Outcome of Nasal Layer Reinforcement With Autologous Dermis in Cleft Palate Repair on Postoperative Fistula Formation.

Palatal fistulae are challenging complications following cleft palate repair. The addition of acellular dermal matrix (ADM) to cleft palate repair has been shown to reduce fistula formation in previous studies. The use of autologous dermal graft has all the structural advantages of ADM, has less rejection and immunogenic potential, and is cost effective.A prospective study.Patients with Group II and III cleft palate (Nagpur Classification) without prior intervention for palatal repair in the Department of Plastic Surgery at PGIMER from January 2020 till June 2021.The addition of autologous dermal graft for palatoplasty.Outcome of the study was fistula development or exposure of dermal graft.Autologous dermal graft was harvested of average dimension of 8.73 cm2 (range 5.25-18 cm2) from groin region. Sixteen patients were included in the study. Among them, 2 patients (12.5%) developed postoperative fistula (Type III &V Pittsburgh Classification).Our study showed that the rates of postoperative fistula formation are comparable with prior literature using artificial dermal matrices.

Botulinum Toxin for a Better Scar in Cleft Lip Surgery: A Prospective Randomized Control Trial.

INTRODUCTION: An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair. METHOD: The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements. RESULTS: Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A. CONCLUSIONS: Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.

Rotation Flaps in Series: Simple Innovation for Complex Scalp Defects.

A 42-year-old man presented with 2 full thickness defects in left parieto-temporal and right temporo-occipital regions with normal intervening scalp tissue. These 2 adjacent but discontinuous defects were covered in one stage with an innovative rotation flap design that provided 1 flap each for these 2 defects. This innovative flap design permitted one stage reconstruction with primary closure of the donor sites.

No Traces of SARS-CoV-2 In Wounds of COVID-19 Positive Patients: A Pilot Study.

Background This study was performed to investigate the presence of SARS-CoV-2 virus in wounds of COVID-19 positive patients. Methods This is a single-center observational study. COVID-19 patients with wounds (traumatic/infective/surgical) were included in this study. Preoperative, intraoperative, or postoperative specimens were collected and analyzed with real-time reverse transcriptase polymerase chain reaction (rRT-PCR) to know the presence of the virus. Results A total of eight patients were included in this study. Eleven samples were collected (seven wound swabs, two peritoneal fluids, and two tissue specimens) and analyzed. None of the samples from the wound tested positive for the virus while they were tested positive for nasal swab taken simultaneously or within 3 days prior. Conclusion The wounds of COVID-19 patients are considered negative and can be managed with routine wound precautions.

Assessing the Role of Virtual Surgical Planning in Mandibular Reconstruction With Free Fibula Osteocutaneous Graft.

BACKGROUND: The role of virtual surgical planning and three-dimensional printing in improving the accuracy, precision, functional and aesthetic outcomes have been demonstrated in the literature; however, there is a dearth of studies evaluating these parameters. OBJECTIVE: This study was carried out at a tertiary care center in North India to assess the accuracy of virtual surgical planning in mandibular reconstruction. METHOD: All the included patients were preoperatively assessed with a contrast enhanced computed tomography (CECT) of head and neck. Based on the dimensions a patient-specific fibula cutting guide was fabricated by three-dimensional printing. All patients were evaluated with a postoperative CECT at 6 months of follow-up. The precision outcomes were measured by comparing surgical results with the images of the preoperative virtual planning based on several measurements on the reconstructed mandible such as anteroposterior measurement, transverse measurement, height of the mandible, angle of the mandible, and lateral tilt.The secondary outcomes analyzed were the mean total operative time, mean ischemia time, and morbidity parameters. RESULT: Twelve consecutive patients (6 male, 6 female) with mean age of 33.1 ±â€Š11 years who underwent free fibula graft mandibular reconstruction were included in the study. The mean difference in the anteroposterior, transverse, and height dimensions were 0.87 ±â€Š0.43 mm (P = 0.24), 2.43 ±â€Š3.72 mm (P = 0.64), and 1.08 ±â€Š0.67 (P = 0.88), respectively. The difference in the angles of the reconstructed mandible was 2.37 ±â€Š3.92 degrees (P = 0.51) and of lateral tilt was 1.57 ±â€Š1.5 degrees (P = 0.54). The mean total operative time was 639 ±â€Š27.2 minutes and mean ischemia time was 88.4 ±â€Š8.6 minutes. CONCLUSION: All the patients had satisfactory aesthetic results and good oral function at 6 months postoperative period.

Donor Site Changes in Bone Thickness, Volume, and Density Following Split Cranial Bone Graft Harvest.

The calvarium can provide large amount of good quality corticocancellous autogenous bone graft. Although many studies have highlighted the advantages of the split cranial bone graft, there is no published work available in the literature about the fate of donor site of the split cranial bone graft. The present study was undertaken to assess the donor site as regards to the thickness, volume, and the density of the residual bone over a period of 12 months in the postoperative period. A total of 30 patients in the age group of 15 to 43 years were studied from January 2015 to January 2016. Postoperative computer tomography scans were taken at 2 weeks, 6 months, and 1 year postoperative to measure the bone thickness, volume, and density at the donor site of the split cranial bone graft harvest. The bone thickness at the donor site showed progressive increase in the thickness over the period of study and the average increase in thickness was about 12.4% at the end of 1 year. The average increase in volume at the donor site was of 2.65% after 12 months. Similarly, the average bone density increased by 3.7% at the end of 1 year. This prospective study conclusively proves that the residual bone at the donor site of the split cranial bone graft harvest site continues to grow in thickness and density over a period of 1 year.

From "head to heart: " reconstruction of a sternal cleft with split calvarial bone graft in a 15-month-old child.

Sternal cleft is a rare anomaly and has been variously managed by using either autogenous tissue or synthetic materials for bony reconstruction. We report the reconstruction of sternal cleft in a 15-month-old child with a single-piece outer-table cranial bone graft that was harvested by splitting in situ. The reconstructed sternum was covered with bilateral pectoralis major advancement muscle flaps.

Hypertelorism.

The term orbital hypertelorism (ORH) implies "widely apart orbits." This may also be associated with the abnormal vertical orientation of the orbits (dystopia). This deformity may be unilateral or bilateral, symmetric or asymmetric and may be present in a variety of craniofacial conditions. The treatment is primarily carried out for aesthetic reasons. The timing of treatment is dictated by the underlying condition and the type of procedure envisaged. The mainstay of treatment consists of moving the orbits medially to near normal position. This is accomplished by either an orbital translocation or facial bipartition technique. The choice of procedure is governed by the shape of the maxillary arch and associated occlusal conditions. We must differentiate between the telecanthus (also called pseudo-hypertelorism) and a true ORH as the management differs in these two conditions. The ORH involves extensive intracranial and extracranial operation whereas the telecanthus correction is relatively simpler surgery. The article will discuss the aetiology, classification, presentation, treatment options, timing of surgery and the choice of surgical procedures. Illustrative case reports with long-term results will be used to explain the management of these patients.

Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets.

BACKGROUND: The importance of adequate nutritional support in burned patients cannot be overemphasised. For adequate long-term compliance by the patients, diet should be formulated in accordance with their pre-burn dietary habits, religious beliefs, and tastes. PATIENTS AND METHODS: A study was conducted in 42 consecutive patients suffering from 10% to 50% of 2(nd) and 3(rd) degree thermal burns with the aim to compare nutritional status, clinical outcome, and cost-effectiveness of vegetarian and non-vegetarian diets. The patients were divided into two groups depending upon their pre-injury food habits. Total calories were calculated by Curreri formula. Both groups were compared by various biochemical parameters, microbiological investigations, weight, status of wound healing, graft take, and hospital stay and they were followed for at least 60 days postburn. RESULTS: The results were comparable in both groups. Vegetarian diet was found to be more palatable and cost-effective. CONCLUSION: Vegetarian diet is a safe and viable option for the patients suffering from burn injury. The common belief that non-vegetarian diet is superior to vegetarian diet is a myth.

Epidemiology of electrical burns and its impact on quality of life - the developing world scenario.

BACKGROUND: Electrical burns are devastating injuries and can cause deep burns with significant morbidity and delayed sequelae. Epidemiological data regarding the etiology, socioeconomic differences and geographic variation are necessary to assess the disease burden and plan an effective preventive strategy. These severe injuries often lead to amputations and thus hamper quality of life in the long term. AIM: To identify the population at maximum risk of sustaining electrical burns. We also studied the impact of electrical burns on these patients in terms of quality of life as well as return to work. METHODS: The study was conducted at a tertiary referral teaching hospital over a period of eighteen months. All patients with a history of sustaining electrical burns and satisfying the inclusion criteria were included in the study. All relevant epidemiological parameters and treatment details were recorded. The patients were subsequently followed up at 3 mo, 6 mo and 9 mo. The standardized Brief Version of the Burn Specific Health Scale (BSHS-B) was adopted to assess quality of life. Statistical analysis was conducted using IBM SPSS statistics (version 22.0). A P value of < 0.05 was considered statistically significant. RESULTS: A total of 103 patients were included in the study. The mean age of the patients was 31.83 years (range 18-75 years). A significant majority (91.3%) of patients were male. The mean total body surface area (TBSA) in these patients was 21.1%. In most of the patients (67%), the injury was occupation-related. High voltage injuries were implicated in 72.8% of patients. Among the 75 high voltage burn patients, 31 (41%) required amputation. The mean number of surgeries the patients underwent in hospital was 2.03 (range 1 to 4). The quality of life parameters amongst the patients sustaining high voltage electrical burns were poorer when compared to low voltage injuries at all follow-up intervals across nine domains. In eight of these domains, the difference was statistically significant. Similarly, the scores among the amputees were poorer when compared to non-amputees. The difference was statistically significant in six domains. CONCLUSION: Electrical burns remain a problem in the developing world. Most injuries are occupation-related. The quality of life in patients with high voltage burns and amputees remains poor. Work resumption was almost impossible for amputees. These patients could not regain pre-injury status. Steps should be taken to create awareness and to implement an effective preventive strategy to safeguard against electrical injuries.

Effect of obesity on autonomic functions of Heart among healthy volunteers at a teaching Institute.

Background: Obesity usually results from an imbalance between energy intake and energy expenditure, that is, energy homeostasis, which is controlled by the autonomic nervous system. This imbalance results from multifaceted interactions of genetic, physiological, behavioral, environmental, endocrine, nervous, metabolic factors, which lead to hemodynamic and metabolic alteration. Objective: To study the effect of obesity on the autonomic functions of the heart. Methods: An observational analytical study was carried out among 100 subjects. All healthy volunteers of 30-50 years were included. The subjects were grouped into two categories of body mass index (BMI): 30-39.99 kg/m2 as Obese group and BMI: 18.50-24.99 kg/m2 as Non -Obese group. Out of 100 subjects, 50 were obese and 50 were non-obese. The interview was taken. General physical examination and anthropometric measurements were recorded. The assessment of various cardiac autonomic function tests was carried out. Results: Both groups were comparable for age and sex (P = 0.754). The resting heart rate, SBP, and DBP in the obese group were significantly higher compared to the non-obese group (P < 0.05). All values of autonomic function tests in the non-obese group were significantly higher compared to the obese group (P < 0.05) except for the Standing to lying ratio (P > 0.05). The values of SBP and DBP increased significantly in the non-obese people after the isometric handgrip test and cold press test compared to the obese people (P < 0.05). Conclusion: We conclude that the resting HR, SBP, and DBP were higher in obese people. However, after applying autonomic function tests, non-obese people respond better to these tests compared to obese people in the form of an increase in these parameters. Obesity is, thus, found to affect the autonomic function tests.

New insights into NO adsorption on alkali metal and transition metal doped graphene nanoribbon surface: A DFT approach.

The aim of this article is to investigate the sensing performance of NO gas molecule on the graphene nanoribbon domain for the determination of structural and electronic properties. Effect of an alkali metal (lithium) and a transition metal (iron) on the armchair oriented graphene nanoribbon (ArGNR) surface for the sensing purpose of NO gas has been performed through the quantum mechanics based Density Functional Theory (DFT) calculations. Various configurations of ArGNR doped with Li and Fe atoms such as one-edge doped, center doped, both-edge doped Li-ArGNR and Fe-ArGNR have been simulated, and a detailed comparative study of lithium and iron doping on different configurations of ArGNRs for the adsorption energy, stability analysis, band gap analysis and density of states analysis has been quantitatively evaluated. By comparing the adsorption energy of NO, it is found that Li doping enhances the strength of NO adsorption on the different variants of ArGNR. Computational results predict that the undoped ArGNR is insensitive to the NO gas adsorption with adsorption energy of about -0.41 eV. Our results determine that substitutional doping of Li doping at one edge doped and both-edge doped position increases the adsorption abilities of ArGNRs in these configurations with adsorption energies of approximately -6.92 eV and -9.64 eV that is 16 and 23 times greater than the pristine ArGNR (Pr-ArGNR). Band nature for both type of doping estimates the changing behavior of ArGNRs from semiconductor to metallic transition after the adsorption of NO molecule. It is concluded that the Li doping at one edge and both edge position of ArGNR makes it an excellent potential sensing material for the sensing purpose of NO gas as compared to the Fe doped configurations.

The "Standing Cone" Flap for Thumb: A Spinoff the Hypogastric Flap in Combined Defects of Dorsum of Hand and Thumb.

Background: The management of combined defects of the dorsum of the hand and the thumb can be quite challenging. The conventional teaching has been to use more than 1 flap for such discontinuous defects of the hand. Methods: We present a novel technique to provide a reliable skin cover to a concomitant second defect over thumb, which otherwise would require an additional flap, by recruiting the excess skin available after closure of the primary flap donor site of the hypogastric flap being used for the defect on the dorsum of hand. We report a case series of 5 patients wherein this technique has been used successfully. Results: The modified technique was able to successfully manage the concomitant defects of the dorsum of hand and the thumb in 1 stage. Conclusions: We find this innovation can help cover 2 separate defects on dorsum of hand and the thumb in 1 stage by utilizing just 1 flap instead of the conventional method of raising 2 flaps for such defects.

Role of Fat Graft Alone versus Enriched Fat Graft with Stromal Vascular Filtrate in Painful Amputation Stump.

BACKGROUND: Traumatic amputations are very prevalent in today's world. Successful rehabilitation of an amputee largely depends on how well he/she adapt to prosthesis. However, because of poor scar characteristics, these patients often complain of pain while using prosthesis. Autologous fat graft is being vastly used all over the world to improve the scar of various etiologies. However, it has been associated with unpredictable resorption rate. OBJECTIVES: We report the results of the study which was done to assess the consequences of fat grafting over scars and to see its effects on pain management in amputated stump and compare the autologous fat graft with stromal vascular filtrate (SVF)-enriched fat graft for scar remodeling and pain modulation on amputation stumps. MATERIALS AND METHODS: A prospective randomized trial was conducted from July 2014 to December 2015. A group of ten patients, who were unable to wear prosthesis due to painful amputation stump, incorporated in the study and randomly distributed in two groups. Group A of five patients (case group) was treated with autologous fat graft enriched with SVF while Group B (control group) of remaining five patients was treated with fat graft alone. The results were assessed at baseline, at 1 month, and at 6 months postoperatively using patient and observer scar assessment scale (POSAS) score. Magnetic resonance imaging (MRI) was done to compare fat content preoperatively and 6 months postoperatively. RESULTS: All ten patients reported improvement in scar characteristics, most notably in pain in both scales of POSAS score. The improvement was comparable in both groups. However, the fat content in case group was significantly more in comparison to control group when assessed 6 months postoperatively using MRI scan. CONCLUSION: Autologous fat grafting is a viable and minimally invasive solution for painful amputation stump. Enrichment of fat graft with SVF can enhance its viability over long term. This study was done as a pilot project. Hence, further long term studies with large sample size are needed to ascertain the benefits observed in this study.

Studies on the Determination of Antioxidant Activity and Phenolic Content of Plant Products in India (2000-2017).

Background: Ayurveda, the traditional Indian therapeutic system, involves herbs and spices as drug ingredients and a kind of food intake regulation. The health and curative aspects of plant products are often ascribed to their antimicrobial and antioxidant activities (AA). However, it seems somewhat possible to correlate the AA of herbal extracts or plant isolates with their phenolic contents (PC). Objective: Indian researchers have carried out some tests for the determination of AA and PC of plant products that are worth mentioning. Methods: Among the herbal analysis techniques, the important contributions of Indians and people of Indian origin in this field include the remarkable separation of phenolic compounds, including the use of reversed-phase columns, on-line HPLC, the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay to effectively screen and identify antioxidant compounds from herbal extracts, and other chromatographic, spectrographic, and spectroscopic techniques, in the analysis of complex biological matrices. Results: The aim of this paper is to present an overview of such arguments with reference to herbal drugs and food intake regulation for specific ailments. Conclusions: The lack of uniformity in the use of test protocols for antioxidant assays (particularly using the DPPH free radical) and differences in in vitro mechanisms of antiradical activity and in vivo metabolism of polyphenols have been the issues associated with these experiments that have been raised by researchers in the period from 2000 onward.