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Purpose: To analyze the demographic, clinical, and microbiological profile of patients presenting to our unit with chronic wounds of various etiologies with an intent to give a current overview of chronic wounds. Patients and Methods: We performed a prospective observational study of patients presenting with chronic wounds from October 2018 to September 2019. The study was conducted at the Department of Burns and Plastic Surgery of a tertiary care institute in a non-metropolitan city in Central India. A total of 103 patients were included in the study. Data collected from the patients included demographic details, history, clinical features, and relevant laboratory reports. Wound swabs obtained by Levine’s technique were sent for culture and sensitivity studies. Treatment was instituted according to the clinical picture and modified if necessary. Progress was monitored until the wound healed, either by conservative management or by surgical intervention. Patients were followed up for six months thereafter. Results: Most of the patients presented with lower limb wounds (n=81, 78.64%). Swab specimens from 103 wounds were cultured. Among the isolates, gram-negative organisms were more common than gram-positive organisms. Staphylococcus aureus was the most common species isolated, followed by Pseudomonas aeruginosa. The frequency of infections caused by other gram-negative organisms like Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis was on the rise. There were significant differences in the patterns of antimicrobial resistance in our patients. Sharp debridements were required in almost all cases for wound preparation. Most of the patients (n=74, 71.84%) underwent surgical intervention for achieving wound closure. Split-thickness skin grafting (STSG) was the most common surgical intervention performed (n=45, 43.68% patients), followed by local and distant flaps. Conclusion: Our study gives a current overview of the causes, clinical presentation, prevalent microbial flora, and their antibiotic susceptibilities prevalent in chronic wounds presenting to our unit. Treatments administered are discussed with emphasis on the different reconstructions performed.

BACKGROUND Sensory recovery and durability of the flap is the primary goal of heel soft tissue reconstruction. From the different options, the choice of the flap depends on the size of the defect, its location, and the availability of the donor area. METHODS In this retrospective study, 40 patients having heel defects were included from Jan 2016 to Dec 2018 in which different flaps were used for the reconstruction. The outcome was evaluated in terms of flap survival, recovery of sensation, the durability of coverage, and functional denouement. We also analysed the outcome between neuropathic and non-neuropathic ulcers of the heel. RESULTS Out of 40 patients’ medial plantar artery islanded flap was performed in eight cases, extended reverse sural flap in 16 cases, islanded reverse sural flap in six cases, local flaps in six cases, cross-leg flap in two cases, and free Latissimus Dorsi muscle flaps with Skin Graft cover in two cases. The patients were observed for a mean follow-up time of 15 months (12-20 months). Only two flaps showed marginal necrosis as an immediate complication. The majority of the flaps were tenacious in the follow-up period except for the six flaps that developed delayed ulceration. Return of protective sensation (P=0.006) and mean American Orthopaedic Foot and Ankle Society subjective score (P=0.025) was significantly higher in the non-neuropathic ulcer group. CONCLUSION Locoregional flaps can cover most of the heel defects with a satisfactory outcome. The functional outcome was lower in the reconstructed neuropathic heel ulcer group.

Post-traumatic wounds over the dorsum of the foot are commonly seen in our practice. Road traffic accidents, crush injuries due to the fall of heavy objects and burns are common causes of these injures. The subcutaneous tissue in this region is very thin, and the tendons and bone are frequently exposed in these wounds. Since the skin is loosely attached to the underlying tendons, ligaments, and bones, the skin of the dorsum of the foot is also vulnerable to avulsion trauma. Added to this, there is a paucity of local tissues for coverage. Hence the management of these wounds is quite challenging. Through this article, we intend to describe our experience with traumatic dorsal foot wounds. A total of 33 patients were eligible according to the inclusion criteria and their details were included in the final analysis. There were 26 (78.79%) males and 7 (21.21%) females, with a male to female ratio of 3.71:1. The age of the study patients ranged from 8 to 62 years, with a mean age and standard deviation of 34.39 and 13.566 respectively. Majority of the study patients were in the 21-30 years age group (n=10, 30.3%). Road traffic accidents were the most common cause of traumatic dorsal foot wounds (n=20, 60.61%). Majority of the wounds showed features suggestive of infection (n=22, 66.67%) at presentation. Most of the patients in our study needed surgical intervention, in addition to medical management (n=28, 84.84%). Surgical procedures performed include split-thickness skin grafts, local flaps and free flaps. Early complications occurred in 5 (15.15%) patients and late complications in 2 (6.06%) patients. In conclusion, post-traumatic wounds of the dorsum of the foot are very common and pose a difficult reconstructive challenge. Skin grafts, local tissue flaps and free flap options are available for reconstruction; selection of the appropriate option should be individualized in a given patient. Local or distant flaps should be preferred in comparison to skin grafts, because of their long term durability and lesser chances of contractures. Reconstruction must consider form, function, and aesthetics.

Background: Incisional hernia is the result of a failure of fascial tissues to heal and close following laparotomy. Laparoscopic Meshplasty is a standard method of repair but not usually done in large incisional and recurrent hernias. Recurrence after repair is common in incisional hernia and poses a significant challenge for the plastic surgeons. We describe here a technique of anatomical repair of the large incisional, and recurrent hernia by darning without using mesh, which is effective in midline, paramedian as well as transverse incisional hernias. Aims and objectives to study the outcome and efficacy of our technique of Darning in cases of large and recurrent incisional hernias without using mesh.Methods: It is a prospective non randomized study of 5 year duration in which we have studied 20 cases of either large or recurrent incisional hernia admitted in our hospital. We operated these cases by darning of the rectus sheath without tension by mattress suture by prolene no.1.Results: 20 patients underwent this repair with few minor complications and there was no recurrence for minimum period of follow of 2 years. Approximation of inner margin and separately mattress pattern darning of outer rectus sheath by prolene no.1 strengthens the repair, but do not cause complication associated with meshplasty like infection, adhesion and fistula formatioṇ.Conclusions: Our technique of darning is an extraperitoneal method of hernia repair which do not incorporate mesh and is an effective method of hernioplasty with manageable early postoperative complication. We have not seen any recurrences in follow up period.