Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap.

Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

Coronary artery plaque characterization using MDCT in symptomatic and asymptomatic subgroups of diabetic and non-diabetic population-a comparative retrospective study.

AIM: The study was designed with the aims to evaluate the use of multidetector CT (MDCT) in coronary plaque detection and characterization in diabetic and non-diabetic subjects. Further, to compare the plaque morphology and composition in diabetic and non-diabetic patients in both symptomatic and asymptomatic subgroups. METHODS: We performed CT coronary angiography (CTCA) of 100 patients, out of which 50 had type II diabetes and further subdivided into symptomatic and asymptomatic groups. For every patient, we mapped the disease with different grades of coronary artery disease (CAD), the number of plaques, and histological types of plaques, as well as different atherosclerotic scores were derived to assess the severity and extent of CAD. RESULTS: The total number of assessable segments was 1410 (96%). The symptomatic diabetic patient had a higher prevalence of significant CAD. Coronary, atherosclerotic, and extent scores showed significant difference in diabetic patients as compared to non-diabetic (p < 0.0181, < 0.0125, < 0.0043) whereas severity score was insignificant (p < 0.0627). There was a significant difference in all the scores in symptomatic diabetic and symptomatic non-diabetic subgroups. Further, no difference was observed in the asymptomatic subgroup. Diabetic patients harbor twice the plaque volume as compared to non-diabetic. Vulnerable plaques were more prevalent in asymptomatic patients with intermediate grade stenosis. CONCLUSIONS: CTCA plays a pivotal role in the risk stratification. Diabetic patients were found have intermediate grade stenosis and higher load of both stable and vulnerable plaques than non-diabetics. Furthermore, the percentage of vulnerable plaque was higher in asymptomatic group as compared to symptomatic patients.

Squamous cell carcinoma of the penis and scrotum in a patient with chronic scrotal and penile lymphedema.

Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.