Dermal substitute reinforced single-layer closure of the palatal fistula

Postoperative palatal fistulas are common after surgery to correct a cleft palate. The repair is hindered by palatoplasty-related scar tissue, reduced vascularity, and restricted mobility of flaps. Surgical repair of fistulae is often effective, but recurrence is common. A 3.5-year-old boy presented with anterior palatal fistula. The presence of peri-fistulous scarring prevented two-layered closure. Nasal layer closure was achieved but not the oral layer. The dermal matrix was reinforced in a one-step procedure over the nasal layer and fixed in place using a gel foam. At 6 months, the fistula almost completely healed, with only a pinpoint track remaining that occasionally leaked into the nasal cavity. These results indicate that the application of dermal matrix is a promising technique to repair fistula with surrounding scarring, but larger, prospective trials are needed to confirm its potential benefits

Body contouring surgery in a massive weight loss patient: An overview

The number of patients with history of extreme overweight and massive weight loss (MWL) has risen significantly. Majority of patients are left with loose, ptotic skin envelopes, and oddly shaped protuberances, subsequent to weight loss. Redundant skin and fat can be seen anywhere on the body following MWL. This group of population presents many unique problems and challenges. Body contouring surgery after MWL is a new and exciting field in plastic surgery that is still evolving. Conventional approaches do not adequately cater to the needs of these patients. Complete history, detailed physical examination, clinical photographs and lab investigations help to plan the most appropriate procedure for the individual patient. Proper counseling and comprehensive informed consent for each procedure are mandatory. The meticulous and precise markings based on the procedure selected are the cornerstones to achieve the successful outcome. Lower body contouring should be performed first followed six months later by breast, lateral chest and arm procedures. Thighplasty is usually undertaken at the end. Body contouring operations are staged at few months' intervals and often result in long scars. Staging is important as each procedure can have positive impact on adjacent areas of the body. Secondary procedures are often required. However, proper planning should lead to fewer complications and improved aesthetic outcome and patient satisfaction

Cleft Lip Repair Under Local Anaesthesia in Older Children and Adults

Our experience with repair of cleft lip under local anaesthesia in 16 patients has been reported. The method is safe and does not compromise the quality of repair. It is economical for both the patient and the hospital and saves precious hospital beds for other needy patients

Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique

Phalloplasty is indicated in various conditions of penile loss or absence. There are numerous techniques for phalloplasty including the pedicle and free flaps with the ultimate goal of micturition in standing position, attaining adequate size, aesthesis and sensations for sexual intercourse. Radial forearm phalloplasty is the gold standard flap to achieve above results but gives a very bad scar on the forearm. We present a technique of using prefabricated thigh flap to reduce the morbidity of donor area. The descending branch of lateral circumflex femoral pedicle was placed in a subcutaneous plane over tissue expander. After attaining an adequate size of flap with tissue expansion, it was delayed 3 weeks before phalloplasty. Prefabricated flap was thin and of large size replicating the radial forearm flap used for phalloplasty. Whole forearm defect was covered with the thigh flap, and the thigh could be closed primarily. This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in the whole procedure

A simple and rapid method of repeated tie over dressing

Tie overdressing is commonly used to secure the graft against the raw surface and prevent loss due to of hematoma or seroma. A conventional tie over dressing with silk sutures, is a useful method of securing the graft to raw area. Refixation is difficult when repeated tie over dressings are needed. We assessed a low cost repeated tie over dressing method using sterile sample collection containers and silk suture threads in eight patients. After the graft is applied on the bed, tie-over stitches are taken, and paraffin gauze is applied over with adequate padding; the tie over sutures are passed through the container and the lid is tightened over it to complete the dressing. The lid can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. The skin graft take in all the patients was complete without any seroma or hematoma. A novel and low-cost tie over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation is reported here

Novel Asymmetric Y Design of Fascial Sling for Restoration of Oral Competence and Adequate Mouth Opening in Oral Commissure Defects Post-Malignancy Resection

Reconstruction of through-and-through defects of cheek and commissure resulting from cancer resection are challenging. The specialized function of oral competence that the oral commissure and lip play is difficult to replicate with flap only reconstruction. Static slings play an important role in improving the functional and aesthetic outcome. The asymmetric “y” fascial sling helps in achieving the goals of oral competence along with adequate mouth opening. A total of 10 patients were operated by this technique. The results were satisfactory in terms of functional and aesthetic outcome postsurgery and were maintained 6 months postradiation