Role of Preoperative Skin Stretching in Single-Stage Wound Closure.

Background Mechanical skin stretching (SS) is now becoming one of the commonly sought after procedures for wound healing. This study was aimed to assess the efficacy of preoperative SS for the closure of large wounds and to evaluate various postoperative outcome parameters. Methodology An observational study was conducted from December 2017 to May 2019 where a sample size of 30 patients was included with inclusion criteria being wounds of ≥5 cm width that require surgical management, presence of sufficient healthy skin edge of the wound/scar (at least one) for the stretching procedure, and age between 18 and 70 years. SS devices used were the top closure tension relief system. Postoperatively, various parameters were recorded to evaluate outcomes and complications. Results Majority of wounds that is 16 (53.3%) were <50 cm 2 , 9 (30%) were between 50 and 75 cm 2 , and 5 (16.7%) were >75 cm 2 . The mean duration of stretch was 2.3 ± 0.82 weeks. For 30 wounds treated with staged cycles of wound closure, there was a significant difference between every two visit points, i.e., 10%. The mean patient-reported patient and observer scar assessment scale score was 3.5 ± 0.93. Twenty-five cases (83.3%) had uneventful postoperative recovery. Twenty-seven patients (90%) reported an improved aesthetic outcome. Fourteen patients (46.7%) reported some improvement in function. Conclusion The study concluded that the SS devices are the simple and effective method for the primary closure of large and challenging wounds and skin defects.

Textiles wastewater treatment technology: A review.

The following is a review of published literature on textile wastewater in 2019. Presented are the sections described for the review: concise introduction on the textiles wastewater, followed by a review of present textile treatment technologies organized by physicochemical, biological, and combined processes. Lastly, a discussion of the future topics is presented. PRACTITIONER POINTS: The discharge of textile dye wastewater represents a serious environmental problem and public health concern. Effluents from textile manufacturing, dyeing, and finishing processes contain high-concentration recalcitrant chemicals that are resistant to biodegradation. The textile wastewater needs environmental-friendly and cost-effective combined treatment process.

Fate of environmental pollutants: A review.

A review of the literature published in 2019 on topics associated with the fate of environmental pollutants is presented. Environmental pollutants covered include pharmaceuticals, antibiotic-resistant bacteria and genes, pesticides and veterinary medicines, personal care products and emerging pollutants, PFAS, microplastics, nanomaterials, heavy metals and radionuclides, nutrients, pathogens and indicator organisms, and oil and hydrocarbons. For each pollutant, the occurrence in the environment and/or their fate in engineered as well as natural systems in matrices including water, soil, wastewater, stormwater, runoff, and/or manure is presented based on the published literature. The review includes current developments in understanding pollutants in natural and engineered systems, and relevant physico-chemical processes, as well as biological processes.

Monitoring, sampling, and automated analysis.

A review of the literature published in 2018 on topics related to monitoring, sampling, and automated analysis is presented. The review includes current developments in monitoring, sampling, and analysis of water, wastewater, and groundwater. This review includes the following sections: brief introduction; sample preparation and extraction techniques; real-time, high-frequency, and/or in situ monitoring (microbiological, inorganic, organic, metals, and others); passive monitoring; and the biosensors. In the end, the authors have discussed future of the topic. PRACTITIONER POINTS: Advances in monitoring, sampling and automated analysis of water and wastewater are summarized. Real-time, high-frequency, and in-situ monitoring and analysis of pollutants are summarized. Topics include sample preparation and extraction and passive monitoring, and biosensors for pollutants.

Experience with various reconstructive techniques for meningomyelocele defect closure in India.

BACKGROUND: The estimated incidence of spina bifida is 1-2 cases per 1000 population. In earlier literature, the global prevalence of meningomyelocele (MMC) is reported as 0.8-1.0 per 1000 live births. This retrospective study analyses the outcome of various surgical procedures performed for the closure of MMC defects. METHOD: A total of 22 patients with MMC defects who underwent repair at our institute from July 2016 to August 2018 were included in the study. A retrospective review of all the cases operated was completed to analyse patient demography including defect size, defect location, surgical procedures, complications and the final outcome. RESULTS: Out of 22 cases, wherein the neurosurgery department sought help from the plastic surgery department, 11 defects were closed using the Limberg flap technique, 4 defects were closed with either primary closure or the double flap rotation flaps, one defect was closed using the triple rotation flap and 2 defects were closed using the local transposition flap cover technique. Complications were noted in only three cases. One patient had a local wound infection, while in two other cases, wound dehiscence was observed. All 3 cases were managed conservatively. On average, it takes approximately 70 days in India to close such defects. CONCLUSION: MMC defects can be effectively managed with local flap options such as Limberg flap, local transposition flap or rotation flaps. Various reasons for the delay in closure were reported in patients late to our centre, when the first point of contact was with other departments.

Textiles Wastewater Treatment.

A review of the literature published in 2017 on topics related to textiles wastewater treatment is presented. This review includes the following sections: brief introduction of textiles wastewater treatment, review of current treatment technologies categorized into physicochemical, biological, and combined processes. In the end, the authors have discussed future of the topic.

An algorithmic approach to posttraumatic nail deformities based on anatomical classification.

BACKGROUND AND AIMS: Most of the clinical series on posttraumatic nail deformities (PTNDs) address an individual deformity and its correction. The aim of the study was to classify PTND on the basis of its anatomical defect, devise the reconstructive modality and propose an algorithmic approach to PTND. We have also analysed our results of surgical correction and compared the data with the published literature. METHOD: A 5-year retrospective study of 45 patients with PTND was conducted. The deformities were classified into three groups: intact nail bed, partially amputated nail bed and completely amputated nail bed on the basis of the remnant nail bed. RESULTS: PTNDs with intact nail bed were present in 78%, with partially amputated nail bed in 16% and with completely amputated nail bed in 7% of the patients. Deformities in intact nail bed group were nonadherence (33%), ridged nail (31%), split nail (9%) and nail horn (4%). All patients with partially amputated nail bed presented with hooked nail deformity. A satisfactory result was seen in 87% of nonadherence, 71% of ridged nail, 50% of split nail and 57% of hooked nail. None of the patients with nail horn and absent nail showed a satisfactory result. CONCLUSION: PTND with intact nail bed are consistently benefitted when the option is only split-thickness sterile matrix (STSM) grafting. Appreciable correction of hooked nail deformity can be achieved by the reconstruction of lost components. In our opinion, there is no role of split-thickness germinal matrix (STGM) and STSM graft transfer in total nail reconstruction. LEVEL OF EVIDENCE: III.

Dormant primary cutaneous actinomycosis: Acute exacerbation after 16 years.

Actinomycosis of head and neck are secondary to a nidus in the oral cavity and the aero-digestive tract. Primary actinomycosis without such predisposition is mostly due to trauma. We are presenting a case of this rare variant involving the forehead. The patient had a swelling over the forehead after a windscreen injury, which was asymptomatic for 17 years. However, 1 year ago, there was a repeat blunt trauma on the same site, but there was no breach of skin. Following this, the swelling became tender and started increasing in size. There was no response to a course of antibiotic and the patient had no concomitant history of any systemic illness. The swelling was excised and the biopsy revealed actinomycosis. This presentation of primary actinomycosis after such a long dormancy has never been reported before. This is yet another unusual presentation of actinomycosis, which is notoriously misdiagnosed owing to its rarity and numerous differential diagnoses.

Port retrieval for salvage of tissue expansion in case of lost or malfunctioning port.

Tissue expansion though a promising modality of reconstructive surgery is fraught with many complications. In addition to expander-related complications, subcutaneous port-related mishaps during tissue expansion, though infrequent, can result in procedure failures. We are reporting two patients with port-related complications. In one patient, there was failure to localise the port and the other had a leaking port. Both the expanders were salvaged by retrieving the ports. In the former, as the port was competent, it was simply exteriorised. But in the later case, the connecting tube was retrieved and the incompetent port was replaced with a Luer lock external port. Both the cases were successfully salvaged without any further complications. Expansions were completed and requisite reconstructive end points were achieved.