Reconstruction of post electrical burns scalp defect

Pertinent approach for scalp reconstruction often poses a challenge to plastic surgeons due to numerous reasons like inelastic nature of scalp, hairy nature of scalp and others. Traditional surgical treatment of deep burns of the scalp and skull involved excision of necrotic bone and soft tissues with trephanation of the bone to permit granulation tissue formation followed by skin grafting. However, this approach prolongs wound time and adds additional trauma. Even after initial healing it may necessitate secondary soft tissue and bone reconstruction. Treatment of scalp defect after electrical burn is managed according to the amount of damage. Scalp burn injury with osteomyelitis of the calvarium is seldom mentioned in literature. In the present case, the defect was long standing with skull exposure and hence routine management of scalp defect had to be differed. The calvarial bone was replaced with sequestrum. Complete excision of the sequestrum was done with intact dura. Ensuing defect was covered with local transposition flap. The donor area was covered with split thickness skin graft

Tessiers No. 3 Oblique Facial Cleft

A case of rare variety, of a congenital origin, of lateral, oblique facial cleft is presented. Cleft closure is achieved by using cheek and glabellar flaps

Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids

<b>Background</b> : The calcium channel blocker, verapamil stimulates procollagenase synthesis in keloids and hypertrophic scars. <b> Aim</b> : To study the effect of verapamil in the treatment of hypertrophic scars and keloids and to evaluate the effect of verapamil on the rate of reduction of hypertrophic scars and keloids in comparison with triamcinolone. <b> Methods</b> : The study was a randomized, single blind, parallel group study in which 54 patients were allocated to to receive either verapamil or triamcinolone. Drugs were administered intralesionally in both groups. Improvement of the scar was measured using modified Vancouver scale and by using a centimeter scale serially till the scar flattened. <b> Results</b> : There was a reduction in vascularity, pliability, height and width of the scar with both the drugs after 3 weeks of treatment. These changes were present at one year of follow-up after stopping treatment. Scar pigmentation was not changed desirably by either drug. Length of the scars was also not altered significantly by either drug. The rate of reduction in vascularity, pliability, height and width of the scar with triamcinolone was faster than with verapamil. Adverse drug reactions were more with triamcinolone than with verapamil. <b> Conclusion</b> : Intralesional verapamil may be a suitable alternative to triamcinolone in the treatment of hypertrophic scars and keloids

Mammoth orbitofrontal neurofibromatosis with herniating meningo-encephalocele

We are presenting a mammoth orbito-frontal neurofibroma with a herniating meningo-encephalocele in a 23 year old African male. The tumour measured 87cm &#935; 54cm and occupied the right orbito-temporo-facial region and had destroyed the right orbit. A pre operative embolization of the feeding vessels was followed by a one stage near total excision of the tumour and repair of the meningo-encephalocele in hypotensive anaesthesia. The excised tumour weighed 8 Kg and, to the best of our knowledge, is the largest orbito-facial neurofibroma reported in literature

A Comparative Study and Assessment of Burn Wound Sepsis Using Surface Swab, Fine Needle Aspiration and Wound Biopsy Cultures

The purpose of this study was to evaluate a simple standardized fine needle aspiration method for bacteriologic assessment of burn wound and to determine whether this method is as reliable and useful as the classic invasive biopsy culture method1. Considering the high correlation with the organism in all three methods, viz. swab, aspiration and wound biopsy culture techniques, we feel fine needle aspiration culture has a place in bacteriological assessment of burn wound as it is simple, easy and less painful compared to the more conventional wound biopsy culture technique

DISTALLY BASED SUPERFICIAL SURAL ARTERY FLAP

We describe our experience with the use of distally based superficial sural artery flap for coverage of defects in lower third of leg and foot in 12 patients. In 9 patients the flap was successfully transferred and in 3 cases marginal necrosis of flap occurred. This flap has a constant and reliable blood supply and does not sacrifice a major artery. Other advantages of this flap are easy dissection and is a one stage procedure. In most patients the skin graft site is cosmetically unacceptable

A rare case of synchronous saree cancer

Skin cancers are rather uncommon malignancies comprising less than 1% of all the cancers in India. Saree cancer is a rare type of squamous cell carcinoma (SCC). Saree and dhoti are traditional male and female costumes respectively, which is unique to the Indian subcontinent. Constant wear of this clothing tightly around the waist results in changes in pigmentation and scaling of the skin, acanthosis, scar and ulceration and subsequent, gradual malignant changes. The process of repeated trauma over a long time and consequent interference with the healing process may rationalise the reason for malignant transformation. Few papers have been published on saree cancer, in main stream medical journals. We are presenting a rare case of saree cancer in a 68-year-old woman, with two distant bilateral ulceroproliferative growths in loin (Synchronous), along the waistline, which showed well-differentiated SCC on biopsy. Wide excision with rhomboid transposition flap was done bilaterally

Groin reconstruction after inguinal block dissection

Inguinal block dissection is a necessary component in the treatment of certain cancers. Cancer of the penis is not an uncommon malignancy in the Indian subcontinent and while no one questions the treatment of the primary lesion, the need to remove the inguinal lymph glands concurrently, remains a matter of great controversy. Never the less, the survival of patients with penile cancer depends solely on the presence or absence of metastasis to the inguinal lymph nodes. The hesitation in offering inguinal lymph node dissection in every case is significantly related to the morbidity of the procedure in an attempt to reduce these complications, skin flaps can be used to cover the groin. This article looks at various flaps that can be used in groin reconstruction

Mammoth orbitofrontal neurofibromatosis with herniating meningo-encephalocele

We are presenting a mammoth orbito-frontal neurofibroma with a herniating meningo-encephalocele in a 23 year old African male. The tumour measured 87cm x 54cm and occupied the right orbito-temporo-facial region and had destroyed the right orbit. A pre operative embolization of the feeding vessels was followed by a one stage near total excision of the tumour and repair of the meningo-encephalocele in hypotensive anaesthesia. The excised tumour weighed 8 Kg and, to the best of our knowledge, is the largest orbito-facial neurofibroma reported in literature