Fourth dimension in reconstruction of defects following excision of basal cell carcinoma of head and neck!

Background: Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction. Aim: To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction. Materials and Methods: This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III. Results: A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction. Conclusion: Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery

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Fungal septic arthritis of the shoulder is extremely rare in post arthroscopic rotator cuff repair patients. We report our experience in successfully identifying and managing a rare case of fungal septic arthritis with Debaryomyces subglobosus in an uncontrolled diabetic patient who underwent arthroscopic rotator cuff repair in 2019. Our patient had complete resolution of symptoms and a reasonable functional recovery within 2 months of debridement and initiation of the specific anti-fungal. This case highlights the importance of high clinical suspicion for atypical fungal infections, and the use of culture-independent modern diagnostic tools like DNA-PCR as adjuncts to successfully identify rare pathogens in immunodeficient patients presenting with vague, nonspecific symptoms of infection