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INTRODUCTION AND IMPORTANCE: Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. CASE PRESENTATION: Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. CLINICAL DISCUSSION: Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. CONCLUSION: The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.
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BACKGROUND: Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap. METHODS: A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps. RESULTS: The median age of the patients at surgery was 10.5 days (range, 1-369 days) and the average defect size was 22.5 cm2 (range, 7.1-55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45-120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects. CONCLUSIONS: All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.
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INTRODUCTION AND IMPORTANCE: Retroperitoneal abscess is a rare disease that is often difficult to diagnose and require multidisciplinary management. We report a case of large retroperitoneal abscess and the usage lumbar artery perforator (LAP) for the defect closure. CASE PRESENTATION: A 52-year-old-women was admitted to our emergency with a chief complaint of left flank pain. Patient had history of multiple genitourinary tract procedure and diabetes mellitus type 2. We found a bulging mass on the left flank accompanied by pressure pain. A contrast CT scan revealed a large abscess on the retroperitoneal region that involved the left retroperitoneal hemiabdomen muscles. We performed multistage-treatment comprising of radical abscess debridement, followed by honey-impregnated gauze and negative pressure wound therapy for wound bed preparation. Post-debridement, the defect was closed with LAP and keystone flap. LAP flap was raised and transposed to close the defect on the caudal area. One-month follow up showed the outcome was satisfactory. CLINICAL DISCUSSION: In our case, the source of infection was thought to origin from genitourinary infection. The history of multiple urology procedures and diabetes mellitus became the main risk factors. Multistage managements were needed to eradicate the abscess. The usage of NPWT and honey-impregnated gauze was proven successful in preparing the wound bed prior to definitive closure. Lastly, the utilization LAP flap combined with keystone flap showed satisfactory outcome for defect closure. CONCLUSION: The management of patient with large retroperitoneal abscess require multidisciplinary approach including extensive debridement and well-prepared wound bed. In this report, LAP flap was proven reliable option to resurface large defect around flank area.
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BACKGROUND: Tangential excision in burn patients results in blood loss, with an average of 100 ml per 1% total body surface area (TBSA) excised. This substantial blood loss will be accompanied by decreasing serum albumin concentration, increasing inflammation, capillary leakage, and surgical stress. The importance of maintaining albumin level in burn injury is essential for wound healing, decreasing the susceptibility of sepsis, and preventing acute respiratory distress syndrome, the leading causes of death in burn injuries. METHODS: This was a prospective cohort study at our plastic surgery center in Bandung, West Java, Indonesia from January 2018. Serum albumin were sampled taken preoperatively and postoperatively after 24 h. Correlation to the percentage of burn tissue excised was analyzed. RESULT: Twenty-eight patients with burn injury were enrolled as study subjects. There was a significant drop in serum albumin after tangential excision surgery compared to prior surgery in burn patients with mean reduction of 8.6 ± 7.3% (P-value < 0.05) to the mean postoperative albumin value is 0.15 ± 0.1 g/dL. The albumin drop was correlated with blood loss (r = 0.326, P-value < 0.05) but not with the excision area (r = 0.196), length of surgery (r = -0.077) and TBSA (r = -0.213). Strong correlation was shown between excision area with the amount of blood loss (r = 0.567, P-value = 0.001). CONCLUSION: Tangential excision leads to a reduction in postoperative serum albumin concentration. The magnitude of albumin reduction strongly correlated with the amount of blood loss amount during the procedure.