The conundrum of deep vein thrombosis prophylaxis in burns in India and review of literature.

OBJECTIVE: The aim is to assess the practice of deep vein thrombosis (DVT) prophylaxis among the plastic surgeons attending National Academy of Burns India Conference 2012 (NABICON 2012). BACKGROUND: DVT prophylaxis in burns is a controversial issue as there is no consensus among the community of burn surgeons about the prevalence of DVT, the incidence of pulmonary embolism, the indications for DVT prophylaxis, dosage and duration of low molecular weight heparins (LMWH) and the complications related to DVT and LMWH. METHODOLOGY: A survey was conducted among plastic surgeons attending the NABICON 2012 held at New Delhi, by circulating a questionnaire. The respondents were divided into two groups based on whether burns constituted more than or less than 50% of their practice. The data thus collected were tabulated and analysed. RESULTS: Almost 70% of all the respondents practice some form of DVT prophylaxis. There was significantly higher incidence of complications related to the use of LMWH among the surgeons whose practice of burns was >50%. There was no significant difference between the two groups in relation to the incidence and complication of DVT or recommendation of DVT prophylaxis. CONCLUSION: Majority of plastic surgeons practice DVT prophylaxis routinely and consider multiple criteria such as percentage of burns, age, lower limb involvement, the degree of burns and associated co-morbidities for starting the LMWH.

Dumbbell-Shaped Neurofibroma Over the External Ear.

Dumbbell-shaped swellings in neurofibroma have been commonly described in the spine, thorax, cranial cavity, and pelvis; however, dumbbell-shaped swellings in the peripheries are rare. Here, we report a dumbbell-shaped neurofibroma over the pinna in an 18-year-old female patient, its successful surgical management, and its association with Hashimoto thyroiditis. To the best of our knowledge, this is the first ever case to be reported of a dumbbell-shaped neurofibroma over the external ear and only the fourth case of neurofibromatosis type 1 (NF1) to be associated with Hashimoto thyroiditis.

Gravid uterus in neglected incisional hernia with skin defect-a clinical challenge.

UNLABELLED: Incisional hernia during pregnancy with whole of gravid uterus as the content of the hernia sac is a rare occurrence. When such hernia is associated with skin defect over the sac, the management gets complicated. Very few such cases are reported in the literature. There is no consensus on the management of these cases in the available literature. Here, we are reporting two such cases managed in different ways and reviewed the literature. LEVEL OF EVIDENCE: Level V, Clinical cases.

Genital reconstruction in exstrophy patients.

INTRODUCTION: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. MATERIALS AND METHODS: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. RESULTS: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36) showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. CONCLUSIONS: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional system.