Search

Purpose: To compare the accuracy of unaided visual inspection (UVI) to Software App measurement (SAM) of penile curvature (PC) during hypospadias surgery. Methods: Seven clinical pictures of PC (15°–60°) taken during hypospadias repair were shared with 300 members of the Society of Pediatric Urology (India). The respondents were asked to assess the angles by UVI and indicate their preferred correction method of that PC. For each picture, the angles of curvature estimated by UVI were compared with the objective angle measured using an app (SAM), which was considered an accurate estimation. Statistical analysis was done using software; P30°, the error in UVI estimation was >10°, with no correlation between the accuracy of UVI estimate and surgeon experience. A significant proportion of surgeons chose the incorrect option for PC correction, which was the lowest (69%) for PC 35.8°. Conclusions: Most surgeons preferred UVI to assess PC; UVI is an erroneous technique to measure PC angle, especially in the PC range 30°–60°, where the error was >10°. Most errors were an underestimation of the PC, irrespective of surgeon experience. There was a significant error in the choice of technique for PC correction for a PC of 35°. These results strongly support the objective assessment of PC using SAM during hypospadias repair.

Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal, neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in these defects mandates the use of flap cover; paucity of local tissues necessitates the use of free skin flaps.

Introduction The axial vessels like the anterior and posterior tibial emerge as the first choice of recipient vessels, in free flaps for lower limb trauma. When the defects are located more proximally in the leg, the deeper course of the axial vessels makes the dissection more tedious. Alternative vessels like the descending genicular, medial genicular, and distal end of the descending branch of the lateral circumflex femoral can be used for an end-to-end anastomosis, well away from the zone of trauma. The objective of this study was to define the indications and technique of the use of the sural vessels as the recipient pedicle for proximal and middle third leg defects. Patients and Methods For the period 2006 to 2022, 18 leg defects following road traffic accidents were covered with latissimus dorsi muscle flap using sural vessels as the recipient pedicle. Results Among 18 patients, 8 patients had defect in proximal third, 8 had a combined defect in proximal and middle third leg, and 2 had defect in middle third leg. Two patients developed arterial thrombosis and one patient had venous thrombosis for which re-exploration was performed. Two flaps were lost and sixteen had successful wound coverage. Conclusion The sural vessels as recipient pedicle are easier to access and can be considered as a reliable option for free flaps in limb defects of proximal and middle third leg. Using the submuscular part of the vessel ensures a better distal reach of the flap.

Background Most flap failures in the lower limb are on account of venous congestion. Literature shows a decrease in the incidence of venous failure when two veins are anastomosed. The thoracodorsal pedicle of the latissimus dorsi free flap affords the possibility of a single venous anastomosis. The lack of a second venous outflow could result in venous congestion in the distal limits of the flap, particularly when long flaps are required for large defects or when the recipient veins are smaller in diameter. Methods We describe a consecutive series of 11 cases of latissimus dorsi flaps for leg and foot defects with a mean defect size of 310 cm2, where the serratus anterior vein was used as a second venous outflow channel to ensure maximal venous drainage. Results There were no re-explorations for anastomotic causes. Only one case had partial distal muscle necrosis. There was a delayed anastomotic blowout due to infection resulting in amputation in one case. There was no partial distal muscle necrosis in nine of the ten cases. Conclusion Using the serratus vein as a second venous outflow is of use in reducing incidence of venous occlusion and distal muscle necrosis and can be specially indicated for large flaps and venous diameter discrepancy.

A case series of five patients with skin loss in the lateral face with trismus that followed delayed presentation following trauma, necrotizing infection, and radiation fibrosis was treated with coronoidectomy and condylar excision to effect adequate mouth opening; the anterolateral thigh flap was used for cover and the fascia was used as an interposition graft to prevent recurrence. Two patients with more than 9 years of follow-up had an average of 40 mm interincisal opening.

Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.

Background: Selection of recipient vessels is one of the key factors for a successful microvascular reconstruction. Non-availability of primary recipient vessels in the vicinity necessitates surgeon to approach a remote second-line vascular access. Transverse cervical vessels (TCV) have been described as second-line vascular access for head-and-neck reconstructions. Due to its location, their use can be extended to the proximal chest and upper arm reconstructions. Aim: The aim of the study is to analyse the reliability of TCV as second-line recipient vessels for the upper arm and chest reconstructions in addition to the head-and-neck reconstructions. Materials and Methods: During 2010–2017, 14 TCV were explored as the choice of second-line recipient pedicle for specific indications. Clinical experience with different reconstructions discussed. Results: Out of 14 transverse cervical arteries, 13 were of adequate size for anastomosis. About 12 successful reconstructions were performed involving the head and neck (7), proximal thorax (3) and upper arm (2) for indications such as scarring from different aetiology (8), previous free flaps (2) and sacrificed vessels (2). In one case, the arterial anastomosis was shifted to superior thyroid artery. All the chest and upper arm reconstructions needed a realignment of the pedicle without any kink. Transverse cervical vein (TCv) could be used only 5/14 times either alone or along with external jugular vein (EJV). In other cases, EJV alone was used. All the 12 flaps survived without any vascular event. Conclusions: Transverse cervical vessels are reliable second-line recipient vessels in the head and neck; in addition, they are of use in the upper arm and proximal chest defects.

Traditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures. We report the role of free flaps in postburn facial reconstructions, excluding neck and scalp burns.