site and the tracheal tube. We hypothesized that using a Microcuff oral RAE tube would reduce tube exchange and migration rate. We aimed to compare the performance of Microsoft and uncuffed oral performed tracheal tubes in children undergoing cleft palate surgeries regarding the rate of tracheal tube exchange, endobronchial intubation, and ventilatory parameters. Methods: One hundred children scheduled for cleft palate surgery were randomized into two groups. In the uncuffed group (n = 50), the tracheal tube was selected using the Modified Coles formula, and in the Microcuff (n = 50) group, the manufacturer's recommendations were followed. Intraoperatively, we compared the primary outcome of tube exchange using the chi‐square test. The leak pressure and ventilatory parameters after head extension and mouth gag application were measured in both groups. Results: The tracheal tube exchange rate was significantly lower in the Microcuff group (0/50) than in uncuffed (19/50) preformed tubes (0 vs. 38% respectively; p <.001). The uncuffed and Microcuff tracheal tube were comparable concerning ventilation parameters and leak pressure of finally placed tubes (17.78 ± 3.95 vs. 19.26 ± 3.81 cm H2O respectively, with a mean difference (95% CI) of −1.48 (−0.01–2.98); p‐value =0.059. Cuff pressure did not vary significantly during the initial hour, and the incidence of postoperative airway morbidity between uncuffed and Microcuff tube was comparable, 5/50 (10%) versus 7/50 (14%) with risk ratio (95% CI) of 0.71(0.24–2.1), p value.49. Conclusion: Microcuff oral preformed tubes performed better than uncuffed tubes regarding tube exchange during cleft palate surgery. [ABSTRACT FROM AUTHOR]

Background: Flap monitoring plays an important role in avoiding morbidity in free flap. Clinical monitoring is considered the gold standard, but it is subjective. Digital thermal imaging captures and displays the infrared radiation emitted from an object. This is useful in assessing temperature difference between two surfaces, as well as variation of temperature. Smartphone thermal imaging can be used to assess the tissue perfusion, which requires little training. Materials and Methods: The aim was to assess the validity of Digital Thermal Imaging in early diagnosis of flap failure, compared to conventional clinical methods. Eleven patients of microvascular-free flap reconstruction for defects following malignancy and trauma were included in the study for January 25, 2019-March 25, 2021. Flaps were monitored using three different methods - clinical monitoring, biochemical monitoring, and digital thermal imaging done at the following interval: (1) intraoperative (end of surgery), (2) hourly - for the first 48 h, (3) every 4th hourly on postoperative days 3-5, and (4) every 6th hourly on postoperative days 5-10, and the results were tabulated. Results: Flap temperature was observed to be higher compared to the surrounding skin when there was an event of venous thrombosis. The surrounding skin temperature was to be measured on the side opposite to the side where the flap was raised to do vascular anastomosis. The increase in the temperature difference almost coincided with the clinical and biochemical indicator of failing flaps. Conclusion: Monitoring of the flap temperature and comparing it with the surrounding skin temperature can be incorporated along with the gold standard. It is a simple, objective, and noncontact method compared to clinical monitoring and biochemical methods. A large sample size, multicentric, randomized controlled study is required to validate the same. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and complexities of congenital anomalies of the hand and proposes a novel grading system called the Hand Anomalies and Deformity (HAnD) grading system. This system aims to assist healthcare providers in categorizing hand anomalies, communicating with patients, planning treatment strategies, and setting realistic expectations for outcomes. The grading system classifies anomalies on a scale from I (mild) to IV (profound), with grade III further divided into A and B subcategories for complexity and associated syndromes. The system emphasizes function, considers associated syndromes, and focuses on treatment feasibility. [Extracted from the article]

Introduction Large language models (LLMs) are designed for recognizing, summarizing, translating, predicting, and generating text-based content from knowledge gained from extensive data sets. ChatGPT4 (Generative Pre-trained Transformer 4) (OpenAI, San Francisco, California, United States) is a transformer-based LLM model pretrained on public data as well as data obtained from third-party sources using deep learning techniques of fine tuning and reinforcement learning from human feedback to predict the next text. We wanted to explore the role of LLM as a teaching assistant (TA) in plastic surgery. Material and Methods TA roles were first identified in available literature, and based on the roles, a list of suitable tasks was created where LLM could be used to perform the task. Prompts designed to be fed in to the LLM (specifically ChatGPT) to generate appropriate output, were then created and fed to the ChatGPT model. The outputs generated were scored by evaluators and compared for interobserver agreement. Results A final set of eight TA roles were identified where a LLM could be utilized to generate content. These contents were scored for usefulness and accuracy. These were scored independently by the eight study authors in a scoring sheet created for the study. Interobserver agreements for content accuracy, usefulness, and clarity were 100% for content generated for the following: interactive case studies (generation), simulation of preoperative consultations, and generation of ethical considerations. Discussion LLMs in general and ChatGPT (on which this study is based) in specific, can generate answers to questions and prompts based on huge amount of text fed into the model for training the underlying language model. The answers generated have been found to be accurate, readable, and even indistinguishable from human-generated text. This capability of automated content synthesis can be exploited to generate summaries to text, answer short and long answers, and generate case scenarios. We could identify a few such scenarios where the LLM could in general be utilized to play the role of a TA and aid plastic surgery residents in particular. In addition, these models could also be used by students to obtain feedback and gain reflection which itself stimulates critical thinking. Conclusion Incorporating LLMs into the educational arsenal of plastic surgery residency programs can provide a dynamic, interactive, and individualized learning experience for residents and prove to be worthy TAs of future. [ABSTRACT FROM AUTHOR]

Background Plastic surgery training requires the trainee to assist in surgeries to improve their on-table decision making and hone their surgical skills, but this results in an increased risk of intraoperative complications and increased operative time. It is important to have a training method that orients the trainee toward the surgery to ensure patient safety. Materials and Methods A training method called preoperative preparatory talk (PPT) was devised in which the preceptor orients the trainee toward the planned surgery in three phases. Comparison and statistical analysis of mean operative times of four stages of free flap surgeries after PPT and without PPT were done. Objective Structured Assessment of Technical Skill (OSATS) scores of surgical trainees were also documented for surgeries done with and without PPT and statistical analysis was done for comparing these scores. Results Statistical analysis via unpaired t -test confirmed that after applying PPT, there was a significant decrease in time taken in three out of four stages of free flap surgeries: flap planning and harvesting, recipient site preparation and vessel dissection, and flap division and partial inset. Trainees were found to be better oriented toward the surgery which resulted in a better performance on table that was confirmed by statistical analysis of OSATS score via unpaired t -test. Conclusion PPT ensures better learning for the resident and improves patient safety because of better orientation of the operating team toward the procedure and operating steps. This reduces the operative time of free flap surgeries. We recommend this training method to be incorporated in plastic surgery training programs. [ABSTRACT FROM AUTHOR]

Introduction: Basal cell carcinoma (BCC) is a locally invasive, slowly spreading tumor arising in the basal layer of epidermis and rarely metastasizes. Surgical excision with adequate margins is curative. Reconstruction of post-excisional defects on the face is both essential and challenging. Clinical Cases and Methods: A retrospective review of hospital records for patients operated for BCC of the face excluding the pinna at our institute in the last 3 years was done and a review of the literature was carried out to identify the most common principles governing the optimal reconstruction of post-excisional defects on the face. Literature search was made in Embase, Medline, and Cochrane databases in the last two decades with the filters placed for human and English language studies with the search terms (Facial Basal cell carcinoma) AND reconstruction AND (Humans[Mesh]). Results: Records of 32 patients with facial BCC who underwent excision and reconstruction at our hospital were identified and details were recorded. Our literature search with the terms and filters mentioned above revealed 244 studies with duplicates removed. After further hand-searching, 218 journal articles were identified, reviewed, and a reconstruction algorithm was designed based on the findings. Discussion: Reconstruction of post-BCC excisional defects of the face relies on an adequate understanding of the general principles of reconstruction, subunit principle of facial esthetics, flap anatomy and vascularity as well as operator experience. Complex defects need innovative solutions, multidisciplinary approaches, and newer methods of reconstruction like perforator flaps and newer techniques like supermicrosurgery. Conclusion: Multiple reconstructive options for post-excisional defects of the BCC over the face are available and most defects can be approached in an algorithmic manner. Further well-designed prospective research studies are needed to compare outcomes of different reconstructive options for a given defect and identify the most suitable options. [ABSTRACT FROM AUTHOR]

Cleft lip and palate (CLP) affect about one baby of every 700 newborn due to alterations in the normal development of the primary and/or secondary palate. The prevalence of clefts in India is between 27,000 and 33,000/year. Searches were undertaken in PubMed, Cochrane database, Web of Science, Scopus, and Google Scholar databases, for primary research studies that report on feeding interventions/feeding techniques/feeding methods, challenges faced by mother/care taker/health personnel as they include most of the publications in this area. Papers were independently reviewed by two authors and Thomas et al's assessment criteria checklist (2003) was used to assess the methodological quality. This systematic review was registered in PROSPERO under number CRD42020208437. The review included 25 studies: 21 quantitative, 2 qualitative, and two mixed methods study, involving 1564 infants and children (age ranging from 1 week to 5 years old) and 790 mothers of Infants with CLP from 13 countries. While comparing the efficacy of the three feeding techniques such as paladai fed, bottle fed, and spoon fed in improving the weight gain pattern the result showed mean weight gain among paladai feeding was better than the bottle or spoon-feeding. Common feeding problems observed were nasal regurgitation, vomiting, and choking, etc. Infants with cleft palate had some major challenges such as aspiration, choking, and inadequate growth. Beyond the esthetic and psychologic implications of the presence of orofacial clefts, the feeding of the child is usually the next concern of the parents and caregivers, a factor which can result in considerable stress to the mother. A prompt diagnosis, especially of a CP, and visit by the cleft team immediately after the birth so that the family can be supported and taught the skills of feeding, is essential. [ABSTRACT FROM AUTHOR]

Auricular perichondritis leading to perichondral abscess is an unusual complication of periauricular surgery. Early identification of the condition with aggressive and timely management is mandated to prevent permanent damage to the auricle. This article demonstrates the first reported case in literature of auricular perichondritis due to Neisseria flava. We discuss the presentation, diagnosis and management of auricular perichondritis in this patient and review mechanisms by which commensals acquire pathogenicity as seen in this report. An awareness of this unusual etiology and mechanisms of acquiring pathogenic nature by commensals will help guide clinicians in optimizing management of such conditions. [ABSTRACT FROM AUTHOR]

Introduction The study was carried out to quantify the changes induced by the pandemic in plastic surgery practice and training and to study the impact of the webinars on plastic surgery education from a residents' perspective. Methods In this multicentric study, the number and type of surgeries, cause of injuries, and their regional variation during the coronavirus disease 2019 (COVID-19) period (February-September 2020) were compared with pre-COVID-19 time. An online survey on the impact of webinars was conducted for plastic surgery trainees across the country. Results There was a significant reduction in total number of surgeries (p = 0.003). The procedures for hand (p = 0.156), faciomaxillary injuries (p = 0.25), and replantations (p = 0.46) were comparable; there was a significant reduction in combined orthopedic-plastic-surgical procedures (p = 0.009) during the pandemic. There was a significant reduction in road accidents (p = 0.007) and suicidal injuries (p = 0.002) and increase in assault (p = 0.03) and domestic accidents (p = 0.01) during the COVID-19 period. A usefulness score of >8 was given for the webinars by 68.7% residents. There was no significant difference in perception of utility when correlated with the academic program at their institutes (p = 0.109); 92% opined webinars should continue in post-COVID times. Conclusion There was a drastic reduction in number of elective and emergency procedures during the COVID-19 time, negatively affecting resident training program. Majority of residents felt that webinars could prove a useful adjunct to training in formal training program in post-COVID-19 scenario. [ABSTRACT FROM AUTHOR]

Introduction Competency-based medical education (CBME) approach in the medical curriculum has been introduced globally with the goal of providing flexibility, accountability, and learner-centeredness among medical learners. Traditional surgical skill training in most places has relied on "see one, do one, teach one model," while simulation model-based training has been shown to improve competencies in surgical trainees. We wanted to assess the usefulness of a hydrophilic barrier adhesive foam wound dressing as a novel skin simulation model for learning biomechanics and practice of cutaneous flaps among plastic surgical resident trainees at our institute. Materials and Methods An absorbent, soft polyurethane foam pad located centrally upon a larger polyurethane membrane, coated with a hydrocolloid adhesive, forming an island dressing, was used as a simulation model for this study. It was obtained from the hospital store either after or nearing their expiry dates of clinical use. Plastic surgery residents in different years of training were invited to participate in a simulation workshop, using this novel model, and give their feedback. Results Seventeen residents in different plastic surgery training levels participated in the workshop and gave their feedback on the skin flap simulation model. The simulation model received extremely high (100%) scores on two parameters, namely, utility for flap and suture practice and high scores (88%-94%) for texture, ability to mark, and improving confidence among trainees. Conclusions Adhesive bilayer polyurethane foam can be used as a novel cutaneous skin flap simulation model for understanding the biomechanics of skin flaps and cutaneous flap practice. [ABSTRACT FROM AUTHOR]

Organ transplant has, arguably, been the pinnacle of the advancement in medical science so far and vascularized composite allotransplantation has been the most recent addition to it. The scope of vascularized tissue allotransplantation has been widening with each passing day and more and more reports regarding the safety and efficacy of the procedure have been described. Due to the limited available literature on the management of the complications and implications of the hand transplant, the importance of each report on the procedure is paramount. A mid-arm allotransplant is a challenge in terms of expected motor recovery, and many controversies exist over the efficacy of the procedure altogether. Moreover, our case was complicated by a long ischemia time due to logistic reasons. We share our experience of a transhumeral upper limb allotransplantation, the complications associated with it along with the early postoperative results at 10 months follow up. [ABSTRACT FROM AUTHOR]

Chronic lower limb swelling is frequently encountered in clinical practice. Secondary lymphoedema and chronic venous insufficiency are two frequent causes of chronic lower limb swelling. The most common form of secondary lymphoedema worldwide is filariasis, due to Wuchereria bancrofti. Chronic inflammation and fibrosis are histological hallmarks of lymphoedema. Chronic venous insufficiency refers to venous dilation and venous reflux of long duration. The classical signs include minimal superficial dilation with associated skin changes and ulceration. Both the conditions mimic each other although the treatment is different. The diagnosis need to be confirmed prior to institution of treatment. We present below two cases of chronic lower limb swelling with a review of literature. [ABSTRACT FROM AUTHOR]

Background and objectives: There are no large volume comparative studies available to compare the efficacy of lasers over lights for hair removal in Fitzpatrick V and VI skin types. This study is designed to compare the efficacy of Nd:YAG laser versus IPL in the darker skin types.Study design/materials and methods: Thirty-nine patients included in Group-1 were treated with Nd:YAG and 31 in Group-2 with IPL. Both groups received 5 sessions of treatment. The hair counts were assessed using digital photography and manual counting method before and after treatment and the results were analysed. Patient satisfaction scores and pain scores were recorded in each session and compared.Results: Mean hair reduction in the IPL group was 25.70 and Nd:YAG group was 24.12 (95% CI). In the Nd:YAG group, 59% of subjects had burning sensation while the figure was 32.3% in IPL group. Burning was less in IPL group (p< 0.023). There were no statistically significant differences noticed regarding hyperpigmentation in both the groups (p< 0.115).Conclusion: Both Nd:YAG and IPL are equally effective for epilation of the darker skin types. Nd:YAG is associated with mild burning sensation in a significant number of patients. Patient satisfaction scores were comparable in both the groups. [ABSTRACT FROM AUTHOR]

Background: Graft fixation is important for graft take. Fibrin glue has been proposed as an ideal material, because of its human origin and it provides firm adhesion in seconds or minutes. Objective: To evaluate the efficiency of fibrin glue, in increasing the take of skin graft. Assessment includes surgical time taken for graft fixation, haematoma/seroma formation, engraftment and wound closure by day 14. Methods: The study is an observational prospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, from January 2016 to June 2016. Sixteen patients who underwent split skin grafting were assessed during the study period. Fibrin glue was used on the recipient bed before grafting. Results: Better haemostasis and graft adhesion, with a significant reduction of surgical time, were noted. Conclusion: The safety profile of fibrin glue was excellent as indicated by the lack of any related serious adverse experiences. These findings demonstrate that it is safe and effective for attachment of skin grafts, with outcomes at least as good as conventional methods. [ABSTRACT FROM AUTHOR]

Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction. [ABSTRACT FROM AUTHOR]

Objective: To study and discuss role of external tissue expansion and wound closure (ETEWC) technique using hooks and rubber bands. Materials and Methods: The present study is a retrospective analysis of nine cases of wounds of different aetiology where ETEWC technique was applied using hooks and rubber bands. Results: All the wounds in the study healed completely without split thickness skin graft (SSG) or flap. Conclusion: ETEWC technique using hooks and rubber bands is a cost-effective technique which can be used for wound closure without SSG or flap. [ABSTRACT FROM AUTHOR]

OBJECTIVE: SWCR guidelines for wound management are general guidelines which can be applied in various kinds of wounds. It is useful for all wound care providers dealing with wound management. This article highlights and audit the application of SWCR guidelines for wound management in a tertiary care centre. METHODS: This is a retrospective study of 18 patients from November 2013 to October 2014. The methodology followed was as given in the manual of ‘SWCR Guidelines For Wound Management’. All the patients were followed up for 6 months for recurrence or complications associated with wound healing ( hypertrophic scars, keloids, joint stiffness and contractures). RESULTS: The mean age was 37.27 years with male to female ratio of 5:1. The most common etiology was trauma. Most common site of wound was lower limb. Mean duration of wound was 5.05 weeks. Mean Bates Jansen Wound Assessment Score was 45.5. The maximum size of wound was 30 x 20 cm. The most common organism grown in tissue culture was pseudomonas (37.93%). The mean duration of wound bed preparation (WBP) was 2.11 weeks. Average duration of wound healing was 4 weeks. No complications were noted in 6 months follow up period. CONCLUSION: SWCR guidelines for wound management are general guidelines that may help wound care givers to apply to wounds of varied etiology. [ABSTRACT FROM AUTHOR]

Camphor is a waxy white sublimating chemical derived from natural as well as synthetic sources and widely used in various communities worldwide for a number of medicinal, culinary, and religious reasons. Camphor is burnt as an offering to God in many religious communities. We report three incidences of self inflicted injury from burning camphor on the palm resulting in full thickness burns. Non-suicidal self-injury is socially unacceptable destruction or alteration of body tissue when there is no suicidal intent or pervasive developmental disorder and we have explored an association between this and burn injury. This report also highlights the unique social and cultural pattern of this burn injury and the importance of psycho-therapeautic help for these victims. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To Study Role of Autologous Platelet Rich Plasma (APRP) in Wound Healing. METHODS: This is a retrospective analysis of 19 patients with 21 chronic non healing wounds of different etiologies where Autologous Platelet Rich Plasma (APRP) was used. Patients unfit for anesthesia or refusing for surgery were managed only with APRP (Group-1) and in remaining patients who were fit for anesthesia and willing for surgery, wound bed was prepared by APRP and then covered with Skin Graft or Flap (Group-2). RESULTS: In Group-1 all wounds (10 patients, 11 wounds) healed by APRP. In Group-2 (9 patients, 10 wounds), 6 wounds healed by APRP with Skin Graft and 4 wounds healed by APRP with flap cover. CONCLUSION: APRP helps in healing of chronic non healing wounds. Those patients who are not fit for anesthesia or refusing for surgery can be managed with APRP only. Patients who are fit for anesthesia and ready for surgery, APRP accelerates wound bed preparation for cover by graft or flap. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the use of urine collection bag as an alternative of custom-made plastic bag for Limited Access Dressing (LAD). METHODS: Over a period of 2 years from March 2011 to February 2013, a total of 36 pediatric limb and adult hand injury patients were treated with LAD using urine collection bag. Out of 36 cases 21 cases had initial exposure of bones. RESULTS: All wounds healed without need for flap cover. Twenty three cases were skin grafted to expedite wound coverage. CONCLUSION: LAD using urine collection bag is a simple and efficient method for treating pediatric limb and adult hand wounds. [ABSTRACT FROM AUTHOR]

Background: In past several years, traumas following road traffic accidents and other causes have increased, owing to an increase in mechanization and pace of life. These patients frequently have complicated injuries involving soft tissue and the craniofacial skeleton. Assessment of bony injuries and loss of portions of facial skeleton and their management has proved to be a challenge to the reconstructive surgeon. Aims: Primary bone grafting of craniofacial skeletal injuries provides an opportunity for one stage correction of bony defects. The varied spectrum of primary bone grafts for management of craniomaxillofacial injuries are evaluated in this study. Materials and Methods: Patients with a history of acute trauma resulting in facial skeletal injuries with or without bone loss were included in the study. Primary bone grafting was undertaken in situations requiring contour correction, replacement of skeletal losses and for rigid fixation of fracture segments. Olecranon, Iliac crest, ribs, Vascularized as well as nonvascularized outer table calvarial grafts and nonvascularized inner table calvarial grafts were used in this study. Results: Sixty two patients of craniomaxillofacial injury following trauma requiring primary bone grafting were considered in this study. Fifty seven percent of patients (n=32) required primary bone grafting for replacement of bone loss while bone grafting for contour correction was done in twenty three patients. The parietal calvaria overlying the non-dominant hemisphere was used as a source of bone graft in forty-nine patients. Nearly ninetytwo percent of the patients were satisfied with the results of primary bone grafting. Conclusions: Functional and aesthetic assessment of each of these patients, managed with primary bone grafting revealed a low rate of disabilities and high percentage of satisfaction in this study. [ABSTRACT FROM AUTHOR]

The article discusses the use of laser in lobuloplasty or torn ear lobe surgery. Topics covered include methods to control bleeding in ear lobule surgery, case of a 38-year-old female with bilateral torn ear lobule wherein diode laser was used in surgical repair, and advantages of diode laser for skin incision including sharp cutting edge which allows precise cut.

Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser . An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser . [ABSTRACT FROM AUTHOR]

Low level laser therapy (LLLT) has various clinical utilities including treatment of arthritis, wound management, liposuction, alopecia etc. Recently the concept of wound management is changing from operative treatment to non-operative newer methods like Low level laser therapy. The present study is a case report on the treatment of non-healing venous ulcer, where LLLT was used as an adjunct, which provided accelerated wound healing. In addition, the possible mechanisms of action of LLLT associated with wound healing processes are briefly discussed. [ABSTRACT FROM AUTHOR]

Bleeding is a common problem during escharectomy especially in debilitated burn patients. Even though we are traditionally using scalpel for skin incisions, incisions made using electromagnetic radiation of high frequency in the form of laser are considered to reduce losses during debridement; and are less time taking, less post-operative pain, produces more cosmetically accepted scar and has no ill effects on wound healing. However, experience with laser escharectomy in India is limited. A case of diode laser assisted escharectomy is reported to share our experience with readers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To study & discuss management of Warfarin Induced Tissue Necrosis. METHODS: A case of warfarin induced necrosis was managed with debridement, negative pressure wound therapy (NPWT), autologous platelet rich plasma (APRP), collagen granules, collagen sheet and external tissue expansion wound closure (ETEWC) Technique. RESULTS: Wound healed on adjuvant therapeutic measures in 8 weeks. CONCLUSION: In a case of warfarin induced necrosis if patient and/or wound are not fit for reconstruction/cover then adjuvant wound therapeutic measures help in wound healing. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis is one of the most debilitating and disfiguring scourges among all diseases. This report presents a case of a woman with recurrent breast nodularity after being previously operated for a suspected breast neoplasm. We would like to highlight the issue of similar clinical presentation of a filarial breast lump and other breast lesions leading to inappropriate therapy. [ABSTRACT FROM AUTHOR]