Analysis of surgical outcome and review of literature of schwannomas arising from the extremities

Background: Schwannoma is a benign peripheral nerve sheath tumour derived from Schwann cells. Also known as Neurilemoma, it can affect any nerve in the body. They usually present as a painless swelling or paresthesia over the sensory distribution of the affected nerve. Although it is classically described that schwannomas are well encapsulated and can be completely enucleated during excision, many of them have fascicular involvement and could not be completely shelled out. The aim of this work is to present our experience in operative management of schwannomas located in extremities.Methods: Authors conducted a retrospective review for 18 adult patients with schwannoma, from June 2012 to June 2018.  There were 10 men and 8 women, ranging from 20 to 68 years of age, with a mean age of 46 years old. All patients had excision done for the tumour and histopathological examination confirmed schwannoma. All patients were preoperatively evaluated both clinically and radiologically. FNAC was also done to confirm the origin of the swelling.Results: The mean follow up period has been 2 years. Complete excision with preservation of nerve was done in all cases except for one case in which nerve graft was used.Conclusions: Use of preoperative MRI, magnification and good surgical technique will help to enucleate the tumour completely without any collateral damage or recurrence. The possibility and option of nerve graft should be discussed with patients prior to schwannoma excision, so that nerve grafting could be directly proceeded with patient consent in case there is fascicular involvement of tumour found intraoperatively

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

Plexiform neurofibromatosis of vulva

Plexiform Neurofibromatosis of vulva is a rare, benign tumor of genital tract arising from nerve sheath of peripheral nerve. It may present as solitary lesion or as part of Von Recklinghausen’s disease. Genitourinary neurofibroma is rare, however clitoris and labia majus happen to be the most frequent location of neurofibromatosis involving female genital tract. We present a case of plexiform neurofibroma arising from left labia majora in a young patient having features of Von Recklinghausen's disease. She complained of discomfort while walking due to rubbing of pedunculated mass arising from her labia majora. We carried out the surgical excision of the mass followed by primary repair of labia majora. She has been followed up on out-patient basis for about three months without any recurrence so far

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

One stage repair in Hypospadias by prepucial island flap technique

Surgical repair of hypospadias has taxed the skills of surgeons the world over. One stage repair is preferable as it decreases operative trauma, allows use of virgin unscarred skin, decreases number of hospitalisations and hence is economical. During last 4 years the author has managed 60 cases of hypospadias and their complications in a tertiary care service hospital. The author has randomly used onlay prepucial flap technique and tubularisation of prepucial flap in roughly equal number of cases of hypospadias to assess the advantages and limitations of these techniques in service clientele and their dependents