Functional and aesthetic outcome of different methods of reconstruction of full thickness lip defects.

Background: The lip has functional and aesthetic importance. Lip defects occur due to the variety of etiology and the choice of their reconstruction has profound effect on functions and cosmesis. There are multiple options available for reconstruction according to defect size, but superiority of one method over another is still debated and hence the methods and their outcome were analyzed prospectively. Material and method: Twenty-one patients with all sizes and locations of defects in upper and lower lip with acquired etiology were included in the evaluation. Reconstruction was performed according to defect size, availability of local/regional and distant donor tissue, defect location, patients' comorbid conditions and patients' preference. Patients were assessed at 1 month and 6 months postoperatively. Observers' and patients' input were also taken into account for outcome. Results: Out of 21 patients, 5 free radial artery forearm flap reconstructions, 4 nasolabial flap reconstructions, 5 primary closures of defect, 4 Estlander flap reconstructions, 2 lip advancements, and one Karapandzic flap reconstruction were done. Free flap and nasolabial flap had hypoesthesia and incompetence if commissure is reconstructed and problem of bulk, restricted mobility and vermilion mismatch. Local and lip flaps were associated with decreased stoma size and some form of local scarring and asymmetry. However, all patients were satisfied with the functional and aesthetic outcome. Conclusion: Local flaps are better in terms of functional and aesthetic outcome but with some degree of microstomia which was well tolerated by most patients. Regional and distant flaps provide reconstruction where no other option is available and provide good functional support and acceptable cosmesis.

An Evaluation of Different Bridging Techniques for Short Nerve Gaps.

BACKGROUND: In this study, we investigated sensory and motor outcomes for different bridging techniques for short nerve gaps. MATERIAL AND METHODS: This study was conducted in the Postdoctoral Department of Burns, Plastic, and Reconstructive Surgery of our institution from August 2014 to May 2017. All patients with posttraumatic short nerve gaps of 3 cm or less of median, ulnar, and/or both in forearm and wrists were included in the study. Patients with known causes of neuropathies were excluded. Groups 1, 2, 3, and 4 included 9 patients each, and the nerve gap was managed with reverse sural nerve autograft, inside-out vein conduit autograft, reverse sural nerve with covering inside-out vein autograft, and inside-out great saphenous vein autograft filled with denervated gastrocnemius skeletal muscle autograft, respectively. All the patients were followed-up and examined for sensory and motor recovery with a 2-point discrimination test (2PD) at finger tips in the distribution of reconstructed nerves and medical research council scale (MRCS) for muscle power innervated by the reconstructed nerves. The 2PD and MRCS muscles were compared between the groups using SPSS version 23 through 1-way analysis of variance. RESULTS: All the patients in each group recovered either completely or partially. The 2PD and MRCS muscle power means were compared between the groups. On comparing the mean 2PD and mean MRCS muscle power were compared between the groups using 1-way analysis of variance test. All the groups have been found statistically comparable in spite of the apparent clinical difference. CONCLUSIONS: Although the nerve autograft is the criterion standard for managing the nerve gaps, the vein conduit is a viable alternative to nerve autograft for bridging the nerve gaps 3 cm or less, whereas filled conduit needs more study. However, more patients need to be studied to complete a relevant statistical study.

Hand Injuries by the Killer Kite Manja and Their Management.

Although hand injuries due to kite strings seem to be trivial, these injuries could be serious enough to lose the function of hand. This case series in the division of Plastic and Reconstructive Surgery of our institution from August 2014 to January 2016 evaluated the clinic-etiological profile, severity and management of hand injuries due to kite strings assessed clinically and radiologically. Eleven patients reported kite related injuries during two years, and 5 presented during 17 months. Of 11 patients, 8 were male and 3 were female with a M:F ratio of 2.66:1. The majority of patients presented with the mean age of 19.9±4.27 years. Eight patients presented acutely to the emergency while 3 believed the injury to be trivial and had delayed presentation. Injuries in the right hand were 8 and 3 in the left hand. Seven patients had injuries in zone II of the hand while 4 presented with zone III injuries. Total number of injured digits was 14 (1.4±1.11), total number of injured tendons was 26 (2.36±2.18), only one patient had nerve injury (mean=0.09), and no patient had any major vessel injury. So strict attention to safety measures and parental/guardian supervision while flying kites can avoid many preventable injuries to life and limb and also let the sport be an enjoyable and safe.

A comparative study on evaluation of role of 1.5 mm microplates and 2.0 mm standard miniplates in management of mandibular fractures using bite force as indicator of recommendation.

AIMS AND OBJECTIVES: To compare the maximum voluntary bite force generated at different periods during mandibular fracture healing using miniplates and microplates as means of rigid internal fixation. MATERIALS AND METHODS: Maximum voluntary bite force was recorded in healthy young individuals of different age group from either gender. Patients suffering from symphyseal and parasymphyseal and body fractures were selected and randomly treated using miniplate and microplate osteosynthesis by open reduction and rigid internal fixation. Postoperative bite forces at intervals of 1st, 2nd, 4th, and 6th week were recorded and compared with control group. OBSERVATIONS AND RESULTS: It was noticed that bite forces were significantly reduced in the study groups in comparison to control group and at different intervals of treatment. There was a progressive improvement in the bite force with passage of time. There was no statistical significance in the observed bite force in both the study groups at different intervals of assessment. CONCLUSION: 1.5 mm microplates provide adequate stability comparable to miniplates for the treatment of fractured mandible and should be preferred over miniplates. We further suggest that bite forces should be considered for the assessment of clinical union of bone as well as studies pertaining to selection of hardware for rigid internal fixation.

Myopericytoma of lip: a rare lesion in an unusual location.

Myopericytoma is a rare benign tumor with perivascular myoid differentiation. It shares histomorpholoic features with the so-called hemangiopericytoma, myofibroma and glomus tumor. We hereby report the case of a 14-year-old boy who presented with a slowly growing, painless, firm mass on upper lip, diagnosed as myopericytoma on the basis of histopathology and immunohistochemistry. To the best of our knowledge, this is only the second such reported case.

A large proliferating trichilemmal cyst masquerading as squamous cell carcinoma.

Proliferating trichilemmal cyst (PTC), a rare benign tumor, is a fascinating follicular neoplasm. It occurs on head and neck region of elderly women and its histologic hallmark is trichilemmal keratinization. A 70-year-old female presented to skin outpatient department with complaints of a slowly growing mass on scalp for the past 2 years. On examination, the lesion was firm, mobile, painless, and measured 6 × 5 × 3 cm and was not fixed to the underlying bone. Laboratory investigations were unremarkable. Excisional biopsy was done. Histopathology revealed well-demarcated tumor with variably sized lobules of squamous epithelium undergoing an abrupt change into eosinophilic amorphous keratin without granular cell layer (trichilemmal keratinization). PTC should be differentiated from trichilemmal cyst as it has potential for malignant transformation. Thus, complete excision is recommended for all benign proliferating variants owing to their potential for locally aggressive behavior and malignant transformation.

Versatility of pedicled tensor fascia lata flap: a useful and reliable technique for reconstruction of different anatomical districts.

Aims and Objectives. The aim of this study was to evaluate the versatility of pedicled tensor fascia lata flap for reconstruction of various anatomical regions. Materials and Methods. In this retrospective study a total of 34 patients with defects over various anatomical regions were included. The defects were located over the trochanter (n = 12), groin (n = 8), perineum (n = 6), lower anterior abdomen (n = 6), gluteal region (n = 1), and ischial region (n = 1). The etiology of defects included trauma (n = 12), infection (n = 8), pressure sores (n = 8), and malignancy (n = 6). Reconstruction was performed using pedicled tensor fascia lata flaps. Patients were evaluated in terms of viability of the flap and donor site morbidity. The technical details of the operative procedure have also been outlined. Results. All the flaps survived well except 5 patients in which minor complications were noted and 1 who experienced complete flap loss. Of those with minor complications, 1 patient developed distal marginal necrosis and 1 developed infection which subsided within three days by dressings and antibiotics and in 2 patients partial loss of the skin graft occurred at the donor site out of which 1 required regrafting and another one healed completely with dressing and antibiotics. All the patients were followed up for an average period of 6 months, ranging from 1 to 12 months. Donor site morbidity was minimal. Conclusion. It was concluded that the pedicled tensor fascia lata flap is a versatile, reliable, easy, and less time consuming procedure for the coverage of defects around trochanter, groin, lower anterior abdomen, perineum, and ischial region.

Inferiorly based thigh flap for reconstruction of defects around the knee joint.

BACKGROUND: Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. AIMS AND OBJECTIVES: The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. MATERIALS AND METHODS: This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. RESULTS: Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site. CONCLUSIONS: The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.

Neurofibroma of parotid.

Tumours of neurogenic origin are rare in parotid gland. The authors are presenting here a case of neurofibroma in a 40-year-male who presented with slow growing tumour in preauricular region of 1 year duration.

Trauma of facial skeleton in children: An indian perspective.

AIMS: Both children and adults are subject to similar types of injuries but fractures of facial bones in children are relatively uncommon. The aim of this study was to evaluate the epidemiology of facial bone fractures among children of <12 years, their management and outcome in an Indian city. MATERIAL AND METHODS: This retrospective study included children of <12 years of age with facial bone fractures admitted over a span of 3 years. In order to compare our results we reviewed the existing literature related to pediatric facial bone fractures. RESULTS: A total of 45 children were admitted for facial bone fractures. Forty (89%) of them were above 5 years of age and male to female ratio was 2:1. About 53.33% of these injuries were because of fall from height. Mandible fracture was the most common facial bone fracture among admitted patients. Symphysis and para-symphysis was the commonest site of mandibular fractures, seen in 49% cases. Majority of these fractures were managed by Inter-maxillary fixation and inter-osseous wiring. Mini-plates were used for widely displaced compound fractures. For un-displaced fractures observation alone was sufficient. CONCLUSION: Mandible is the commonest facial bone fracture in children, more often caused by accidental fall from height. The high osteogenic potential of pediatric mandible allows non-surgical management to be successful in an increased proportion of younger patients.