Full thickness skin grafts in periocular reconstructions

PURPOSE: To evaluate the outcomes of eyelid reconstruction in patients who underwent full thickness skin grafts. METHODS: A retrospective, noncomparative intervention study of patients who underwent periocular reconstruction with full thickness skin grafts between 2005 and 2011. RESULTS: One hundred consecutive Caucasian patients were included in the study, 54 women and 46 men. Mean follow up was 32 months. Indications for full thickness skin grafts were excision of eyelid tumors (98%) and cicatricial ectropion (2%). Site of lid defects were lower lid (60%), medial canthus (32%), upper lid (6%), and lateral canthus (2%). The skin graft donor sites were supraclavicular (44%), upper eyelid (24%), inner brachial (18%), and postauricular (14%).Early postoperative complications included lower eyelid graft contracture (1%) and partial failure (1%). Late sequelae included lower eyelid graft contracture (4%) and hypertrophic scarring (23%). Of the 23 patients with hypertrophic scar, 21 achieved good outcomes following massage with silicone gel and steroid ointment and 2 had persistent moderate lumpiness. No statistically significant association was found between graft hypertrophy and donor site or graft size. As high as 95% of all patients achieved good final eyelid position. Good color match was seen in 94% and graft hypopigmentation in 6%. An association between hypopigmentation and supraclavicular and inner brachial donor site was found to be statistically significant. CONCLUSIONS: Most patients (94%) achieved good eyelid position and color match. Majority (91%) of the early postoperative cicatricial sequelae can be reversed by massage, steroid ointment, and silicone gel application. Full thickness skin grafts have excellent graft survival rates and have minimal donor site morbidity

Application of web based geographical information system

49-54Web-based GIS is an application having ability to develop the spatial data in Web based softwares. With the help of Web GIS, Hydrometeorological, ecological, hydrological, water quality, land use and other data can be easily made available to the users. The Web GIS softwares i.e. India-WRIS, Bhuvan, Bhuvan Ganga etc play important role to provide useful information to the users. This paper describes the type of web-GIS maps, advantages of web GIS and other related informations. Information availble on Web GIS may be used by policy makers for taking several decisions. Further, Application of Web GIS based knowledge has also been presented in the paper

Accuracy of clinical diagnosis of benign eyelid lesions : is a dedicated nurse-led service safe and effective?

This article compares an independent nurse-led benign lesion service with a doctor-led one, and assesses the impact of clinician seniority on diagnostic accuracy rates. Retrospective review of benign lesions referred to a teaching hospital and managed in either a doctor- or nurse-led lid service. All lesions were diagnosed clinically, excised and then sent for histological diagnosis. Lesions were categorized into subtypes. Pre-excision clinical diagnoses were compared with histological diagnoses. Sensitivity, specificity and missed malignancy rates were calculated for each subtype. Accuracy was compared between different grades of doctors and a specialist nurse. 264 and 332 lesions were managed in a doctor-led and nurse-led service, respectively. Rates of accurate sub-typing were 79.6% and 80.4% in the doctor- and nurse-led services, respectively (p > 0.05). Clinician seniority had no bearing. Missed malignancies or pre-malignancies accounted for 1.1% and 1.5% of lesions in the doctor and nurse-led services, respectively (p > 0.05). Overall, the remaining misdiagnoses were benign lesions of another subtype (13.6%) or non-specific histological findings (5.0%) and 98.6% of lesions were confirmed as benign on histology. Overall sensitivity and specificity values were: benign epithelial proliferations 95.6% and 92.2%, epidermal inclusion cysts 92.2% and 88.0%, xanthelasma 97.5% and 100.0%, cysts of Moll 66.7% and 96.6%, naevi 39.4% and 99.8% and molluscum 20.0% and 99.8%, respectively. A dedicated nurse-led service is as effective in managing a range of clinically benign lid lesions as a doctor-led one, and clinician seniority has little impact on the diagnostic accuracy of these lesions