Outcome Analysis of Two-Stage Paramedian Forehead Flap for Nasal Defects Reconstruction in Local Population: Experience of 3 Years at Our Center.

The nose is a key aesthetic element of face. Nasal defect reconstruction by forehead flap has been done since ancient times. The aim of this study is to review our experience of the outcomes of two- stage paramedian forehead flap in nasal defects of various aetiologies in the local population. This prospective study was done from January 2020 to December 2022 in the Department of Plastic and Reconstructive Surgery at SMS Medical College and Hospital. A total of 29 patients were included in this study who were candidates for a forehead flap for nose reconstruction due to any aetiology. After informed and written consent, two- stage paramedian forehead flap was done and patients were followed up to 6 months for analysis of outcomes. 29 participants were included in the study. Age range was 18-72 years (mean age 38.5 ± 16.78). 21 (72.4%) were male and 8 (27.6%) were female.23 (79.3%) patients had multiple subunit involvement, 4 (13.8%) patients had single subunit defect and 2 (6.9%) had total nasal defect. Most common aetiology was trauma (58.7%). Early complications including flap and donor site healing related complications were present in 8 (27.5%) patients. Delayed complications were grouped into cosmetic and functional complications and were seen in 22 (75.8%) patients. Cosmetic dissatisfaction was high with the two- stage paramedian forehead flap. Forehead flap is an established gold standard reconstructive option for nasal defects. In a two stage paramedian forehead flap, flap and donor site related issues are minor but cosmetic dissatisfaction is high. With some additional stages, satisfaction among patients increases significantly.

Facial Basal Cell Carcinoma: A Study of Causative Factors and Site-based Algorithm for Surgical Reconstruction.

Background: Basal cell carcinoma (BCC) can be categorized as one of the commonly occurring skin malignancies in the world, with several variations in treatment protocols. Sun exposure has been attributed to its causality; however, other factors such as gender, age, and occupation also affect its incidence. We aimed to characterize the patient population who underwent surgical management for facial BCC at a tertiary referral hospital. Further, we have described an algorithm that may aid in surgical decision-making based on the location of the lesions on the face. Materials and Methods: We performed a retrospective chart review of all patients who presented with a facial BCC to our institution between 2018 and 2019. Data regarding patients' demographic characteristics, skin phototype, average sun exposure, occupation, residence place (rural or urban), and surgical outcomes were recorded. Results: Sixty-eight patients underwent reconstructive procedures after oncologic resection of facial BCC: 41.2% were males and 58.8% were females. Forty-eight (70.6%) patients were from rural areas, and 20 patients (29.4%) from urban areas (P < 0.001). Twenty-six patients reported >2 h of sunlight exposure, 16 reported <2 h of continuous sun exposure, and 26 reported intermittent sun exposure. A significantly higher proportion of patients with facial BCC presented with a Fitzpatrick skin type 4 in comparison to types 3 and 5 (P < 0.001). The most common reconstructive technique was the V-Y advancement flap (n=22, 32.4%), followed by the forehead flap (n=12, 17.6%) and the Limberg flap (n=12, 17.6%). All the flaps were healthy post-operatively and none of them suffered from flap failure, infection, or suture line dehiscence. There was no recurrence at 1-year follow-up. Conclusion: This study gives a correlation between incidence of BCC and age, gender, and sun exposure in Indian population. In our experience, local flaps yield outstanding results and are the first choice for reconstruction of the face when composite defects are not present. Our algorithm aids in surgical decision-making.

Evolution of aesthetic surgery in India, current practice scenario, and anticipated post-COVID-19 changes: a survey-based analysis.

BACKGROUND: The declaration of COVID pandemic by the WHO can certainly be seen as a watershed era the world has witnessed in modern times. All non-essential industries and services have taken a back seat including aesthetic medicine. Over the last decade, India has witnessed a steady growth in medical tourism owing to global standards of care and services at a relatively modest cost. The following study was conducted to ascertain the sea change that this pandemic has brought into aesthetic surgeons' practice, patient management, planning and consultation. This paper throws light on the journey of Indian aesthetic surgery from its infancy to its current presence in the global market as a context of the study. We have also discussed the impact of social media on aesthetic surgeons' practice, lifestyle and its role as an emerging new method of medical education. METHODS: A questionnaire consisting of 62 questions divided in 3 sections was rolled out to 150 Indian aesthetic surgeons who have been practising either independently in their clinics or are associated with hospitals. A: Pre-COVID practice management and lifestyle; B: life during the lockdown; C: anticipated changes in post-COVID era. RESULTS: In the pre-COVID era, an average aesthetic surgeon was finely balancing his profession, personal lifestyle, learning, and recreation. The lockdown clamped their practices which lead into a financial drought; despite which, they were able to maintain their productivity by engaging in webinars, reading, and research. The post-COVID times demand an implementation of safety protocols along with changes in set-up, regulating patient traffic, engaging in distant learning through virtual conferences, and maintaining a healthy lifestyle acquired during the lockdown. CONCLUSIONS: India was rightly witnessing a surge in popularity of aesthetic surgery and medical tourism over the last decade. The corona pandemic has definitely hit this escalating growth curve hard, and it will take some time for the demand to recover. Our study revealed the following conclusions: The effect of COVID 19 demands a major change in aesthetic surgeons' professional practice like limiting consultations, changing hospital floor plan, following COVID testing, and having new safety protocols. Social media is rightly poised to be a major tool for education and marketing as also for recreation and leisure. The role of teleconsultation needs to be reprised and legalised. Webinars and virtual conferences will find more takers in future.Level of evidence: not ratable.

Autologous Platelet Rich Plasma As A Preparative for Resurfacing Burn Wounds with Split Thickness Skin Grafts.

BACKGROUND: Split thickness skin graft is a widely accepted technique to cover large defects. Shearing, hematoma and infection have often been attributed as major causes for graft loss. Autologous platelet rich plasma (PRP) has been used in various treatment modalities in the field of plastic surgery for its healing, adhesive and hemostatic properties owing to the growth factors that are released. This Study primarily throws light on the usage of PRP over difficult Burn wound beds to augment graft uptake and attenuate complications. METHODS: The patients were divided into two groups of those who were subjected to use of autologous PRP as a preparative burn surfacing and the control group who underwent standard method of treatment. RESULTS: Patients in PRP group significantly showed a higher graft adherence rate as compared to those with other method. It also reduced pain, and hematoma formation. CONCLUSION: Application of PRP is a safe, cost effective, easy method to increase graft adherence rate in patients with burns where graft loss is noticed and there is shortage of donor sites.