3. Binder’s syndrome: Modified approach for correction of Nasomaxillary hypoplasia.

Introduction: Binder syndrome is a relatively uncommon syndrome characterized by nasomaxillary hypoplasia. Different approaches for correction of hypoplastic nasomaxillary complex has been developed and studied over years. Our study shows our experience with extra oral only technique of onlay costal cartilage graft for nasal dorsal augmentation, premaxilla augmentation and columella lengthening in three patients. Materials and Method: We report here three patients with nasomaxillary dysplasia whose noses were corrected with onlay costal cartilage grafts using external rhinoplasty approach for nasal dorsal augmentation, columellar lengthening, and premaxillary augmentation. L struts made for nasal augmentation, columellar lengthening, and premaxillary augmentation were fixed to one another by putting it in dissected pockets. Results: All the patients were operated single time. Patients were followed up with sequential photography over 6 months to 2 years. Costal cartilage maintained their volume in post operative period. Conclusion: Binder's Syndrome: Augmentation of the premaxilla is necessary along with nasal augmentation and columellar lengthening with autogenous costal cartilage grafts for effective treatment. Augmentation with costal cartilage is enough to give an aesthetically pleasing facial profile in mild to moderate cases

5. The role of microvascular free tissue transfer for foot and ankle defects: Results and outcome.

Introduction: The foot and ankle defects include large primary defect following trauma, infection with osteomyelitis and oncologic resection with soft tissue loss. The primary goal of lower limb reconstruction is to prevent amputation and give a durable coverage of defects. Therefore, microvascular free tissue transfer is a useful and an effective method for foot and ankle reconstruction. Materials and method: In the current study, we performed a prospective analysis of patients who underwent lower limb reconstruction at our medical institution during the period of January 2018 to October 2018. In our study we reconstructed defects of dorsum of feet and ankle using radial forearm free flap, latissimus dorsi free flap, anterolateral thigh free flap. These were performed patients age ranging between 20 to 55yrs. All the patients were followed for 6 months. Results: there were 15 patients, 13 males and 2 females, with age ranging between 20 to 55years; we reconstructed defects of dorsum of foot and ankle defects with free flap. Overall survival of flap rate was 93.3% (14/15) Conclusion: Free flap is an ideal option for foot and ankle defects especially in patient with large defects to salvage the limb. It is a better option in case of sole and dorsum of foot defects

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)