Isolated intramuscular cysticercosis of the forearm masquerading as malignancy.

A woman in her mid-20s presented to an Indian tertiary care hospital with pain in her left forearm. Extensive initial investigations led to a suspected diagnosis of a peripheral nerve sheath tumour; however, the pathological investigation of the excised tumour mass revealed it to be a case of isolated intramuscular cysticercosis in the forearm. Treatment for cysticercosis was commenced and the patient made a full recovery. Isolated intramuscular cysticercosis without the involvement of other organs is a rare presentation and has only been reported in a handful of case reports. We suggest that isolated intramuscular cysticercosis be considered a differential diagnosis in patients with isolated pain in their muscles and with no other symptoms, in patients with a presentation of solitary swelling and in patients at risk of parasitic infection. In addition, we emphasise the importance of histopathological examination due to the varied presentation of cysts.

Non-perforated Traumatic Pneumoperitoneum in Maxillofacial Trauma: A Compelling Case Report.

Pneumoperitoneum typically results from intraabdominal gas due to gastrointestinal perforation, with exploratory laparotomy serving as the standard management. While non-surgical causes are well established, instances where pneumoperitoneum lacks an identifiable cause even after laparotomy are sparsely documented. Here, we present a case involving a 22-year-old male who, following a high-velocity road traffic injury resulting in a panfacial fracture, exhibited gross subcutaneous emphysema in the neck, pneumomediastinum, and pneumoperitoneum. This report aims to contribute to the growing understanding of such cases, potentially leading to the development of a management protocol that may help avoid unnecessary laparotomies in similar scenarios.

Bulldog Scalp Syndrome.

Bulldog scalp syndrome or cutis verticis gyrata (CVG) is a rare cutaneous disorder with an incidence of just 0.026 to 1 per 100,000 population and cosmetic problems should not be ignored as they can affect the quality of life of patients in social and psychological aspects. In CVG the scalp thickens to form folds resembling sulci and gyri just as the skin fold of bulldog. It is a clinical diagnosis with various etiologies. It is classified as primary essential or nonessential and secondary CVG. It can manifest with symptoms ranging from mild to severe intensity. Cosmetic problems are the major concern that can affect patients' social and psychological health. If the folds are heavy, they can cause mass symptoms. Thus, surgery remains the definitive treatment option for improving the cosmetic appearance. Both our cases have different etiologies, however, were managed surgically with removal of skin folds (gyrae) and scoring of aponeuroses of the scalp followed by stretching of the scalp and closure to improve appearance. The surgical team as well as patients were satisfied with the appearance of the scalp after healing. CVG though a rare disease with various etiologies is a benign condition with good prognosis with no reports of malignant transformation so far.

Data-Driven Enhancements: Unleashing the Power of Data Science in Plastic Surgery.

Plastic surgery is a specialized field of medicine that focuses on reconstructing, restoring, or enhancing a person's appearance through surgical procedures. Over the years, data science has become increasingly relevant in this domain, offering valuable insights and innovations that can improve patient outcomes, enhance surgical techniques, and drive advancements in the field. Data science has revolutionized the field of plastic surgery by providing valuable insights, predictive models, and innovative tools that enhance surgical planning, patient outcomes, and research advancements.

Precision and Progress: Machine Learning Advancements in Plastic Surgery.

Machine learning has emerged as a powerful tool in various healthcare domains, and its application in plastic surgery has shown significant promise. Plastic surgery aims to enhance and reconstruct physical appearance and function, making it an ideal field for integrating machine learning techniques. This abstract presents an overview of the applications, challenges, and potential benefits of machine learning in plastic surgery. One of the key areas where machine learning has been applied is in the preoperative assessment and surgical planning process. By analyzing large datasets of patient images and clinical data, machine learning algorithms can assist plastic surgeons in predicting surgical outcomes, identifying optimal surgical techniques, and minimizing potential complications. These algorithms can learn from past cases and provide valuable insights to improve surgical decision-making and optimize patient care. Furthermore, machine learning has shown promise in facial recognition and analysis, which is crucial in plastic surgery procedures involving the face. Algorithms can accurately detect facial landmarks, assess facial symmetry, and simulate potential surgical outcomes. This technology gives plastic surgeons a more comprehensive understanding of the patient's facial structure and aids in designing personalized treatment plans. Additionally, machine learning algorithms have been employed to automate the analysis of large-scale clinical databases, assisting in identifying patterns, risk factors, and treatment outcomes. By leveraging these algorithms, plastic surgeons can gain valuable insights into patient populations, surgical trends, and postoperative complications. This information can inform clinical decision-making, improve patient safety, and enhance the overall quality of care. Despite the numerous advantages, several challenges need to be addressed when integrating machine learning into plastic surgery. These include the need for high-quality and diverse datasets, algorithm interpretability, ethical considerations, and regulatory compliance.

Artificial Intelligence Revolutionizing Plastic Surgery Scientific Publications.

The integration of AI in plastic surgery scientific publications is revolutionizing the field by enabling efficient data analysis, improving surgical planning, predicting outcomes, and facilitating evidence-based advancements. The ongoing collaboration between AI researchers and plastic surgeons promises to enhance patient care, increase surgical precision, and drive innovation in plastic surgery practice.

Modified Combined Physiological and Debulking Procedure for Lower Limb Lymphedema to Achieve Both Immediate and Sustained Results in Lymphedema.

A 17-year-old girl presented with bilateral lower limb lymphedema since 3 years. Lymphedema in the right leg was Grade III, not pitting and not reducing in size after limb elevation. She hailed from a tribal community. Considering her young age, a single-stage operative procedure for her lymphedematous leg was followed, as she was not prepared for a multistaged operation. However, this operative procedure needed to be a combination of both, debulking and physiological procedures, so as to give her immediate limb girth reduction as well as reduction in recurrence, as seen with debulking procedures. We report a newer technique that could achieve both goals.

Salvage of Injured Lower Limb and Improvement of Quality of Life of a 1½-Year-Old Child.

We present a case of left proximal femoral artery transection injury in 1½-year-old male child due to a fall over a bike handle after sustaining a road traffic accident. He was presented to the emergency room with a cut proximal end of the left femoral artery and a fracture upper end of the shaft of the femur seen at the wound site. Following initial resuscitation, the patient was planned for wound exploration, fracture stabilization, and femoral artery repair which were executed, and salvage of the lower limb of 1½-year-old child was achieved. We conclude that teamwork, training, and experience in repairing pediatric vessels and timely pediatric vascular repair play a pivotal role in the salvage of a limb and improvement of the quality of life of a child.

The prospective study of change of perception of postgraduate students on objective structured clinical examination in burns and plastic surgery.

BACKGROUND: In this study, we attempted to assess the change of perception of postgraduate students on objective structured clinical examination (OSCE) in burns and plastic surgery after first five OSCE. METHODS: A prevalidated feedback questionnaire was used to assess and score the perception of postgraduate students on OSCE in burns and plastic surgery. The opinion of postgraduate students on the feedback questionnaire after first and fifth assessment tests based on OSCE was analyzed. The results were compiled on a data sheet and analyzed using Microsoft Excel and plotted as graphical interpretation. The statistical analysis was done using MedCalc software. RESULTS: The results of the study showed that there is a positive change in perception of students in favor of monthly assessment based on OSCE in burns and plastic surgery after fifth assessment. The mean students' favorable perception score after the first assessment with was 30.2 ± 2.828 (mean ± standard deviation [SD]) and after fifth assessment, 43 ± 2.828 (mean SD) with Student's test t = 10.119 and P < 0.0001 which is highly significant statistically in favor of OSCE after fifth assessment. CONCLUSIONS: We observed in our study that the monthly assessment based on OSCE is well accepted by the students of our subspecialty after few assessments; however, further studies are required to augment the evidence.

Management of Ulnar Nerve Tuberculoma: A Challenge to Plastic Surgeons.

Tuberculoma is a well-circumscribed, space-occupying lesion. However, the involvement of peripheral nerves is rare. Here, we report a rare case of left ulnar nerve tuberculoma managed by surgical exploration and tangential excision of tuberculoma lesion sparing, most of the nerve fibers followed by antitubercular treatment. The patient responded well to the management strategy with improvement in motor and sensory activity of the affected limb.

Harmonic Lingual Frenotomy for Ankyloglossia: A Newer Novel Technique.

The objective of this is to report a newer novel technique of harmonic scalpel frenotomy, a day care procedure under local infiltration anesthesia that could achieve quick bloodless adequate ankyloglossia release and excellent healing with subsequent improved articulation and speech. The procedure was performed, patient followed up for six months and excellent results noted. A 37-year-old male patient presented with type II ankyloglossia on Coryllos ankyloglossia grading scale and class III on Kotlow's assessment. A quick bloodless frenotomy with adequate release of ankyloglossia was achieved using harmonic scissors. Patient experienced no discomfort. Patient was observed for two hours and discharged the same day with chlorhexidine mouth gargles and analgesics. Postoperative healing was excellent with adequate tongue protrusion and improvement in articulation and speech. We report this newer novel technique of harmonic scissors frenotomy, a day care procedure under local infiltration anesthesia, that achieved quick bloodless adequate ankyloglossia release, excellent healing and evident improvement in articulation and speech.

Various Options for Scrotal Reconstruction: A Prospective Observational Study.

Background Scrotal defects in developing countries are common challenges for the reconstructive surgeon and hence this work has been done with the aim to compare the outcome, advantages and disadvantages of different modalities of scrotal reconstruction. Methods The prospective observational hospital-based study of reconstruction of scrotal defects following trauma and Fournier's gangrene was done over a period of three years. Scrotal defect reconstruction was done in 35 patients by scrotal advancement flap, split thickness skin grafting, medial thigh flap, anterolateral thigh flap and groin flap keeping in mind the various indication of different modalities. The reconstructed scrotums were observed for flap survival and skin graft intake for seven to 10 days in the hospital and then were followed for three months in a follow-up clinic. Results and observations The mean age of our patients was 48.57±5.01 years. Most of the soft tissue defects of the scrotum were post-traumatic (83%). Scrotal reconstruction was done often by flaps and more frequently used flap for reconstruction of scrotum was scrotal advancement flap. All flaps and grafts survived well. Mean hospitalization time was highest for groin flap cover whereas mean operative time was highest for anterolateral thigh flap cover. Conclusion Every case of scrotal defect needs an individual approach for scrotal reconstruction depending upon patient age, general condition of the patient, wound status, and the patient's requirement.

Immediate Versus Late Flap Coverage for Traumatic Soft Tissue Defects of Lower Extremity: A Comparative Observational Study.

Background The lower extremity trauma in patients often gets operated on late for the wound coverage and is associated with more health costs and other resources. Therefore, this study has been conducted to compare the outcome in terms of flap survival, complication rates, and hospital stay between immediate and late flap coverage of lower extremity traumatic wounds. Methods The comparative analysis of outcome is done in terms of flap survival, complication rates, and hospital stay after immediate and late flap coverage of 25 (n = 25) patients of lower extremity traumatic wounds in each group. The patients were observed, and data obtained were tabulated in a Microsoft Excel spreadsheet. The statistical analysis was done using IBM SPSS (V26.0, IBM Corporation, Armonk, NY, USA) statistical software. The chi-square test was used for descriptive data and the student's unpaired t-test for discrete-continuous data analysis. The p-value of less than 0.05 is considered significant. Results The mean defect size with SD in the immediate flap cover group is 54.5 ± 29.5 cm2, while in the late flap cover group, it is 85 ± 65 cm2 with a significant p-value of 0.0378. The mean flap size with SD in the immediate flap coverage group is 70.5 ± 34.5 cm2, while in the late flap coverage group, it is 117 ± 87.5 cm2, and the difference is statistically significant. The mean hospital stay with SD in the immediate flap coverage group is 7.5 ± 2.5 days. In contrast, in the late flap coverage group, it is 29.5 ± 8.5 days, and the difference is statistically very significant. Conclusion There are equivalent results in patients undergoing immediate and late flap coverage for the traumatic soft tissue defects of the lower extremity. There is a significant decrease in the hospital stay after immediate flap reconstruction, which subsequently reduces both direct and indirect health costs. However, there is a larger size flap requirement in cases of immediate lower extremity wound coverage.

Photogrammetric Anthropometry to Determine the Female Waistline.

BACKGROUND: In this study, we attempted to develop a reference guide to determine the female waistline based on the golden ratio for waist sculpting in females, which may help in waist sculpting by liposuction or non-invasive techniques. MATERIAL AND METHODS: To understand the anatomy of the waist, we studied the 60 photographs of females and measured the distances between important anatomical landmarks. The different values and proportions obtained were compared between different groups of heights and two groups of BMI using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) through analysis of variance (ANOVA). RESULTS: There is a golden ratio in the distances between xiphoid to waist and waist to the abdominal crease that is close to 1:1.66, and the waist is at the junction of the upper 2/5th and lower 3/5th of the height from xiphoid to abdominal crease. The location of the waist is at one-third of the whole length of the abdomen (the whole length of the abdomen being the length from the xiphoid to the pudendal cleft). CONCLUSIONS: We observed in our study that there is a definite mathematical relationship between the length of the abdomen and the waist position, which may be applied for female waist sculpting.

Free Vascularized Supraclavicular Autologous Heterotopic Lymph Node Transfers Without Skin Paddle for Lymphedema Lower Limb.

Free vascularized lymph node transfer (VLNT) is one of the new and highly efficacious procedures in the cases of lymphedema. In this case, we present a case of lower-limb lymphedema which was managed by this procedure where a supraclavicular LN was harvested and transferred to the lower leg. VLNT from the supraclavicular region is a very effective treatment for physiological restoration of the lymphatic flow in established cases of lower-limb lymphedema because of well-hidden favorable scar and minimal chances of secondary iatrogenic lymphedema in the donor region unlike other sites such as groin and axilla. The VLNT should be preferred over manual lymphatic drainage because it is very effective treatment for physiological restoration of the lymphatic flow, however, the further analytical studies are required to confirm statistically the effectiveness of the same over other modalities.

The COVID-19 pandemic impact on clinical load of plastic and reconstructive surgery in a tertiary care hospital of north India: A retrospective comparative analysis.

BACKGROUND: The objective of the study was to analyze and determine statistically significant impact of the COVID-19 on clinical load of plastic and reconstructive surgery practices. MATERIALS AND METHODS: The retrospective analysis and comparison of the number of patients visiting to outpatient clinic, number of patients admitted, number of patients operated in the plastic and reconstructive surgery department during the COVID-19 pandemic months of January 2020-June 2020 with the same months of preceding non-COVID-19 year was done. The data obtained were tabulated in Microsoft Excel spread sheet and the statistical analysis done using MedCalc statistical software. RESULTS: The mean ± standard deviation of patients attended in outpatient department (OPD), admitted in inpatient department (IPD), emergency surgeries performed, and elective surgeries performed during -COVID-19 versus COVID-19 pandemic period is (651.167 ± 310.42 vs. 212.5 ± 307.591), (83.5 ± 16.263 vs. 34.333 ± 53.74), (5.167 ± 4.243 vs. 3.333 ± 4.95), and (74.333 ± 28.284 vs. 40.833 ± 60.811), respectively. The difference in means is highly significant statistically in the number of patients attended in OPD, admitted in IPD, and elective surgeries performed during pre-COVID versus COVID period; however, the difference in the means is not statistically significant in the number of emergency surgeries performed during pre-COVID versus COVID period. CONCLUSION: The COVID-19 pandemic has significantly reduced the number of patients attended in OPD, admitted in IPD, and elective surgeries performed in the department of plastic surgery. However, there is a reduction in number of emergency surgeries but statistically insignificant. The strategy is to use telemedicine portal e-Sanjeevani services for OPD, encourage admission of patients with reverse transcription polymerase chain reaction negative for COVID-19, and perform reconstructive and esthetic plastic surgery operative procedures using COVID-19 appropriate precautions.

A novel modification of Bardach's two-flap palatoplasty for the repair of a difficult cleft palate.

Bardach described a closure of the cleft utilizing the arch of the palate, which provides the length needed for closure and is most effective only in narrow clefts. Herein, we describe a case where we utilized Bardach's two-flap technique with a vital and easy modification, done to allow closure of a wide cleft palate and to prevent oronasal fistula formation at the junction of the hard and soft palate, which are otherwise difficult to manage with conventional flaps. The closed palate showed healthy healing, palatal lengthening, and no oronasal regurgitation. We advise using this modification to achieve the goals of palatal repair in difficult cases where tension-free closure would otherwise be achieved with more complex flap surgical techniques, such as free microvascular tissue transfer.

Acquired Periungual Fibrokeratoma Looks like a Supernumerary Digit: An Uncommon Soft Tissue Tumor.

Acquired digital fibrokeratoma is an uncommon, benign fibrous tumor that usually occurs in adults as a solitary lesion with a typical size of less than 1 cm. We present a case with periungual growth and nail plate deformity. The growth was completely excised after raising the epinychial flap and the fold was reconstructed. The histological results confirmed the digital fibrokeratoma. The rarity of digital fibrokeratoma and its unique morphological appearance of the tumor makes it interesting. Acquired periungual fibrokeratoma, an uncommon benign fibrous tumor of an unknown etiology, typically found at the distal end of the digits, may present with nail plate deformation due to chronic pressure, and in order not to damage the matrix, the tumor should be excised carefully, which can cause permanent nail dystrophy. In addition, we emphasize the importance of ruling out other causes of abnormal growths and of considering fibrokeratoma during differential diagnoses.

Plaster Burn: Challenge to Plastic Surgeon.

BACKGROUND: The thermal burn is accidental and also is the hidden and worst complication of medical plaster application. This study evaluated clinical and aetiological profile and severity of plaster burns. METHODS: In Department of Burns, Plastic and Reconstructive Surgery from 1st August 2014 to 31st December 2015, six patients with plaster burn were assessed for total body surface area and depth of burn. The wounds were cultured and dressed with moist dressings daily till the surgical procedure and satisfactory healing. RESULTS: The youngest patient was 10 and oldest 65 years (mean age: 40.20±6.67 years, 4 males and two females with ratio of 2:1). Three patients sustained plaster burn injury accidentally at home and 3 developed burn after medical application of plaster. The hands burns were observed commonly in accidental plaster burns, while ankle was often involved in iatrogenic plaster burns. The iatrogenic burns were mostly deep in thickness varying 2nd to 4th degree, while accidental burns were often 2nd degree. Superficial 2nd degree burns were managed conservatively, and deep 2nd degree burns were skin grafted. Fourth degree burn was managed with reverse sural flap alone and another with vacuum-assisted closure followed by reverse sural flap and skin grafting. CONCLUSION: Plaster burn is still a challenge to plastic surgeon and it is advised for applying casts to utilize all available means to limit the amount of casting material provided. It can be accomplished without compromising the cast strength to minimize the risk of thermal injury when applying plaster or composite casts.

The Effect of Oral Propranolol versus Oral Corticosteroids in Management of Pediatric Hemangiomas.

BACKGROUND: Hemangiomas are the most common benign tumors of infancy. This study evaluated the efficacy of oral propranolol comparing to oral steroids in management of pediatric hemangiomas. METHODS: In North India from January 2012 to January 2015, sixty children <6 years old with superficial hemangiomas were divided into 2 groups; oral propranolol vs. oral prednisolone. All participants were assessed for electrocardiogram, heart rate, blood pressure and sugar and initial therapy was started using 1 mg/kg and in absence of adverse effects, 2 mg/kg was administered after 2 weeks. The hemangioma Activity Score (HAS) was used for scoring and patients were followed up for 6 months. RESULTS: The propranolol group mostly showed early response to the drug and needed the drug for less time compared to corticosteroid group. In propranolol group, 16.5%, 23% and 59% needed the drug to be continued for 8-12, 4-8 and 4 months. In corticosteroid group, the therapy was continued for 8-12, and 4-8 months in 76.8% and 16.5% and in 6.6% was stopped within 4 months. In propranolol group, the response was 70% compared to 40% in other group. The mean HAS decreased significantly in propranolol group when compared to steroid group. Three patients on prednisolone developed Cushingoid features, while 1 patient in propranolol group had mild flue like symptoms. CONCLUSION: Two mg/kg of oral propranolol significantly decreased HAS, when compared to oral prednisolone, with good parent satisfaction, minimal adverse effects and no recurrence/relapse of hemangiomas after a follow up period of 6 months.