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Objective: To determine if systemic administration of low-molecular-weight heparin impacts venous compromise in loco-regional flap reconstruction for head and neck subsites. Methods: This prospective study was conducted on patients who had developed features of venous compromise of the flap. The case group received low-molecular-weight heparin (dalteparin). Results: Of the 73 patients who developed venous congestion, low-molecular-weight heparin was administered in 47 patients. In the low-molecular-weight heparin subset, 23 patients had either reversal or non-progression of venous compromise (48.9 per cent). Of the patients who had no response to low-molecular-weight heparin rescue, complete necrosis was seen in 4 and partial flap necrosis was observed in 19. The corresponding numbers in the control group were 13 and 12, respectively (odds ratio 23.9, p = 0.002). Additionally, the low-molecular-weight heparin arm had a lower incidence of partial or complete flap necrosis (p = 0.002). Conclusion: Low-molecular-weight heparin salvage, when instituted early, is likely to result in a significant reduction in flap-related morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Flaxseed is known for its anti-inflammatory and antioxidant properties, which could be attributed to periodontal wound healing. Early wound healing contributes to favourable treatment outcomes. Glutathione peroxidase is a ubiquitous antioxidant biomarker known for its scavenging action of free radicals, thereby maintaining the health of periodontal tissues. Aim: To evaluate the additive effect of brown flaxseed gel following surgical periodontal therapy. Materials and Methods: This randomised controlled trial was conducted at the Department of Periodontics, Saveetha Dental College in Chennai, Tamil Nadu, India from November 2023 to February 2024. Total of 30 patients were included in the study, with 15 patients in the control group and the other 15 patients (test group) were administered brown flaxseed gel following flap surgery. The included patients were allocated into test and control groups through simple randomisation. Postoperative flap surgery, the Early Healing Index (EHI), and healing scores were evaluated at the 1st and 2nd weeks. Salivary glutathione peroxidase levels were also assessed at the 1st and 2nd weeks following periodontal therapy. An Independent t-test was used to compare the mean values between the test group and the control group. Results: The mean age of the eligible participants was 35.6±4.57 years. Better healing was observed in the test group compared to the control group in the 1st postoperative week, as recorded by the EHI with a mean of 2.96±0.90 in the test group and 2.06±0.70 in the statistically significant control group. Salivary glutathione levels were significantly increased in the test group with a mean concentration of 14.1±.78 mu/mL and 10.5±0.42 mu/mL in the control group at the end of the 2nd week, respectively. Conclusion: Brown flaxseed gel is an efficacious therapeutic agent in improving periodontal wound healing and also has prudent antioxidant activity. [ABSTRACT FROM AUTHOR]

Background and Aim: Reconstruction of the eyelid is a surgical challenge, keeping in view both the cosmetic and functional importance of the eyelid. Here, we are describing our experience with the McGregor flap technique for the closure of full-thickness eyelid defects. Materials and Methods: This study was conducted prospectively from August 2015 to July 2018 in one of the tertiary care hospitals in North India. This study consisted of a total of 15 patients treated for eyelid defects following the excision of neoplastic disease of the lids. The final result of the reconstructive procedure was recorded at 6 months postoperatively. Results: Most of our patients were above the age of 50 (11 patients) and comprised predominantly females (9 patients). All the defects were reconstructed by the McGregor flap technique. We had excellent functional results in 13 (86.66%) patients, a good result in 1 (6.66%) patient, and an acceptable result in another (6.66%) patient. In terms of cosmesis, excellent results were found in 13 (86.66%) patients and acceptable in the remaining 2 (15.38%) patients. Conclusion: The McGregor flap for eyelid defect reconstruction is a reliable, good, and easy technique for reconstructing full-thickness eyelid defects involving up to 2/3rd of the horizontal length of eyelids. The technique can be successfully used for upper eyelid reconstruction with excellent functional and cosmetic results. [ABSTRACT FROM AUTHOR]

Mastectomy serves as the main surgical treatment for both invasive and in situ breast carcinoma and large phyllodes tumors. It is associated with skin necrosis, seroma, and surgical site infection in up to 30% of patients. In the present trial, we compared the complications in patients undergoing skin flap elevation by one of the 4 techniques: thick skin flap raised by scalpel(group1), thin skin flap raised with scalpel (group 2), thick skin flap raised with diathermy (group 3), and thin skin flap raised with diathermy (group 4). A randomized trial with superiority hypothesis and 2 × 2 factorial design was conducted at All India Institute of Medical Sciences New Delhi. Mastectomy skin flap necrosis (MSN) was recorded as the main outcome of interest. MSN was noted in 2.5% in group1, 10% in group 2, 7.5% in group 3, and 30% in group 4. MSN was observed in 5% cases with thick flap compared to 20% cases with a thin skin flap (p = 0.007). Raising the flap with scalpel was associated with MSN in 6.25% compared to 18.75% in the diathermy group (p = 0.029). We conclude that raising a thick flap with scalpel is associated with lowest risk of skin flap necrosis. Trial Registration: Clinical Trial Registry- India CTRI/2014/09/004978 [ABSTRACT FROM AUTHOR]

Introduction: A prospective randomized study was conducted to evaluate and compare the efficacy of conventional dressing, foam dressing, and vacuum-assisted closure (VAC) in the management of diabetic foot ulcers (DFUs). Material and methods: Ninety patients with DFU were included in the study conducted between 2018 and 2021 at a tertiary care center. Group 1 patients (n = 30) were treated with conventional dressing, group 2 patients (n = 30) with foam dressing, and group 3 patients (n = 30) with VAC dressing. The duration of treatment, number of debridement, need for the secondary procedure, cost of treatment, and duration of hospital stay were compared between the three groups. Results: There was a significant difference in the duration of treatment among the three groups with VAC being the least (group 1, 31.17 days; group 2, 24.13 days; group 3, 15.17 days). The mean number of debridement was also significantly less in the VAC group (2.37, 2.43, and 1.60, respectively). The need for the secondary procedure, like flap or skin graft, was also the least in the VAC group, although insignificant. The mean hospital stay of the study subjects was 31.17 days, 24.13 days, and 15.17 days in the 3 groups, respectively. The mean cost of the treatment was 3076.67 INR, 3717.33 INR, and 10,680 INR, respectively. Conclusion: VAC dressing is the best option amongst the available dressing modalities in terms of faster healing and a short hospital stay. Foam dressing does provide an economically viable option with better results than conventional dressing. [ABSTRACT FROM AUTHOR]

Purpose and background: To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage. Aims and objectives: To provide stable and sensate cover to small and moderate posterior heel defects. Materials and methods: This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35 years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5 cm in width and 5.5–7.5 cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13 months. Results: All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable. Conclusions: LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium. [ABSTRACT FROM AUTHOR]

Introduction: The goals of periodontal therapy include preventing illness, slowing or stopping disease development, replacing lost periodontal tissues, and preserving the therapeutic outcomes. The apical repositioning of the gingival edge during traditional periodontal surgery exposes the root surface to the oral cavity and reduces pocket depth. It may lead to attachment loss, Gingival Recession (GR). It is also commonly recognised that periodontal surgery causes pain and suffering. Laser assisted periodontal therapy has been the subject of study in an effort to address these drawbacks. Aim: To compare the efficacy of diode laser as an adjunct to Open Flap Debridement (OFD) with that of OFD alone in the management of chronic periodontitis patients. Materials and Methods: This randomised clinical trial with split mouth study design will be conducted in Periodontics Department at Sharad Pawar Dental College, Wardha, Maharashtra, India, for a duration of six months. Thirteen patients (26 quadrants) with generalised chronic periodontitis patients will be selected. The Probing Pocket Depth (PPD) ≥5 mm after phase I therapy will be included in this split mouth study. Diode laser (920 nm) will be used as an adjunct to OFD (test) as compared with conventional flap surgery (control). Clinical parameters like Plaque Index (PI), Papillary Bleeding Index (PBI), PPD, Relative Attachment Level (RAL) and Relative Gingival Marginal Level (RGML) and GR will be recorded at baseline and six months post-therapy. Visual Analogue Scale (VAS) will be used to determine patient discomfort intraoperatively and after one week. A questionnaire for patient-based outcomes will be administered after period of six months postsurgery and response will be recorded. Student's paired t-test will be used for comparing the treatment groups at baseline and six months. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to report the technical nuances of glans wings creation in anatomical plane facilitating liberal glans wings mobilization with preservation of glanular vessels for tension-free glansplasty in surgery of hypospadias in primary and redo cases. Materials and methods: Eighty-six primary hyposapdias and 7 cases of distal hypospadias, operated elsewhere and presented with glans and urethroplasty dehiscence, undergoing tubularized-incised-plate (TIP) repair were included after ethical approval. Technical points of glans wings creation in the subfascial plane included (i) creation of Buck's fascia window, just proximal and lateral to the point of bifurcation of corpus spongiosum, (ii) creation of subfascial- pret unica I plane on the tunica albuginea of corpora cavernosa up to ventral limit of laid open glanular meatus, (iii) release of pillars of corpus spongiosum off the glans base keeping the basal lamina propria covering the vascular arcade intact, (iv) release of glans base off the tip of corpora cavernosa and composite flap of corpus spongiosum pillars with Buck's fascia off the corpora cavernosa, (v) approximation of glans wings over the tubularized-inci sed-plate covered with dartos, and (vi) approximation of fasciospongioplasty flaps at hypospadiac meatus. Outcome measurement included (i) intra and postoperative problems and (ii) elimination of glans dehiscence. Results: There occurred 1 injury to the tunica albuginea of ventral corpora cavernosa and 1 button-hole injury to subcoronal mucosal collars. Flaps for fasciospongioplasty were short in 11. One glans dehiscence occurred in flat glans. Conclusions: This technique is effective in creating glans wings in the anatomical plane with the preservation of glanular vessels and flaps for fasciospongioplasty eliminating the possibility of glans dehiscence in both fresh and redo cases. [ABSTRACT FROM AUTHOR]

Introduction: Achieving regeneration of the lost periodontal structures after surgical approach plays a major role. This healing can be interrupted due to the presence of invasive bacteria which is present in the periodontal tissues. Aim: To compare laser-assisted and conventional flap surgery using microsurgical instruments and under surgical operating microscope with hydroxyapatite graft in the treatment of intrabony defects. Materials and Methods: This prospective randomised split-mouth clinical study was conducted in Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from June 2020 to December 2021. A total of 24 bilateral intrabony defects were selected for the study. Control sites (n=12) received the graft after conventional open flap debridement. In the test group (n=12), graft placement was done followed by laser irradiation with diode laser (980 nm, power: 3.0 W; frequency 2.5 KHz) for 30 seconds. The entire flap surgery procedure was performed under Surgical Operating Microscope (SOM). Clinical parameters such as plaque index, gingival index, probing depth, relative attachment level, were assessed at 3 months and 6 months. Healing index was assessed after 7 days of surgery. Radiographic parameters were assessed at baseline and 6 months using Cone Beam Computed Tomography (CBCT). Descriptive statistics, Independent samples t-test, repeated measures analysis of variance and Paired t-tests were used in data analysis. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software. Results: Intragroup comparison showed statistical significance in all clinical and radiographical parameters (p-value<0.001). Intergroup comparison between the test and control group did not show any statistical significance in terms of plaque index, gingival index, relative Clinical attachment level, probing depth (p-value≥0.05). Intragroup comparison of the depth of defect was statistically significant in both test (p-value=0.011) and control groups (p-values=0.002). Intergroup comparison did not show any statistical significance in linear bone fill (p-value=0.1). Intergroup comparison did not show any statistical significance in defect angle (p-value=0.773). No statistical significance was obtained in percentage fill (p-value=0.074). Intergroup comparison did not show any statistical significance in the clinical and radiographical parameters. Conclusion: The additional laser irradiation at the test site did not exhibit any significant benefits in the bone regeneration. All the outcomes were similar in test and control group. [ABSTRACT FROM AUTHOR]

Larger breast tumors that are unsuitable for breast conservation surgeries are common in the developing world and are usually treated with mastectomy. This report showcases our experience with the muscle-sparing latissimus dorsi (MSLD) flap for breast reconstruction after wide local excision or partial mastectomy. This is a retrospective review of patients undergoing breast reconstruction with MSLD flap after wide local excision between February 2016 and June 2018. The study of the aesthetic and functional outcomes was the primary objective and postoperative morbidity (pain, seroma, flap necrosis) as secondary objective. The aesthetic outcome was assessed individually by the patient and doctor as satisfactory, fair, good, and excellent. Donor site appearance was graded as satisfactory or unsatisfactory. Disability of the shoulder was assessed subjectively (limitation to perform activities involving overhead abduction at shoulder joint) and objectively by measuring the range of motion at shoulder joint. Ten patients (5 carcinoma, 5 phyllodes) were included. The mean tumor size at time of operation was 4.2 cm for breast cancer patients (assessable in 4 patients) and 6.5 cm (4–9.5 cm) for phyllodes. Skin island of flap had a mean size of 7.5 × 8 cm. Donor site was closed primarily. No donor site seroma was seen. Necrosis of flap margins occurred in one. The aesthetic outcome was good in two and excellent in eight; donor site was rated as satisfactory in all. No patient experienced disability of the shoulder on subjective assessment and objective assessment. MSLD flap offers a satisfactory aesthetic outcome with minimal functional arm compromise or donor site morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Hidradenitis Suppurativa (HS) is a chronic socially debilitating disorder of unknown aetiology. Surgical treatments include simple incision and drainage; excision followed by healing by secondary intention or split-skin grafting, and the more recent method of excision followed by local-flap reconstructions. In this study, the use of a lateral thoracic fasciocutaneous island flap based on vessels arising from the thoracodorsal or thoracic lateral vessels is described. Aim: To describe the benefit and outcomes of lateral thoracic flap reconstruction technique in treatment of axillary hidradenitis suppurativa. Materials and methods: This prospective interventional study was conducted at the Plastic Surgery Department at Amala Institute of Medical Sciences, Thrissur, Kerala, India (tertiary care center), from January 2017 to June 2018. The study included 36 patients with chronic axillary hidradenitis, who underwent lateral thoracic flap surgery on one or both axillae. These patients were studied closely preoperatively during surgery and during postoperative follow-up period. The basic demographic details, clinical parameters and Hurley stage; along with postoperative outcomes were recorded. Data was summarised using descriptive statistics. Results: The study sample consisted of 36 patients with a mean age of 38.33±13.11 years. There were 20 females and 16 males. Eleven patients were having co-morbidities in the form of type 2 diabetes mellitus or hypertension. The mean duration of illness was 3.17±1.44 years. Six patients had bilateral axilla involvement and underwent bilateral axillary reconstructions. Out of these 36 patients; 30 patients only had antibiotic treatment previously and five patients underwent excision of affected axillary skin previously without flaps; one patient was treatment naïve. Twenty four patients were Hurley stage 2 and 12 were stage 3. These patients were taken up for repair with a lateral thoracic flap. The mean postoperative hospitalisation was 6 days. There was no impairment of shoulder movement in the early or late postoperative period. There were no surgical complications in terms of vessel damage or flap viability. All flaps healed without complications and there was no recurrence of disease or scar contracture during the follow-up period. conclusion: Lateral thoracic flap reconstruction for axillary hidradenitis suppurativa is without doubt the strategy for treating axillary HS due to its lower recurrence rates. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of non-melanoma skin cancers (NMSCs) is increasing over the last few decades. This necessitates an early diagnosis which is nowadays aided by dermoscopy. Once diagnosed early, the treatment armamentarium is diverse and includes both topical and surgical modalities. Objective: Our aim was to diagnose pre-malignant and malignant NMSCs at an early stage and treat them as per the standard protocol. Materials and Materials: Out of 136 patients of pre-malignant and malignant tumors enrolled, 100 were taken up for treatment. These were then classified into various subtypes on the basis of clinical examination and dermoscopy. The selected patients were subjected to topical treatment or surgical modalities, wide local excision or flap excision, based on the type of tumor and its size. Results: The pre-malignant group included actinic keratoses, Bowen's disease, and keratoacanthoma, whereas the malignant group included undifferentiated squamous cell carcinoma (SCC), differentiated SCC, pigmented basal cell carcinoma (BCC), noduloulcerative BCC, and superficial BCC. Actinic keratoses, superficial BCCs, and five cases of keratoacanthoma were treated with topical therapies with a resolution of 90% in 86.8% cases. All the remaining cases (62 in number) were treated with conventional and flap surgery with 88% and 89.1% clearance rates, respectively, with complications in only 7 patients. Conclusion: A prompt identification of NMSCs can enable selection of the appropriate treatment modality for a specific lesion and thus reduce their associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Reconstruction of finger contractures is a challenge for the plastic surgeon. It is important to restore the length, function, along with providing a good quality skin cover (Sridhar and Hariharan in Int J Sci Stud 5(2):55-58, 2017). This study is aimed to show use of square flap in finger contractures along with determining its functional outcome. Three cases of finger contractures were reconstructed between May 2020 and December 2020 in a tertiary care hospital in north India. Departmental clearance was done. Written informed consent was taken. Results were analyzed as per successful reconstruction, type of reconstruction and stages, complications, and functional outcome. The surgical outcome has shown improvement in overall function. Square flap has proven to be a useful flap in post-burn/trauma finger reconstruction. [ABSTRACT FROM AUTHOR]

Breast cancer is rising among women in India. Most of the cases are presented at the locally advanced stage where axillary dissection is needed. In this article, we have described our approach of axillary dissection in the technically challenging high nodal burden axillas., (Celsius.)

The objective of this study was to clinically evaluate and compare the efficacy of the vestibular incision subperiosteal tunnel access (VISTA) technique using Bio-Gide (Geistlich) membrane enhanced with GEM 21S (Osteohealth) with periosteal pedicle graft (PPG) using a coronally advanced flap. Multiple gingival recession sites in 15 individuals were randomly assigned either to experimental site A (VISTA) or experimental site B (PPG) in a split-mouth design. The clinical parameters were recorded at baseline and 9 months postoperatively. Repeated measures analysis of variance with post hoc Bonferroni correction and paired t test were used to assess statistical significance (P < .05). Mean recession depth significantly decreased from 4.21 ± 1.08 mm (presurgery) to 0.61 ± 0.92 mm (9 months) with VISTA (87.37 ± 17.78% root coverage) and from 4.17 ± 1.18 mm (presurgery) to 1.16 ± 0.92 mm (9 months) with PPG (71.84 ± 19.25% root coverage). Width of keratinized tissue and clinical attachment gain were significantly higher in the VISTA group compared with the PPG group. Within the limits of the study both VISTA and PPG groups resulted in a significant amount of root coverage. The VISTA technique was less invasive and required minimal time and clinical maneuvering. It also resulted in a superior esthetic outcome. [ABSTRACT FROM AUTHOR]

We describe a pedicled latissimus dorsi myocutaneous (LDMC) flap with a wing-shaped skin paddle to cover large breast defects. It allows primary closure of the donor site with the added advantage of some flap projection. This is performed utilising the principles of M-plasty and the anatomy of thoracodorsal musculocutaneous perforators, which would not be possible with the conventional flap design. Analysis of a series of 23 patients who underwent breast reconstruction using wing shaped skin component LDMC technique between 2011 and 2019 in a breast unit of a Tertiary Care Hospital is presented here. Patient characteristics, technical details, and outcomes were analysed. Mean patient age was 41 (SD 10.9) years. The mean defect dimensions were 13.5 (SD 3.4) cm and 10.5 (SD 2.6) cm in length and width, respectively. The mean flap area was 147 (SD 67.2 cm2).The donor site defect was closed primarily in all the cases. The average length of inhospital stay was 4.9 (SD 1.5) days (range 3–9 days). One patient (4.3%) had marginal necrosis of the flap, three patients (13%) had donor site seroma, and two patients (8.7%) suffered donor site wound dehiscence. None of the complications entailed re-surgery or delay the onset of adjuvant therapy. At a mean follow-up of 37.5 (SD 33.9) months, none of the patients reported tumour recurrence or donor site morbidity. Wing-shaped skin component of latissimus dorsi myocutaneous flap offers a simple and reliable pedicled flap to cover large breast defects with minimal donor site morbidity. It creates a mild breast mound and may avoid the use of implants and its associated complications in small-breasted patients. It can be conveniently performed in non-microsurgical setups. [ABSTRACT FROM AUTHOR]

Introduction: Tissue defects of heel require resurfacing by flaps that could bear a great proportion of body weight and assist in pain free locomotion with minimum morbidity. The distally based sural flaps, also known as reverse sural flaps, have found widespread applications including reconstruction of the weight bearing heel. The durability of the reverse sural flap and its ease of resurfacing peculiar contour of the heel have encouraged its use. The evaluation of the functional aspect of this flap with regards to the pain, ulceration and ambulation is vital to establish and authenticate its use in heel reconstruction. American Orthopaedic Foot and Ankle Society (AOFAS) clinical ratings scale is one of the assessment schemes to this end. Aim: To evaluate the usefulness and versatility of reverse sural flap in reconstruction of heel as well as assessment of functional outcome of foot using AOFAS scoring system. Materials and Methods: In this prospective study, carried out in the Department of Plastic Surgery in eastern Uttar Pradesh, India, 15 patients with soft tissue defects of the weight bearing heel were found to fulfil the inclusion criteria. Reconstruction was carried out using reverse sural flap and its surgical planning as operative details were discussed. AOFAS scale was used to measure functional outcome of the reconstructed heel. Results: Average age was 38.33±13.48 years and they presented earlier than 72 days. The dimensions of the reverse sural flap were 147.46±20.87 cm2 to resurface heel defects of 57.75±17.08 cm2. The largest defect was 13 cm long and 7 cm wide. Three flaps demonstrated distal necrosis as the length: width ratio was more than the well described safe limit of 3:1. They were 19-22 cm long while the width was narrowed to 5-7 cm at the base resulting in unfavourable dimensions and consequent necrosis. Other complications were persistent discharge and ulceration. AOFAS rating had a maximum score of 60, the average score being 50.2±7.39 (31-58). Conclusion: The AOFAS clinical rating is a reliable and valid quantitative tool which is used for evaluating functional outcome in patients with reconstruction of weight bearing heel. Reconstruction of such challenging defects by the distally based sural flap proves its versatility and relialibity. At the same time, the surgical technique of flap harvest is safe, of short duration and provides alternative to microsurgical reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Large abdominal wall hernias often require techniques for wall expansion to improve surgical outcomes. The peritoneal flap hernioplasty (PF) is one such technique that utilizes the hernia sac to reconstruct the abdominal wall, however, with limited published data. It is a modification of the Rives-Stoppa mesh repair where a part of the bisected hernia sac is utilized to reconstruct the anterior fascia and the other part for the posterior fascia. We present a collated retrospective analysis of the outcomes from three centers performing PF with or without transverse abdominis release (TAR) in patients with complex ventral hernias., Methods: The PF was performed in patients with incisional hernias, both midline and lateral. The primary outcome measured was hernia recurrence. The secondary outcomes were to evaluate pain, surgical site infection, seroma, hematoma, wound dehiscence, pseudo-recurrence, Clavien-Dindo score for complications, and the patient's reported quality of life. The quality of life was assessed by oral questionnaires in the follow-up period., Results: We analyzed 63 patients (38 female, 25 male) with a mean width of hernia defect of 11 cm SD 4. Based on the European Hernia Society (EHS) classification 42 patients were W3 and 21 were W2 hernias. Fifty patients had a midline hernia, while the rest of the patients included transverse, subcostal, and rooftop incision hernias. The classical peritoneal flap procedure was done in 29 (46%) patients, while the peritoneal flap with TAR was done in 34 (54%) patients. Four patients had symptomatic seroma (6%), seven superficial surgical site infection (SSI) (11%), one deep SSI (1.5%), one skin necrosis (1.5%), and one anterior peritoneal flap necrosis (1.5%). No patient required postoperative ventilatory support. The mean pain score on day one was 3/10. There was no recurrence in the mean follow-up of 17 months (range 5 to 49 months). Overall, 58 of 63 (92%) patients reported being satisfied with their surgery., Conclusion: In our multicentre study, we found the PF technique with or without TAR for midline and non-midline ventral hernia leads to satisfactory outcomes in terms of low recurrence, low rate of complications, and a good quality of life in the medium to long term. It appears to be a useful technique in the surgeon's armamentarium to repair W2 and W3 hernias needing expansion of abdominal domain., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Gingival recession remains an important problem in dental esthetics. Various surgical techniques have been proposed for treating multiple gingival recessions. The objective of this study was to evaluate and compare the effectiveness of a coronally positioned flap (CPF) with or without acellular dermal matrix allograft (ADMA) in the treatment of multiple marginal tissue recession. Twenty patients with a mean age of 31.6 years presented with 43 buccal/labial multiple recession defects (Miller Class I/II). Ten patients each were randomly assigned to one of two treatment groups: group 1 (ADMA) or group 2 (CPF). The clinical parameters gingival recession (GR), probing pocket depth (PD), clinical attachment level (CAL), and width of the keratinized gingiva (KG) were recorded before surgery and 6 month postsurgery. The mean baseline recession defect was 3.0 mm for group 1 and 2.8 mm for group 2. After 6 months, both treatments resulted in significant root coverage (P < .01), reaching an average of 2.7 mm (90%) in group 1 and 1.8 mm (66%) in group 2. The difference in recession reduction between treatments was statistically significant. There were no statistically significant differences between the treatments in PD and KG. CAL gain (3.0 mm) was significantly higher in group 1 compared with group 2 (2.0 mm). The results of this study demonstrate that ADMA with a CPF is an effective procedure for the treatment of multiple gingival recessions. [ABSTRACT FROM AUTHOR]

Background: Open traumatic tendoachilles injuries due to toilet seats are least reported. The exact mechanism of such injuries is debatable. None of the studies have reported associated neurovascular injuries and the need for microvascular tissue transfer.Methods: It is a 5-year prospective observational study from Sep 2013 - Aug 2018 at a tertiary care center on 26 patients who had sustained foot injuries due to squatting type toilet seats. All the patients were managed by thorough wound irrigation and debridement followed by repair of cut tendoachilles, other tendons and neurovascular structures. All the complications and secondary procedures required were recorded. Functional outcome was assessed by Boyden clinical outcome score. Follow up ranged from 1 to 5 years.Results: All the 26 patients reported a particular mechanism of injury. Complete transection of tendoachilles was seen in 23 (88.5%) patients and partial transection in three (11.5%) patients. Microvascular repair of cut posterior tibial artery was undertaken in three and posterior tibial nerve in two cases and microvascular parascapular flap in one case for soft tissue reconstruction. Twenty-three (88.5%) patients had good to excellent Boyden score while three patients (11.5%) had fair to poor score at 1 year. Such severe injuries due to toilet seats have never been reported in literature.Conclusions: Squatting toilet seats can cause devastating foot injuries involving tendons and neurovascular structures and may require microvascular tissue transfer for definitive wound management. The risk of such injuries will continue unless some modifications are undertaken in the design of the seat. [ABSTRACT FROM AUTHOR]

Avascular necrosis (AVN) of the femoral head is a progressive disease that generally affects patients in the second through fifth decades of life; if left untreated, it leads to complete deterioration of the hip joint. Treatments range from simple decompression of the femoral head, to muscle pedicle bone grafting of the involved area, or by using a vascularized fibular graft with varying degree of success. If the disease have progresses further causing secondary arthritis, Total Hip Arthroplasty may be necessary. We present a study of management of 60 young patients aged less than 50 years having either early stage AVN (stage I and II A/B of Ficat & Arlet classification) or Neck of the femur fractures, treated with quadratus femoris muscle pedicle bone grafting & cancellous screws. With aim To evaluate the results of the above modality in the management of AVN of the hip & neck femur fractures and to study the radiological & functional outcome of the procedure in young patients. [ABSTRACT FROM AUTHOR]

Objectives: Hydroxyapatite, tricalcium phosphate, and bioactive glass are the most commonly studied alloplastic materials in periodontal regeneration. These materials have been tested alone and in combination with one another, but evaluation using all three materials in one defect has not yet been attempted. Although posttreatment histologic evaluation or reentry procedures are ideal for objectively assessing regeneration, computed tomography (CT) has become one more technique in clinicians' armories to judge the effectiveness of any such interventions. Hence, the present study was undertaken to clinically ascertain the healing of intrabony defects following treatment with a composite alloplast and complement the study with volumetric assessment using CT. Method and Materials: Twenty defects in 10 patients were treated either with open flap debridement or open flap debridement and bone graft implantation in a split-mouth study design. Clinical parameters including probing depth, clinical attachment level (CAL), and gingival margin level were recorded at baseline and at 6 months postsurgery. Plaque Index and Gingival Index were measured at baseline, 3 months, and 6 months. Hard tissue measurements were recorded using a high-resolution spiral CT scan. Results: A statistically significant (P < .05) improvement in all parameters (namely probing depth, CAL, percentage defect fill, and linear bone growth) was observed in both groups of patients. However, the test group showed better clinical and radiographic outcomes when compared to the control group (P < .05). Conclusion: The new composite alloplast resulted in better treatment outcomes than open flap debridement alone. Moreover, the use of CT scan in ascertaining the various defect parameters in periodontal treatment of intrabony defects appears promising. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of β-tricalcium phosphate (β-TCP) (Synthograft, Bicon USA) in periodontal osseous defects in comparison to open flap debridement (OFD). Method and Materials: Twelve patients showing clinical and radiographic evidence of almost identical bilateral infrabony defects were selected. The infrabony defects in the 12 patients were treated with OFD+β-TCP on one side and OFD on the other side. Clinical evaluation was performed at baseline and 6 months following therapy. Results: No differences in probing depth (PD) reduction or clinical attachment level (CAL) gain were observed, although a statistically significant difference was observed for the defect fill between the two groups. Six months after therapy, sites treated with OFD+β-TCP showed a reduction in mean PD from 9.67 ± 2.35 mm to 4.00 ± 1.60 mm (P < .05), a change in mean CAL from 9.92 ± 3.15 mm to 5.00 ± 3.86 mm (P < .05), and the mean defect fill was 2.92 ± 0.90 mm. In the sites treated with only OFD, the mean PD was reduced from 7.58 ± 1.08 mm to 2.67 ± 0.65 mm (P < .05), the mean CAL changed from 6.83 ± 1.34 mm to 1.83 ± 1.64 mm (P < .05), and the mean defect fill was 0.83 ± 0.39 mm. Reduction of 5 mm in PD was observed in 5 of the 12 defects (42%); 4 of the 12 defects (33%) gained 3 mm of CAL in the test sites. PD reductions and CAL gains of 3 to 6 mm were measured in the majority of the cases (60% to 75%) regardless of treatment modality. Conclusion: Within the constraints of this study, both therapies resulted in significant PD reductions and CAL gains 6 months after surgery. Sites treated with OFD+β-TCP showed a significant defect fill compared to those treated with OFD alone. [ABSTRACT FROM AUTHOR]

Objective: Assessment of results of repairing vesicovaginal fistula (VVF) with or without the use of interposition flaps. Material and methods: This prospective randomized study was conducted between January 2012 to December 2017 in the Department of Urology, King George's Medical University, Lucknow, India. Obstetric and gynecological simple fistula of ≤4 cm were included for evaluation. Those with complex or complicated fistula or fistula due to malignancy were excluded. Patients were divided into two groups (group 1 and group 2) depending upon route of repair i.e., transvaginal or transabdominal, respectively, as per the characteristics and location of the fistula. These two groups of patients were randomized into two subgroups (1A, 1B and 2A, 2B) based on the inclusion or omission of the interposition flap during fistula repair. Perioperative and postoperative parameters (blood loss, mean operating time, hospital stay, and requirement of analgesics) and success rates of fistula repair were compared. All complications that occurred in the postoperative period till the last follow-up appointment were recorded. The Clavien-Dindo Classification was used to stratify the complications. Results: Fifty-seven patients underwent transvaginal repair in group 1 (29 with Martius flap: group 1A; 28 without Martius flap: group 1B), while 69 patients underwent transabdominal repair in group 2 (35 with interposition flap: group 2A; 34 without flap: group 2B). Blood loss, mean operating time, hospital stay, and the requirement of analgesics were comparable between each subgroup-1A versus 1B and 2A versus 2B, respectively. The overall success rate of repair across all groups was 96.04% (121/126). The success rate was 93.1% in transvaginal repair with Martius flap versus 96.43% in transvaginal repair with no flap (p=1.0). Success rate was 97.1% in transabdominal repair with an omental flap versus 97.06% in without an omental flap (p=1.0). Mean follow-up period was 39.6 months (range: 6-68 months). Out of 29 patients with Martius flap interposition, 9 (31.03%) of them reported a significantly reduced sensation on the labia majora. Of these 9 patients, 5 reported numbness while the remaining 4 experienced pain as compared to the patients in subgroup IB, who did not report any altered sensation in the labia. (p=0.0019). Conclusion: The success rates are similar in simple VVF repair (fistula size less than 4 cm) irrespective of the use of interposition flaps. However, overall morbidities following repair with the interposition flap are higher when compared with repair without interposition flap, either by the transvaginal or by the transabdominal route. [ABSTRACT FROM AUTHOR]

Tracheocutaneous fistulas present secondary to homicide, suicide, and accidents. Most of the times, they can be repaired primarily, with secondary reconstruction required in complex cases. Such reconstructions can be performed using pedicled flaps without much difficulty. Any surgeon, without the need of microsurgical expertise or special instrumentation, can perform such reconstruction. Three patients presented to the department following homicidal cutthroat injuries, with trachea-cutaneous fistula. Two patients were managed with pectoralis major musculocutaneous flaps and one was managed with sternocleidomastoid flap. All patients attained good wound healing and fistula closure. The two skin paddles provided lining and cover, and the intervening muscle provided an additional waterproofing. These flaps are a reliable method of reconstructing such defects. [ABSTRACT FROM AUTHOR]

The article focuses on a new procedure offered by neurosurgeons at Chennai's Kilpauk Medical College Hospital in India where a custom-made three dimensional-printed titanium flap is used to patch the missing portion of the skull in patients who undergo brain surgery.

Background: Pterygium is an ocular surface disorder with prevalence rates ranges from 0.3% to 29% in different parts of the world. Vascular endothelial growth factor (VEGF) has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva. Bevacizumab is a recombinant, humanized anti-VEGF antibody suggested as a possible adjunctive therapy for pterygium excision that appears to have a role in prevention of recurrence. We conducted this study to evaluate the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients.Methods: In this randomized prospective clinical study, the patients were randomized into two groups of 30 patients each. Study group received 1.25 mg/0.05 ml subconjunctival bevacizumab 1 week before pterygium surgery with conjunctival autograft. Control group received 1.25 mg (0.05 ml) subconjunctival normal saline 1 week prior to pterygium surgery with conjunctival autograft. Patients were followed up at day 1, day 7, 1 month and 3 months. The main outcome measures were morphology of pterygium after injection, intra-operative ease, recurrence of pterygia, and any complications.Results: After giving bevacizumab, there was statistically significant improvement in grade, color intensity, size of pterygium, and symptoms of patients. Intra-operatively, less bleeding was observed by the surgeon. No statistically significant difference regarding reduction in astigmatism, improvement of visual acuity, and complications were observed in two groups. Recurrence was noted in five patients (8.33%) in total study population at the end of 3 months. It was present in two patients (6.67%) in Group A and three patients (10%) in Group B.Conclusion: Single preoperative administration of subconjunctival injection bevacizumab given 1 week before the pterygium excision with conjunctival autograft decreases the vascularity of newly formed blood vessels, hence may decrease recurrence rate though not in our study. [ABSTRACT FROM AUTHOR]

Objective: Agricultural hand injuries occur mainly among young adults, many affecting the dominant hand, thereby impeding patients' ability to work or cope with social obligations. This study was carried out with the aim of collecting data on the epidemiology and management of agricultural hand injuries in Indian subjects. Method: The study was conducted in the Department of Plastic and Reconstructive Surgery, JN Medical College, AMU, Aligarh, India, from October 2009 to December 2013. Patients with agricultural hand injuries were included. Data collected included socio-demographic details, mode and type of injury, type of reconstruction, complications, length of hospital stay and assessment of post-reconstruction status. These data were tabulated and analysed. Results: The typical patient was young (mean 33.2 years), of lower socio-economic status and with a total disregard for safety regulations. There is clustering of cases during the wheat harvest season (April-June). Wheat thresher injuries were the most common cause of partial hand amputation (51%), especially during this season. This was followed by fodder cutting (kutti/chara) machine injury, especially in females and children (36%). A simple classification for these injuries has been described and Grade II injury was the commonest. Reverse radial forearm lap was the most suitable regional lap for coverage, whereas thoraco-umbilical lap was the most commonly used distant lap. Patients who had the single-stage procedure had a significantly shorter stay. Conclusion: Agricultural hand injuries are not totally avoidable and their incidence can be reduced by proper education, but the low economic and literacy status of the patients is a big hurdle. The forearm offers many laps for reconstruction of hand, which can be used in defects on dorsal or palmar aspect of hand and results in early discharge from the hospital and early rehabilitation. In patients with associated injury to the forearm, abdominal laps can be used for cover . Declaration of interest: None declared. [ABSTRACT FROM AUTHOR]

Even if human beings are the most intelligent among all living beings, they are still not immune to attack from wild animals. Human contact with bears has become more frequent as their habitat is being endangered by frequent deforestation. The sloth bear is one of the few bear species found in India, especially in the hilly areas of Southern Odisha. Bears are highly intelligent and omnivorous animals with long claws coupled with powerful shoulder. Here, we describe the tale of a poor tribal male's encounter with a sloth bear resulting in critical injuries to face, scalp, skull bone, with brain matter fungating-out of the skull. We immediately went for debridement of the, bulged-out contused brain matter and opted for delayed repair of scalp defect with antero-lateral thigh free-flap to save him from fatality along with an acceptable cosmetic repair of the defect. [ABSTRACT FROM AUTHOR]

Objective: To study the feasibility and reliability of the superior gluteal artery perforator (SGAP) flap for the reconstruction of sacral pressure ulcers. Method: A prospective study was conducted between 2009 and 2012 where a total of 15 patients with sacral pressure ulcers underwent reconstructive surgery with an is landed pedicled SGAP flap.Success of the flap reconstruction and primary healing were defined as a healed wound within 30 days of the procedure. Reconstructive failure was defined as those cases that resulted in a non-healed wound,thereafter. Results: Of the 15 patients in the evaluation, 12 were male and 3 were female. Eleven patients were paraplegic, 3 were ambulatory and one was quadriplegic. All reconstructed flaps survived completely with no mortality or major donor site complications. Three patients had a minor infection and wound dehiscence that healed spontaneously. All wounds healed within 30 days of surgery following local wound care and culture-sensitive antibiotics. No recurrence of the pressure ulcer occurred during follow-up. The non-paraplegic patients did not develop gait disturbances following the surgery. Conclusion: These observations suggest that the is landed pedicled SGAP fasciocutaneous flap is a relatively easy flap to raise, with good reliability and minimal complications, and is therefore highly recommended for the reconstruction of the sacral pressure ulcer. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Objective: Palatal fistulas are not uncommon after palatoplasty. Although there are currently many techniques that can be used to close large palatal fistulae, most of these procedures are usually cumbersome and mostly unreliable with high recurrence rates. The facial artery musculomucosal (FAMM) flap was described to circumvent these problems. The purpose of this study was to review our experience with the FAMM flap to reconstruct palatal fistulas, most of them being recurrent. Materials and Methods: A retrospective analysis was done of 11 FAMM flaps performed between January 2007 and March 2012. Results: There were no major complications. Venous congestion was seen in two cases. Two flaps developed terminal marginal necrosis. One patient had suture line dehiscence. There were no recurrences of the fistula after repair. All patients had a satisfactory closure of the fistula. Conclusion: FAMM flap is a reliable and versatile flap that provides like with the like tissue and is a good option for closure of recurrent wide palatal fistulae. [ABSTRACT FROM AUTHOR]

Objective: To highlight the role of fasciocutaneous flaps in the management of leg and foot defects sustained after trauma, in rural India. Method: This was a prospective study conducted on patients with traumatic defects of the leg and foot, admitted between May 2001 and April 2007. Selection of flaps was done on the basis of defect size, site and condition of surrounding tissue. Ipsilateral flaps (proximally- and distally-based), contralateral-leg flaps and free flaps (anterolateral thigh and radial forearm) were raised according to standard techniques and wounds resurfaced accordingly. The outcome was considered 'excellent' when there was no flap necrosis and no donor site morbidity, 'good' when there was some infection, either at the donor or recipient site, but no necrosis, 'satisfactory' when partial flap necrosis and 'poor' when there was flap loss. Results: One-hundred and ten patients (86 males and 24 females) with post-traumatic leg defects underwent reconstruction with different fasciocutaneous flaps. The ages of the patients ranged from 6 years to 58 years, with a mean age of 28.2 ± 11.5 years. Forty cases (37%) underwent immediate reconstruction within the first 72 hours and in 70 cases (63%) delayed reconstruction was done. Hospital stay of the patients ranged from 8 days to 54 days, with a mean of 20.2 ± 1.9 days. There were no complications recorded at donor site. The overall results were considered excellent in 92 cases (84%), good in 12 (11%), satisfactory in four (3.6%) and poor in two cases (1.8%), where flap necrosis occurred. Conclusion: Our results suggest fasciocutaneous flaps are convenient, simple, reliable and easy to manage. The majority of compound leg defects can be reconstructed with fasciocutaneous flaps either from the ipsilateral leg, contralateral leg or in the form of free flaps. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Background: Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover. We reviewed the results of the local flaps of lower limb, done by orthopedic surgeons. Materials and Methods: We retrospectively reviewed the results of the lower limb flaps done between January 2005 and December 2006. All flaps done at and below the level of knee were included. Results: There were 105 patients with 120 flaps during this period. Two patients with two flaps were lost to follow-up. The average age was 32 years. Sixty-four patients had Type IIIB Gustilo and Anderson injuries. Thirty-nine patients had isolated soft tissue injuries. The indications for flaps were exposed bone, tendon, and joint in 45, 11, and 12, respectively, or a combination in 35 patients. The flaps done were 51 reverse sural artery, 35 gastrocnemius, 25 local fasciocutaneous, and seven foot flaps. The flap dimensions ranged from 2 × 2 to 30 × 15 cm. Ninety-three flaps (79%) healed primarily. Among 25 flaps (21%) with necrosis, 14 flaps required secondary split skin graft for healing, while the other nine flaps healed without further surgery. Conclusion: Appropriate soft tissue cover provided by orthopedic surgeons can help in providing independent, composite care of lower limb injuries. [ABSTRACT FROM AUTHOR]

Introduction: Treatment of panurethral stricture is considered a surgical challenge. We searched the literature to present a comprehensive review. Materials and Methods: A review of literature was performed using MEDLINE/PubMed database using terms "urethral stricture" and "urethroplasty." Only articles published between 1990 and 2009 and written in English language were included in the review. Results: The main causes of panurethral strictures are previous catheterization, urethral surgery, and lichen sclerosus. The treatment of each individual case has to be tailored according to the etiology, history of previous urethral surgeries, availability of local tissues for flap harvesting, availability of appropriate donor tissue, and the expertise of the treating surgeon. In patients with complicated strictures, previously failed urethroplasties and in patients with poor quality of urethral plate two-stage surgery is a better option. In all other situations, either a flap or graft urethroplasty or if adequate tissue is not available then combination of flap and graft gives reasonable success rates. Conclusions: Panurethral strictures are relatively less common. For successful results, the surgeon should be experienced and should be familiar with all the treatment modalities. [ABSTRACT FROM AUTHOR]

Objective: Management of distal anterior urethral stricture is a common problem faced by practicing urologists. Literature on urethral stricture mainly pertains to bulbar urethral stricture and pelvic fracture urethral distraction defect. The present article aims to review the management of the strictures of fossa navicularis and pendulous urethra. Materials and Methods: The literature in English language was searched from the National Library of Medicine database, using the appropriate key words for the period 1985-2010. Out of 475 articles, 115 were selected for the review based on their relevance to the topic. Results: Etiology of stricture is shifting from infective to in inflammatory and iatrogenic causes. Stricture of fossa navicularis is most often caused by lichen sclerosus et atrophicus and instrumentation. Direct visual internal urethrotomy is limited to selected cases in the management of pendulous urethral stricture. With experience and identification of various prognostic factors, conservative management by dilatation and internal urethrotomy is being replaced by various reconstructive procedures, using skin flaps and grafts with high success rates. Single-stage urethroplasty is preferred over the 2-stage procedure as the latter disfigures the penis and poses sexual problems temporarily. Conclusions: Flaps or grafts are useful for single-stage reconstruction of fossa navicularis and pendulous urethral strictures. The buccal and lingual mucosa serves as a preferred resource material for providing the inner lining of the urethra. Off-the-shelf materials, such as acellular collagen matrix, are promising. [ABSTRACT FROM AUTHOR]

Background. The forehead flap for nasal reconstruction was first described in India and has been the cornerstone for nasal coverage of wide defects. More recently, this forehead flap for nasal reconstruction has been through a great variety of modifications and can be done as a single, two or three-stage procedure. Nasal reconstruction requires a critical analysis of the involved tissues, a thorough anatomical and surgical knowledge from the plastic surgeon, to be able to offer a better esthetic result. The aim of this paper is to describe an alternative of the forehead flap for a single-stage nasal reconstruction to cover a wide nasal defect. Conventional technique. The forehead flap is a composite flap consisting of skin, subcutaneous tissue, frontalis muscle and a thin layer of areolar connective tissue. The flap is harvested by dissecting the paramedian pedicle based on the supratrochlear vessels, which are located superficial to the periosteum and exit the medial superior orbital rim then travelling vertically along the muscle. The forehead flap is elevated and transferred as an island in a single-stage procedure, restoring the esthetic subunits of dorsum and lateral sidewall. Clinical case. We describe the case of a patient to whom wide resection of a basocellular carcinoma in the nasal dorsum was performed in the Instituto Nacional de Cancerologia. We performed immediate reconstruction with a single-stage forehead flap, achieving adequate functional and esthetic results. Conclusions. Nasal reconstruction can be performed with a single-stage procedure using the forehead flap achieving adequate functional and esthetic results. [ABSTRACT FROM AUTHOR]

Summary: Fireworks are used worldwide to celebrate popular events (e.g. festivals, official celebrations, weddings). The festival of lights (Diwali) is celebrated with fireworks in India. During this period, many patients from all age groups present to hospital with injuries due to fireworks. Prevalence, period of occurrence, sex and age variation, adult supervision, causative fireworks, mode of lighting, age groups prone to injury, patterns of injury caused by individual fireworks, and the body parts injured were studied. One hundred and fifty-seven cases (92 retrospective, 65 prospective) with injury due to fireworks presenting to the Department of Plastic Surgery at KEM Hospital between 1997 and 2006 were studied. The prevalence of injuries has decreased steadily over the last 10 years (41 cases in 1997, 3 cases in 2006). The maximum number of injuries (35%) was seen in the age group 5–14 years; 92% of these children were unsupervised. The commonest cause of injury was firework misuse (41% of cases), followed by device failure (35%). Device failure was commonest with flares/fountains (ground firework emitting sparks upwards) and aerial devices. Flare/fountains caused most injury (39%), sparklers the least (0.6%). Flare/fountains, ground spinners, sparklers, and gunpowder (explosive material from cracker, obtained by tearing paper wrapper and obtaining chemicals) caused only soft tissue burns; stringbombs (high-intensity fire cracker made by wrapping chemicals with jute strings/coir in layers) and rockets (aerial device that zooms upwards and bursts) caused blast injuries, leading to soft tissue disruption and bony injuries. Emergency surgery was done if indicated: tendon and/or neurovascular repair, fracture fixation, flap cover or amputation. Superficial burns were treated with dressings. Certain wounds needed only thorough cleansing of the wound and primary suturing. We concluded that, over a 10-year period, the prevalence of firework injury decreased due to increased awareness in the community. Aggressive awareness campaigns by government and non-government organisations was the cause. We can minimise the number and severity of accidents by raising awareness regarding safety precautions, encouraging professional displays and motivating manufacturers to adhere to strict quality control. [Copyright &y& Elsevier]

Summary: The submental artery island flap (SIF) is gaining acceptance as a simple and reliable option in selected oral oncologic reconstructions. The present study aims to assess the usefulness of submental artery flap in oral reconstruction with respect to flap reliability, cosmesis, function, donor site morbidity and oncological safety. Thirty (30) patients who underwent ablative surgery and reconstruction using the submental artery island flap for oral cancer at Regional Cancer Centre, Trivandrum, India, between October 2004 and December 2006 were prospectively studied for the flap viability, cosmesis, function (speech and swallowing) and locoregional recurrence. The site and stage of the tumour, type of resection, management of the neck and the technique of flap transfer were recorded and the patients were followed up to assess the status of the flap and its donor site and the oncologic outcomes. There were 19 men and 11 women, ages of whom ranged from 30 years to 78 years with a mean±SD of 53±11 years. With the exception of one patient who had undergone neck dissection as part of a previous surgery, all patients underwent neck dissection or at least a level I clearance along with the wide excision of the primary lesion. The follow up period ranged from 4 to 25 months with a median of 13.5 months. Six patients either recurred locoregionally or had metachronous second primary constituting an over all recurrence rate of 20%. The size of the skin paddle ranged from 3×3cm to 7×6cm, with a mean size of 4.9×4cm. One total and one partial flap loss were observed. One patient had intractable hair growth on the flap even 3 months after surgery. Donor site healing was excellent in all cases and the donor site scar was well hidden. The long term cosmesis and functions were good in all the patients. The submental artery island flap is a simple and reliable option for oral cancer reconstruction in carefully selected cases, with acceptable cosmetic and functional results and reasonable oncological safety. [Copyright &y& Elsevier]

The article presents an analysis of 27 cases of injuries of the lower limb with tissue-loss, which were admitted to the Plastic surgery unit of the Institute of Post Graduate Medical Education and Research in Kolkata, India. It also evaluates the methods adopted in providing skin graft. It mentions that all the injuries, which include avulsion and laceration, were related to street accidents and were contaminated by dirt and grease. The various methods of treatment was discussed.

Background: The closure of the periodontal flaps post-surgery is a necessity for attainment of a primary union between the flap margins and the establishment of a healthy dentogingival junction. N-butyl cyanoacrylate is a tissue adhesive, which can be used for the closure of the incised wounds to overcome the problems associated with conventional suture materials like silk.Objective: The present study was carried out to assess the healing of the periodontal flaps when closed with the conventional silk sutures and N-butyl cyanoacrylate.Materials and Methods: The study was carried out on 24 patients who needed flap surgical procedure for pocket therapy.Results: It was found that healing with the cyanoacrylate is associated with less amount of inflammation during the first week when compared with silk. However, over a period of 21 days to 6 weeks, the sites treated with both the materials showed similar healing patterns.Conclusion: It can be concluded that cyanoacrylate aids in early initial healing. [ABSTRACT FROM AUTHOR]

Introduction: Cover flaps are needed in management of any bodily defect involving bone, tendon, nerve & vessels. The major objective of a plastic surgeon, facing a complex soft-tissue defect, is to replace "like with like" tissues at minimal donor site "cost" and with maximal accuracy & efficacy. Aims: To study the "Propeller Flaps" utility in reconstructive surgeries, evaluate its planning and complications involving donor site morbidity. Methodology: The prospective study was conducted on 15 cases (11 males/4 females) of propeller flaps during the period of two years (2010-12) in Department of Plastic Surgery and Burns, Bangalore Medical College and Research Institute (BMCRI), Karnataka, India. The propeller flaps were performed in cases with defects due to any cause. Exclusion criteria: Cases with Peripheral Vascular Disease (PVD). Flaps were performed and details recorded. Results: Overall results revealed problem resolution in 87% cases (13 cases). Comprehensive description of each flap type and its related cases are given in the table. It has been categorically found that there were 2 flap partial losses. Partial necrosis has been reported in heavy-smoker patients. Conclusion: This current study clearly justifies that careful application, optimal designing & judicious scientific application of local perforator flaps for lower-limb wounds including rest of the body is successful in many aspects providing high-quality reconstruction ensuring minimal morbidity. It is cost-effective as well as time-saving. [ABSTRACT FROM AUTHOR]

Two patients with accidental radiation injury presented at the Sir Ganga Ram Hospital. The first patient, a 41-year-old male, presented with a large necrotic patch on his right gluteal region, which was debrided. Due to the progressive nature of the injury, he developed further necrosis and a non-healing ulcer over the right gluteal region, which was further debrided and covered with a tensor fascia lata flap. Further necrosis over the ischial region was debrided and covered with a pedicled gracilis muscle flap, following which he again required debridement and flap cover for the residual area, which then finally healed. The second patient had a history of radiation exposure followed by a non-healing ulcer on right arm. He was managed by debridement and flap coverage in a single sitting. These two cases suggest that wide excision, thorough debridement and coverage with vascularised tissue are effective in treating radiation ulcers and emphasise that all radiation sources and their management should be strictly controlled. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 30-year-old lady, who had BIRADS IV lesion with diffuse microcalcification on the breast. The patient had nderwent nipple-sparing mastectomy (NSM) for breast reconstruction. The patient had showed a routine recovery with no morbidity following the postoperative care.

Background: Chest wall recurrence can occur after breast cancer. Isolated chest wall recurrences usually occur after treatment that uses all three methods: surgery, chemotherapy, and radiation to the chest wall. Chest wall recurrences usually require one or two rib resections for oncological clearance. Our aim was to assess the usefulness of thoracoepigastric flap in the reconstruction of chest wall for isolated chest wall local recurrence of breast carcinoma. Methods: We studied 36 patients aged 31-65years with isolated chest wall involvement, with or without rib infiltration, for 24months. Patients underwent immediate chest wall reconstruction with mesh and a thoracoepigastric flap. Outcomes were oncological safety and cosmetic outcomes after chest wall reconstruction. To assess oncological safety we used margin status. We used a questionnaire to evaluate personal experience after the reconstruction. Findings: After modified radical mastectomy, 16 patients had positive or close margins and 20 patients were margin-negative. Operating time ranged from 130 to 210min (mean time 154min). Blood loss ranged from 75 to 300mL (mean volume 134mL). The skin island used for volume replacement ranged from 4cm by 3cm to 10cm by 6cm. No patient had margin positivity or close margins. Major wound complications occurred in three patients. Minor wound complications occurred in five patients. Five patients developed seroma. We followed up patients for 12-23months. Interpretation: Isolated chest wall recurrences are completely resectable if we have oncoplastic options such as the thoracoepigastric flap. This technique has increased the oncological safety with less margin-positive resections after immediate reconstruction of chest wall with good cosmetic outcome and less donor site morbidity. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to compare the treatment of gingival recession defects using a coronally-advanced flap procedure with or without placental membrane., Methods: Sixty teeth in 15 patients with single and multiple Miller's class I and II gingival recession defects bilaterally in the anterior and premolar region of the maxilla and mandible were divided into two groups. In group I (control), 30 recession defects were treated with coronally-advanced flap alone using Zucchelli's technique. In group II (test), 30 recession defects were treated with coronally-advanced flap along with placental membrane. Probing depth, height of the gingival recession (HGR), clinical attachment level (CAL), width of the gingival recession, and width of the keratinized tissue (WKT) were recorded at baseline and 3 and 6 months after the surgical procedures., Results: There was a statistically-significant reduction in the HGR, gain in the CAL, and WKT in group II compared to group I., Conclusion: Coronally-advanced flap with placental allograft provides a reliable technique for root coverage when compared to coronally-advanced flap alone., (© 2018 John Wiley & Sons Australia, Ltd.)

Introduction: Open injuries of the limbs offer challenges in management as there are still many grey zones in decision making regarding salvage, timing and type of reconstruction. As a result, there is still an unacceptable rate of secondary amputations which lead to tremendous waste of resources and psychological devastation of the patient and his family. Gustilo Anderson's classification was a major milestone in grading the severity of injury but however suffers from the disadvantages of imprecise definition, a poor interobserver correlation, inability to address the issue of salvage and inclusion of a wide spectrum of injuries in Type IIIb category. Numerous scores such as Mangled Extremity Severity Score, the Predictive Salvage Index, the Limb Salvage Index, Hannover Fracture Scale-97 etc have been proposed but all have the disadvantage of retrospective evaluation, inadequate sample sizes and poor sensitivity and specificity to amputation, especially in IIIb injuries., Methods: The Ganga Hospital Open Injury Score (GHOIS) was proposed in 2004 and is designed to specifically address the outcome in IIIb injuries of the tibia without vascular deficit. It evaluates the severity of injury to the three components of the limb--the skin, the bone and the musculotendinous structures separately on a grade from 0 to 5. Seven comorbid factors which influence the treatment and the outcome are included in the score with two marks each. The application of the total score and the individual tissue scores in management of IIIB injuries is discussed., Results: The total score was shown to predict salvage when the value was 14 or less; amputation when the score was 17 and more. A grey zone of 15 and 16 is provided where the decision making had to be made on a case to case basis. The additional value of GHOIS was its ability to guide the timing and type of reconstruction. A skin score of more than 3 always required a flap and hence it indicated the need for an orthoplastic approach from the index procedure. Bone score of 4 and 5 will require complex reconstruction procedures like bone transport, extensive bone grafting or free fibular graft. Regarding the timing of reconstruction, injuries with a score of 9 or less indicated a low violence trauma and were amenable for early soft tissue reconstruction whereas injuries with a score of 10 or more indicated high violence injuries where a staged reconstruction policy must be followed., Conclusions: Ganga Hospital Open Injury Score was found to be highly useful in decision making regarding salvage in IIIB injuries. The individual tissue scores were also useful to provide guidance regarding the timing and type of bone and soft tissue reconstruction.

Introduction: Over last five years we have performed 248 urethral reconstructions and in 76 patients buccal mucosa was used. Here we are analyzing our five year experiences with BMG (buccal mucosa graft) in reconstruction of navicularis fossa, penile and bulbar urethral strictures of various length and etiology. Methods: Over five years 76 patients age range from12 to 60 years underwent treatment of anterior urethral stricture using BMG including bulbar urethra 52 (69%), penile 10 (13%), panurethral 8 (10%) and fossa navicularis 6 (8%). BMG was used as dorsal onlay 48 (63%), augmented anastmotic repair 18 (24%) and staged repair 10 (13%). Most strictures were idiopathic 27 (36%), inflammatory and BXO related 22 (29%), iatrogenic 19(25%) and traumatic 8(10%). 34 (44%) patients had undergone some intervention previously. Patients were followed up with uroflowmetery and IPSS. Failure was defined as an obstructive voiding pattern with radiologic or cystoscopic evidence of recurrent stricture. Results: Overall success rate of BMG was 60 (79% ) and restricture occurred in 16(21% ) patients in follow up ranged from 8 months to 4.5 yrs. Restricture managed with penile flap in two, internal urethrotomy in 5, staged repair in two patients, perineal urethrostomy in 4 and three patients lost to follow up. Conclusions: Placement of buccal mucosa graft in management of anterior urethral stricture is feasible and reproducible over a long period of time. [ABSTRACT FROM AUTHOR]