Maxillary Melanotic Neuroectodermal Tumour of Infancy Managed by Local Excision.

Tumours of the children involving the head and neck region are seen infrequently. Melanotic Neuroectodermal Tumor is an uncommon tumour of infancy involving the head and neck region typically. The case report describes a cheek swelling in an infant which on investigation was confirmed to be a Maxillary Melanotic Neuroectodermal tumour, subsequently subjected to excision and doing well on follow up.

Hyperbaric oxygen therapy as an adjunct to the standard wound care for the treatment of diabetic foot ulcers in Indian patients: a cost utility analysis.

BACKGROUND: Diabetic foot ulcer (DFU) is a common complication of diabetes. Hyperbaric oxygen therapy (HBOT) is an adjunct treatment that expedites the healing of DFU. AIM: To evaluate the cost-utility of using standard wound care (SWC) plus HBOT as compared to SWC alone for the treatment of DFU from a societal perspective in the Indian context. METHOD: A Markov decision analysis model comparing SWC with and without HBOT was developed. Data for the model were derived from relevant literature and secondary data from India. The main outcome measures were minor and major lower extremity amputations (LEA) averted, incremental quality-adjusted-life-years (QALY) gained, incremental costs, incremental cost-effectiveness ratio (ICER) per amputation averted and ICER per QALY gained. Sensitivity and threshold analyses were also done. RESULT: HBOT, when added to SWC, lowered the proportion of minor LEA and major LEA among patients with DFU by 6.1% and 4.2%, respectively. The discounted ICER was INR 193,939 [95% CI: 186,745-203,753] or US$ 2,621 [95% CI: 2,524-2,753] per QALY gained. CONCLUSION: SWC plus HBOT is not cost-effective in India. Additional information is required on patient experiences with adjunctive HBOT, if it were to be adopted as the standard of care in India.

Flaps in adult urethrocutaneous fistula repair: a report of two cases with the review of literature.

Urethrocutaneous fistula (UCF) poses a challenge to the reconstructive urologist in terms of its location, patient's expectations, availability of tissues for interposition, wound infection and chances of recurrence. Also, patient-related factors, such as uncontrolled diabetes, local surgery with extensive tissue loss, prior history of radiation, poor nutritional status and presence of any distal obstruction in the urethra severely affect the outcomes of a good repair with vascularised flap. We report two cases of UCF repair in adults using scrotal and gracilis muscle flaps (GMFs), their anatomic basis, technicality and advantages. The scrotal flap was used in the first case where it was freely available and GMF in second case where the patient had already undergone extensive local tissue debridement for Fournier's gangrene and hence, we had to look for a distant flap for protection of the UCF repair. Both patients had an uneventful recovery, there were no early or late treatment-related complications and follow-up after the third and sixth month of surgery revealed no recurrence and the patients are voiding well.

Vision and Ocular Surface Salvage in Extreme Postburn Cicatricial Ectropion With Infectious Exposure Keratitis.

Prevention and early management of postburn cicatricial ectropion is the best strategy to avoid ocular complications, with poor visual prognosis in extreme cases. A 51-year-old man presented with diminution of vision and absolute inability to close both eyes, 3 months after thermal burn injuries to face, upper limbs, and trunk. His best corrected visual acuity (BCVA) was 1/60 in BE. He had bilateral extremely severe ectropion involving both upper and lower lids with complete inability to close the eyes. The ensuing exposure keratitis developed secondary infection by Methicillin-resistant Staphylococcus aureus (MRSA) in the right eye and multidrug-resistant Pseudomonas aeruginosa in the left eye. His extreme ectropion prevented infection healing, so its release and full-thickness skin grafting was done when partial resolution of infection was noted. After 3 months, he had moderate residual ectropion in BE; vascularized corneal scar in the inferior part of the right eye (BCVA:20/40) and adherent leucoma in left eye (BCVA:HM). Prioritizing ectropion surgery in our extreme case for infection control, facilitated corneal healing. Our case highlights the extreme consequences of not taking preventive measures or of managing incident ectropion following thermal injury to the face.

Intense pulsed light vs silicone gel sheet in the management of hypertrophic scars: an interventional comparative trial in the Indian population.

Introduction: Hypertrophic scars are abnormal scars that are a source of great functional, psychological and financial burden to the patient. Currently available treatment modalities are either very cumbersome to use or have not provided very satisfactory results. Intense pulsed light (IPL) therapy for the management of hypertrophic scars has been recently introduced. However, most of the studies available are from the Western population. In this trial, we aim to study the effect of IPL on the South Indian population with darker skin and compare it with an existing treatment modality (silicone gel sheet). Materials and Methods: This trial was an interventional clinical trial conducted from September 2015 to March 2017 on 28 patients with 65 hypertrophic scars. Each scar was divided into 2 equal parts (4.6 x 1 cm2). One half of the scar was treated to 4 sessions of 29J/cm2 of IPL at 3 weekly intervals. A silicone gel sheet (SGS) was applied over the other half and changed at 3 weekly intervals. The Vancouver scar scale was used to grade both halves of the scar before treatment, at each visit and 3 weeks after treatment completion. Results: Scars treated with IPL showed a significant reduction in the pliability (p=0.002) and hyperpigmentation (p=0.000) as compared to scars treated with SGS. Though the percentage reduction in the height of the scar was more in the IPL group (15.4% as compared to 4.6%in the SGS group), the result was not statistically significant (p<0.065). As most scars in our study showed normal vascularity at the beginning, the percentage reduction in vascularity between both groups was the same (p<0.597). The reduction in the median VSS score was more in the IPL group compared to SGS group (p=0.00). Conclusion: IPL therapy offers a safe and effective means of hypertrophic scar treatment, especially on large scars where other treatment modalities may not be feasible. Minimal side effects that occur can be prevented with proper pre, intra and post procedure cooling.