Novel Asymmetric Y Design of Fascial Sling for Restoration of Oral Competence and Adequate Mouth Opening in Oral Commissure Defects Post-Malignancy Resection.

Reconstruction of through-and-through defects of cheek and commissure resulting from cancer resection are challenging. The specialized function of oral competence that the oral commissure and lip play is difficult to replicate with flap only reconstruction. Static slings play an important role in improving the functional and aesthetic outcome. The asymmetric "y" fascial sling helps in achieving the goals of oral competence along with adequate mouth opening. A total of 10 patients were operated by this technique. The results were satisfactory in terms of functional and aesthetic outcome postsurgery and were maintained 6 months postradiation.

Dermal Template for Superficial Defects Related to Intra Oral Malignancy.

Flaps are the workhorse reconstructive options for management of defects for oral malignancy. Superficial defects are traditionally managed with skin grafting or healing by secondary intention, each of which have its own problems. We would like to share our experience of use of dermal template for superficial intra oral defects related to oral malignancy. Patients with cancerous and pre-cancerous lesions which resulted in defects involving mucosa and superficial muscles were included in the study. All the patients were managed with Matriderm 2 mm dermal template without the use of skin graft/ flap. 7 patients in the period of 6 months with superficial defects were managed with Matriderm alone. Two patients had lesions on the tongue while five had it on Buccal mucosa. None of these patients had post operative pain, contracture or trismus. Speech and swallowing at 6 month average follow up is normal. Dermal Substitutes are effective method of management of superficial intra oral defects with no donor area morbidity.

Non-COVID-19 Cutaneous Mucormycosis from a Plastic Surgical Perspective.

Background Cutaneous mucormycosis is a rare and fulminant infection associated with high mortality. Plastic surgeons come across this infection in the settings of road traffic accidents, surgical site infections, and as a secondary infection with underlying bacterial soft tissue infections. Due to this infection's rarity and aggressive course, it is essential to initiate prompt multidisciplinary management at the first presentation. With this study, we aim to present a protocol for managing the condition. Methods This is a retrospective observational study of patients with cutaneous mucormycosis managed at a tertiary care hospital from January 1, 2016 to November 30, 2022 excluding patients with mucormycosis who tested positive for coronavirus disease 2019. Results Of 24 patients, 22 were males, and most were in the age group of 41 to 60 years. Sixteen patients survived and five out of eight deceased had comorbidities, six presented primarily without prior debridement, and six had trunk involvement. Conclusion A high index of clinical suspicion is necessary for early diagnosis and management of patients with invasive cutaneous mucormycosis. A multidisciplinary approach with appropriate medical and surgical management can improve outcomes in cases that otherwise carry a high mortality rate.

Successful Outcome of Post Liposuction Extensive Necrotizing Soft Tissue Infection of Abdomen and Concomitant Jejunal Perforation-A Case Report.

Introduction Liposuction is one of the common cosmetic surgery procedures performed. Although rare, the complications associated with it are necrotizing soft tissue infection and bowel perforation. We would like to share our experience of such a complication that was managed successfully. Case Report We were referred a 65-year-old male patient with signs and symptoms of intestinal obstruction who had undergone liposuction of abdomen 1 week before and now had discoloration of the abdominal skin. The discoloration was present from just below the costal margin and was extending up to bilateral inguinal regions. Laterally the discoloration extended up to the mid axillary line on both sides. Imaging studies showed dilated small bowel. During laparotomy, he underwent debridement of all discolored skin and repair of the single jejunal perforation. Postoperatively patient was first managed on intravenous fluids, nasogastric aspiration and total parenteral nutrition for 10 days. The wound was managed with silver dressings that led to healthy granulations. The patient was at high risk for anesthesia for skin grafting; hence, he was managed with allograft for 10 days. The patient then underwent skin grafting once he was fit. The graft took up well and he resumed regular activities. Conclusion This is unique as the patient had extensive necrotizing soft tissue infection of the abdominal skin after liposuction along with intestinal perforation and obstruction that was managed successfully due to aggressive surgical intervention, allograft, and good supportive care both in the intensive care unit and in ward.

Minimising the donor area morbidity of radial forearm phalloplasty using prefabricated thigh flap: A new technique.

Phalloplasty is indicated in various conditions of penile loss or absence. There are numerous techniques for phalloplasty including the pedicle and free flaps with the ultimate goal of micturition in standing position, attaining adequate size, aesthesis and sensations for sexual intercourse. Radial forearm phalloplasty is the gold standard flap to achieve above results but gives a very bad scar on the forearm. We present a technique of using prefabricated thigh flap to reduce the morbidity of donor area. The descending branch of lateral circumflex femoral pedicle was placed in a subcutaneous plane over tissue expander. After attaining an adequate size of flap with tissue expansion, it was delayed 3 weeks before phalloplasty. Prefabricated flap was thin and of large size replicating the radial forearm flap used for phalloplasty. Whole forearm defect was covered with the thigh flap, and the thigh could be closed primarily. This new technique of using prefabricated thigh flap has significantly reduced the donor site morbidity both aesthetically and functionally without the use of skin grafting in the whole procedure.

Replantation in scapulothoracic avulsion amputation of the right upper limb in a 3-year-old child- A preliminary report.

Replantations for major amputations of upper extremity have been widely performed. We report a unique case of successful replantation of scapulothoracic avulsion amputation in a child. In this manuscript, we discuss the various challenges faced during the procedure and chances of neural recovery.

A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect.

INTRODUCTION: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. MATERIALS AND METHODS: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. OBSERVATIONS AND RESULTS: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. CONCLUSION: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.

A simple and rapid method of repeated tie over dressing.

Tie overdressing is commonly used to secure the graft against the raw surface and prevent loss due to of hematoma or seroma. A conventional tie over dressing with silk sutures, is a useful method of securing the graft to raw area. Refixation is difficult when repeated tie over dressings are needed. We assessed a low cost repeated tie over dressing method using sterile sample collection containers and silk suture threads in eight patients. After the graft is applied on the bed, tie-over stitches are taken, and paraffin gauze is applied over with adequate padding; the tie over sutures are passed through the container and the lid is tightened over it to complete the dressing. The lid can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. The skin graft take in all the patients was complete without any seroma or hematoma. A novel and low-cost tie over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation is reported here.

Pedicle streaking: A novel and simple aid in pedicle positioning in free tissue transfer.

INTRODUCTION: The pedicle positioning in free tissue transfer is critical to its success. Long thin pedicles are especially prone to this complication where even a slight twist in the perforator can result in flap loss. Pedicles passing through the long tunnels are similarly at risk. Streaking the pedicle with methylene blue is a simple and safe method which increases the safety of free tissue transfer. MATERIALS AND METHODS: Once the flap is islanded on the pedicle and the vascularity of the flap is confirmed, the pedicle is streaked with methylene blue dye at a distance of 6-7 mm. The streaking starts from the origin of the vessels and continued distally on to the under surface of flap to mark the complete course of the pedicle in alignment. The presence of streaking in some parts and not in rest indicates twist in the pedicle. OBSERVATION AND RESULTS: Four hundred and sixty five free flaps have been done at our centre in the last 5 years. The overall success rate of free flaps is 95.3% (22 free flap failures). There has not been a single case of pedicle twist leading to flap congestion and failure. CONCLUSION: This simple and novel method is very reliable for pedicle positioning avoiding any twist necessary for successful free tissue transfer.

Body contouring surgery in a massive weight loss patient: An overview.

The number of patients with history of extreme overweight and massive weight loss (MWL) has risen significantly. Majority of patients are left with loose, ptotic skin envelopes, and oddly shaped protuberances, subsequent to weight loss. Redundant skin and fat can be seen anywhere on the body following MWL. This group of population presents many unique problems and challenges. Body contouring surgery after MWL is a new and exciting field in plastic surgery that is still evolving. Conventional approaches do not adequately cater to the needs of these patients. Complete history, detailed physical examination, clinical photographs and lab investigations help to plan the most appropriate procedure for the individual patient. Proper counseling and comprehensive informed consent for each procedure are mandatory. The meticulous and precise markings based on the procedure selected are the cornerstones to achieve the successful outcome. Lower body contouring should be performed first followed six months later by breast, lateral chest and arm procedures. Thighplasty is usually undertaken at the end. Body contouring operations are staged at few months' intervals and often result in long scars. Staging is important as each procedure can have positive impact on adjacent areas of the body. Secondary procedures are often required. However, proper planning should lead to fewer complications and improved aesthetic outcome and patient satisfaction.