Distally based peroneus brevis muscle flap for the use of reconstruction of lower third defects of leg and ankle

Peroneus brevis is a muscle in the lateral compartment of the leg which is expendable with minimal functional deficit. The objective of this study was to find out its use in the coverage of the defects of the lower third of leg and ankle. A retrospective analysis of the use of pedicled peroneus brevis muscle flaps used for coverage of defects of the lower third defects of leg and ankle between May 2022 and 2023 was carried out among 10 patients with said defects. The flaps were distally based for defects the lower third of leg and ankle. Split skin graft coverage was done in all cases. The distally based peroneus brevis muscle flap was used in a series of 10 patients with defects over the lateral malleolus (40%), anterior lower 1/3rd of tibia (40%) and tendoachilles (20%). Flap survival was 100% in all cases with 3 cases having 20% split skin graft loss. Donor site healed well in 100% of cases and no long term muscle function deficit was observed in all cases. This flap has a unique vascular pattern and falls into the type-4 muscle flap category under the Mathes and Nahai Classification. The flap is simple to raise and safe for the reconstruction of small-to moderate-sized skin defects of the distal third of the tibia and all parts of the ankle except the medial malleolus, which is too far from the pedicle of the distally based flap.

Effect of myo-inositol and di-chiro inositol plus vitamin D supplementation during pregnancy on prevention of gestational diabetes: a multi-centric, prospective, randomized, double-blind clinical trial

Background: Aim of study was to evaluate the impact of myoinositol and D-chiro inositol plus vitamin D supplementation on the prevention of gestational diabetes mellitus (GDM) in pregnant women. Methods: In the multi-centric, prospective, randomised, double-blind clinical trial, either vitamin D alone (group I) or myoinositol and D-chiro inositol plus Vitamin D (group II) were administered to pregnant women from 12 weeks of gestation. The administration was continued until delivery to primigravids who were normoglycemic at 12 weeks of gestation and consented. From October 2018 to December 2019. A total of 1250 women were enrolled, and randomly allocated to either of the groups: 630 women in Group I and 620 in Group II. The allocation was blinded. The primary outcome was the rate of GDM as assessed by oral glucose tolerance test (OGTT) recommended by diabetes in pregnancy Study Group India (DIPSI), International Federation of Gynecology and Obstetrics (FIGO) and the Government of India, at first antenatal visit followed by at weeks 24 to 28 in both the groups. Results: The rate of GDM was found more in group I as compared to group II treated with myoinositol and D-chiro Inositol plus vitamin D, but the difference was not statistically significant (5.08% in group I and 3.22% in group II). Conclusions: In conclusion, an improved trend has been noticed in the reduction of the rate of GDM with myoinositol and D-chiro inositol plus vitamin D as compared to vitamin D alone. Myoinositol and D-chiro inositol plus vitamin D supplementation may be a good option for pregnant women to prevent the GDM occurrence especially in women having positive risk factors for GDM.