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Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST—7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST—7 days (range 6–10) as compared to Group C—20 days (range 12–48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.

Introduction Burns are a worldwide problem with majority of them occurring in low and middle-income countries. The hurdles in treatment of burns in the resource restricted setting are unique and challenging. The role of intravenous antibiotics in reducing mortality and morbidity related to infection and sepsis has not been studied extensively in the Indian sub-continent. Materials and methods This was a retrospective study conducted at a tertiary burn care center in India over a period of six months with follow up of one month from the day of burn injury. Results Data from a total of 157 patients were collected and analysed. In Prophylaxis group (n = 77), sepsis was detected in 33 patients and 38 patients expired. In No Prophylaxis group (n = 80), sepsis was detected in 37 patients and 40 patients expired. In Inhalational burns subgroup, patients belonging to Prophylaxis group (n = 30) had 20 patients diagnosed with pneumonia while 22 patients did not survive till 30th post burn day. Patients in No Prophylaxis group who had inhalational burns were 38 in number. Pneumonia was diagnosed in 29 of them while 27 did not survive till 30th post burn day. In Pneumonia subgroup, patients belonging to Prophylaxis group had lower mortality rate as compared to No Prophylaxis group. Conclusion Our study does not support the routine usage of antibiotic prophylaxis in patients with burn injuries, but their administration can be considered in certain specific subgroups like patients with inhalational burns and patients developing pneumonia. Pneumonia is an independent risk factor for mortality when no antibiotic prophylaxis is used in burn patients.

Background: The purpose of this study was to determine bacteriology of community‐acquired musculoskeletal infections requiring hospitalization and to compare this with published national and international data. This will help treating physicians select the appropriate antibiotic. Methods: All patients who underwent surgical procedures for community‐acquired musculoskeletal infections over a period of 22 months were included in the study. Hospital acquired infections, post‐operative infections and infections involving prosthetic joints were excluded. Patient characteristics, treatment details, cultured organisms and their antibiotic sensitivity were recorded. Results: Forty‐five patients with 46 cases met the inclusion criteria. Ten patients were from paediatric age group. Soft tissue infections were the most common diagnosis and accounted for 20 cases. The remainder were septic arthritis (n = 17) and osteomyelitis (n = 9). Thirteen patients (28.3%) had negative cultures from the operative samples. Staphylococcus aureus was the most common isolated organism overall accounting for 23 cases (69.7%). Methicillin‐resistant S. aureus (MRSA) sensitive to vancomycin was cultured in four adult cases (12.1%), of which three were hand infections (50%). For the entire cohort, 67.7% and 61.3% isolates that were tested were sensitive to cefazolin and flucloxacillin, respectively. Conclusion: The bacteriological profile in this study is consistent with European and Australian data. While the overall MRSA infection rate was low, it was much higher among hand infections and is comparable to reports from the USA. Flucloxacillin and cefazolin should be considered as the first line of antibiotic therapy for all cases. Vancomycin should be considered when MRSA is suspected.

Chronic unreduced dislocations of the proximal interphalangeal joint are uncommon and management principles for these injuries have not been defined. The dislocation can be volar or dorsal and closed reduction is rarely successful owing to soft tissue contractures. We describe an extensile midaxial approach to the proximal interphalangeal joint for release of contractures, open reduction, and repair of critical structures. A smaller contralateral incision can be made if needed for additional soft tissue release. Using illustrative cases, we discuss technical points that are essential for a successful outcome and common pitfalls that could lead to complications. A functional range of motion with a stable joint can be achieved as long as articular cartilage is relatively preserved.

The purpose of this study was to determine bacteriology of community-acquired musculoskeletal infections requiring hospitalization and to compare this with published national and international data. This will help treating physicians select the appropriate antibiotic.All patients who underwent surgical procedures for community-acquired musculoskeletal infections over a period of 22 months were included in the study. Hospital acquired infections, post-operative infections and infections involving prosthetic joints were excluded. Patient characteristics, treatment details, cultured organisms and their antibiotic sensitivity were recorded.Forty-five patients with 46 cases met the inclusion criteria. Ten patients were from paediatric age group. Soft tissue infections were the most common diagnosis and accounted for 20 cases. The remainder were septic arthritis (n = 17) and osteomyelitis (n = 9). Thirteen patients (28.3%) had negative cultures from the operative samples. Staphylococcus aureus was the most common isolated organism overall accounting for 23 cases (69.7%). Methicillin-resistant S. aureus (MRSA) sensitive to vancomycin was cultured in four adult cases (12.1%), of which three were hand infections (50%). For the entire cohort, 67.7% and 61.3% isolates that were tested were sensitive to cefazolin and flucloxacillin, respectively.The bacteriological profile in this study is consistent with European and Australian data. While the overall MRSA infection rate was low, it was much higher among hand infections and is comparable to reports from the USA. Flucloxacillin and cefazolin should be considered as the first line of antibiotic therapy for all cases. Vancomycin should be considered when MRSA is suspected.

The medical education system in India is not perfect and recent developments have again raised questions about the working and conduct of the Medical Council of India. There are loud calls for standardization and, in the midst of this chaos, there are always people who strive for excellence, who try to absorb knowledge at every opportunity and who can burst onto the mega screen anytime. Our aim should be to provide them with the congenial environment in which they can flourish.

Sir, although it is well accepted that amputated part should be preserved properly at a low temperature till the blood flow is re‑established, how to do it while the surgery is on? It is still considered a challenge and a cause for frustration to achieve it in a sterile surgical field, especially while performing major limb replantations.

Objectives To find out factors that are responsible for the patient or provider delays in the diagnosis of breast cancer in India. Design This prospective study was designed to be conducted over a period of two years including a cohort of 100 patients with locally advanced breast cancer. The delays were assessed using questionnaires prepared according to the Indian scenario. Setting A prospective study in an Indian setting. Participants One hundred patients with locally advanced breast cancer receiving neoadjuvant chemotherapy were included after providing informed consent and receiving ethical committee clearance. Main outcome measures The most common factor responsible for delays in diagnosis was observed to be the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease. Results One hundred patients of locally advanced breast cancer were evaluated using standardized questionnaires to assess the delays in diagnosis. Provider delays were found to be significant (the unregistered doctors or quacks being a significant cause of delays). The average time lapse before diagnosis for rural patients was higher (67.5 days) compared to urban patients (53.7 days). The literacy levels of the patients also had a significant impact on the delays at diagnosis. The delay in illiterates was 60.6 days compared to 49.5 days for literates. Conclusions The most common factor responsible for delays in reporting and diagnosis was observed to be at the end of the health providers, although illiteracy and lack of adequate healthcare services also contributed significantly. Unregistered medical practitioners or quacks contributed significantly to the delays in reporting and diagnosis of the disease.

Response evaluation following neo-adjuvant chemotherapy in breast cancer is usually done without taking in to account the axillary response and the available tools like 'response evaluation criteria in solid tumors' (RECIST) have this limitation. These criteria rely solely on the response observed in the primary tumour. Neoadjuvant response index is one such attempt to have a comprehensive assessment of response both in the primary tumour and the axilla.30 cases of locally advanced breast cancer (LABC) were assessed for response using 'Neo-adjuvant Response Index'. The index always gives score between '0' (no response or progressive disease) and '1' (pathological complete response i.e. no invasive tumor in breast as well as axilla). This index includes axillary response as well and provides a spectrum of response rather than dividing patients into simply responders and non-responders .Mean reading of index was found to be 0.2925 in this study. Three patients achieved an index of 1. This index correlates significantly with the existing scales for assessing response. Hormone negative tumors were found to be more chemo responsive with higher rates of pathological complete response (pCR) while ER/PR + Her2- tumors showed a very poor response to NACT.Based on the observations of the present study it may be submitted that Neoadjuvant Response Index (NRI) is a reliable and simple tool that can serve as a comprehensive and accurate method of assessing response to neo-adjuvant chemotherapy as it takes in to consideration both the tumor and axillary response unlike the existing RECIST, binary system (responders are those with greater than 50 % reduction), RCB method and the available biomarkers. This study being first of it's kind in Indian population, in spite of it's limitations, could prove to be a launching ground for further reasearch and contribute substantially to the evidence base.

Background Pediatric burns have a long-term social impact. This is more apparent in a developing country such as India, where their incidence and morbidity are high. The aim of this study was to provide recent prospective epidemiological data on pediatric burns in India and to suggest future preventive strategies. Methods Children up to 18 years old admitted to the Department of Burns, Plastic & Maxillofacial Surgery, VMMC & Safdarjung Hospital, New Delhi, between January and December 2014 were included in the study. Data regarding age, sex, etiology, total body surface area (TBSA), circumstances of injury, and clinical assessment were collected. The Mann-Whitney test or Kruskal-Wallis test or ANOVA was used to compare involved TBSA among various cohort groups accordingly. Univariate and multivariate linear regression analyses were used to determine the predictors of TBSA. Results There were a total of 475 patients involved in the study, including seven suicidal burns, all of whom were females with a mean age greater than the cohort average. Age, type of burns, mode of injury, presence or absence of inhalation injury, gender, and time of year (quarter) for admission were found to independently affect the TBSA involved. Electrical burns also formed an important number of presenting burn patients, mainly involving teenagers. Several societal issues have come forth, e.g., child marriage, child labor, and likely psychological problems among female children as suggested by a high incidence of suicidal burns. Conclusions This study also highlights several issues such as overcrowding, lack of awareness, dangerous cooking practices, and improper use of kerosene oil. There is an emergent need to recognize the problems, formulate strategies, spread awareness, and ban or replace hazardous substances responsible for most burn accidents.

Introduction Elephantiasis as a result of chronic lymphedema is characterized by gross enlargement of the arms, legs or genitalia, and occurs due to a variety of obstructive diseases of the lymphatic system. Genital elephantiasis usually follows common filariasis and lymphogranuloma venereum. It may follow granuloma inguinale, carcinomas, lymph node dissection or irradiation and tuberculosis but this happens rarely. Vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis is very rare. We present two very unusual cases of vulval elephantiasis due to tuberculous destruction of the inguinal lymph nodes. Case presentation Two Indian women - one aged 40 years and the other aged 27 years, with progressively increasing vulval swellings over a period of five and four years respectively - presented to our hospital. In both cases, there was a significant history on presentation. Both women had previously taken a complete course of anti-tubercular treatment for generalized lymphadenopathy. The vulval swellings were extremely large: in the first case report, measuring 35 × 25 cm on the right side and 45 × 30 cm on the left side, weighing 20 lb and 16 lb respectively. Both cases were managed by surgical excision with reconstruction and the outcome was positive. Satisfactory results have been maintained during a follow-up period of six years in both cases. Conclusions Elephantiasis of the female genitalia is unusual and it has rarely been reported following tuberculosis. We report two cases of vulval elephantiasis as a consequence of extensive lymph node destruction by tuberculosis, in order to highlight this very rare clinical scenario.