A large multilobulated ankle swelling: rare presentation of gout

We are presenting a case study of a male patient presented to our outpatient department with large lobulated hard swelling in subcutaneous plane of left ankle. We found large whitish soft tissue masses. We did chemical analysis of same and it showed presence of uric acid crystals. This is a very rare presentation of gout. Upto the best of our knowledge only one such lesion has been reported from Turkey. So we wish to report this rare presentation of Gout

Novel technique for reconstruction of challenging defects around knee joint: distally based split vastus lateralis myocutaneous flap and review of literature

Background: Reconstruction of soft tissue defects around the knee joint is often challenging because of exposed bone or tendon, infected wound, open joint or exposed implant or prosthesis. The aim of the study was to analyse feasibility of distally based split vastus lateralis myocutaneous (VL-MC) flap for covering soft tissue defects around knee joint and To report a new technique for coverage of soft tissue defects around knee joint with distally based split Vastus Lateralis myocutaneous (VL-MC) flap and to assess functional and aesthetic outcome.Methods: A total of 3 distally based split Vastus Lateralis myocutaneous flaps were used for reconstruction of soft tissue defects and exposed implant around knee and upper third of tibia. Defect sizes ranged from 5x7 cm to 12x10 cm size. A systematic review of Literature was done using key words of distally based split vastus lateralis myocutaneous flap and various articles were reviewed. The patients were followed up in postoperative period for assessment of this flap considering functional and aesthetic parameters.Results: The flap survived well without any loss in all 3 cases. The donor site was closed primarily in all the cases. Complete functional recovery was achieved by 4 weeks. Patients were satisfied with aesthetic appearance as well.Conclusion: Distally based split VL-MC flap is a safe and reliable option for reconstruction of the complex defects around knee.

Extended reverse sural artery pedicle flap: a versatile and reproducible option for coverage of ankle and foot defects

Background: Coverage of soft tissue defects around distal third of the leg, particularly ankle and foot is a common situation faced by a plastic and reconstructive surgeon. Options available for such defects are limited due to scarcity of additional soft tissue that can be used without exposing tendons or bone. Associated conditions such as major vascular compromise, comorbidities and lack of facilities or expertise make free tissue transfer less preferred. Distally based sural artery flap has been a frequently used flap in such conditions, easy to perform and has reproducible results. We extended the reach of the flap and reproduced the results.Methods: We performed extended reverse sural artery pedicled flaps in 19 patients who presented to us between 2015 to 2017 with soft tissue defects around ankle and foot. Patients included 15 post RTA, 2 diabetic foot, 1 post resection defect and 1 post burn contracture release defect. Size of the defect ranged between 8x6cm to 14x10cm. Average follow up period was ranging from 8 months to 2.5 years.Results: All the flaps healed well without any obvious complications except one patient in whom marginal necrosis (2 cm margin of distal most flap) was observed and was secondarily treated with skin grafting.Conclusions: We observed that extended reverse sural pedicle flap is a rapid, reliable option for coverage of soft tissue defects around ankle and heel, sparing major vessel compromise and lengthy surgical procedure during free tissue transfer. This flap should be the first option for the patients with trauma and defects over weight bearing foot in whom peroneal axis vessels are preserved

Presentation and treatment of congenital constriction ring syndrome: case series of 12 patients

Background:We intend to present our experience of varied presentation and treatment of 12 cases of congenital constriction ring syndrome.Methods: A prospective study of patients presenting with the characteristics of the congenital constriction ring syndrome was undertaken. Twelve patients made up of 7 males and 5 females were seen. The age at presentation ranged from nine days to 5 years with a mean age of 12.9 months. Nineteen limbs were affected, made up of four right upper limbs, six left upper limbs, six right lower limbs and three left lower limbs. In the upper limb malformations involved total 36 digits, arm in one case and forearm in one case; in the lower limb malformations involved total 27 toes, foot in one and leg in four cases. Types of lesions which were found: constriction rings, intrauterine amputations, simple syndactyly.Results: Treatment options ranged from observation to multi-staged operations. Surgical correction of the constriction ring was done by excision and w-plasty to prevent or alleviate lymphoedema, multiple release incisions over distal limb to reduce the edema.Conclusion: Congenital constriction ring syndrome is of uncertain aetiology and could cause morbidity in the new-born. The syndrome and its complications are amenable to corrective surgery with good results. Early intervention is desirable for a successful outcome

A large multilobulated ankle swelling: rare presentation of gout

We are presenting a case study of a male patient presented to our outpatient department with large lobulated hard swelling in subcutaneous plane of left ankle. We found large whitish soft tissue masses. We did chemical analysis of same and it showed presence of uric acid crystals. This is a very rare presentation of gout. Upto the best of our knowledge only one such lesion has been reported from Turkey. So we wish to report this rare presentation of Gout. [Int J Res Med Sci 2016; 4(4.000): 1302-1303

Novel technique for reconstruction of challenging defects around knee joint: distally based split vastus lateralis myocutaneous flap and review of literature

Background: Reconstruction of soft tissue defects around the knee joint is often challenging because of exposed bone or tendon, infected wound, open joint or exposed implant or prosthesis. The aim of the study was to analyse feasibility of distally based split vastus lateralis myocutaneous (VL-MC) flap for covering soft tissue defects around knee joint and To report a new technique for coverage of soft tissue defects around knee joint with distally based split Vastus Lateralis myocutaneous (VL-MC) flap and to assess functional and aesthetic outcome. Methods: A total of 3 distally based split Vastus Lateralis myocutaneous flaps were used for reconstruction of soft tissue defects and exposed implant around knee and upper third of tibia. Defect sizes ranged from 5x7 cm to 12x10 cm size. A systematic review of Literature was done using key words of distally based split vastus lateralis myocutaneous flap and various articles were reviewed. The patients were followed up in postoperative period for assessment of this flap considering functional and aesthetic parameters. Results: The flap survived well without any loss in all 3 cases. The donor site was closed primarily in all the cases. Complete functional recovery was achieved by 4 weeks. Patients were satisfied with aesthetic appearance as well. Conclusions: Distally based split VL-MC flap is a safe and reliable option for reconstruction of the complex defects around knee. [Int J Res Med Sci 2016; 4(6.000): 2089-2092

Presentation and treatment of congenital constriction ring syndrome: case series of 12 patients

Background: We intend to present our experience of varied presentation and treatment of 12 cases of congenital constriction ring syndrome. Methods: A prospective study of patients presenting with the characteristics of the congenital constriction ring syndrome was undertaken. Twelve patients made up of 7 males and 5 females were seen. The age at presentation ranged from nine days to 5 years with a mean age of 12.9 months. Nineteen limbs were affected, made up of four right upper limbs, six left upper limbs, six right lower limbs and three left lower limbs. In the upper limb malformations involved total 36 digits, arm in one case and forearm in one case; in the lower limb malformations involved total 27 toes, foot in one and leg in four cases. Types of lesions which were found: constriction rings, intrauterine amputations, simple syndactyly. Results: Treatment options ranged from observation to multi-staged operations. Surgical correction of the constriction ring was done by excision and w-plasty to prevent or alleviate lymphoedema, multiple release incisions over distal limb to reduce the edema. Conclusion: Congenital constriction ring syndrome is of uncertain aetiology and could cause morbidity in the new-born. The syndrome and its complications are amenable to corrective surgery with good results. Early intervention is desirable for a successful outcome. [Int J Res Med Sci 2016; 4(6.000): 2181-2184

An Unusual Presentation of Gastric Volvulus in A Nontraumatic Diaphragmatic Hernia in An Old Man

Abstract Diaphragmatic hernias of the Bochdalek / Morgagni type are rare in adults( 5%). Symptoms of these hernias are attributable to the involved viscera. The diagnosis may be made with radiography of the chest in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms. Both hernias require repair on presentation because of the risk of incarceration. We present a case of a 65-year-old, male who was misdiagnosed earlier and treated for peptic ulcer disease or GORD. Diagnosis was established pre-operatively by plain chest radiograph and barium meal. A dorsolateral defect was located on left side of diaphragm on CT scan that was corrected by using a prolene mesh via an abdominal approach

Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty

Background: Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. "Warping" can also be utilized to change the curvature of the graft. Materials and Methods: We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes. Results: All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion. Conclusion: The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained