Flap cover in a patient with severe haemophilia type A.

Haemophilia A is a rare haematological disorder due to deficiency of Factor VIII, causing an abnormal coagulation response to injury. In severe haemophilia A, Factor VIII level is < 1%, often manifesting with spontaneous bleeding into joints. Judicious use of recombinant Factor VIII therapy to maintain adequate levels in the intraoperative, immediate and late post-operative periods, together with adjuvant pro-coagulants, can ensure a safe outcome following surgery. We describe the successful management of one such patient suffering from Marjolin's ulcer of the right gluteal region, who needed wide local excision followed by flap cover. A protocol for management of such patients is also suggested. This is the first such case report from the Indian subcontinent, with only a few such published reports from the West.

Smart apps for the smart plastic surgeon.

Smartphones have the ability to benefit plastic surgeons in all aspects of patient care and education. With the sheer number of applications available and more being created everyday, it is easy to miss out on apps which could be of great relevance. Moreover, the range of android applications available has not been extensively discussed in the literature. To this end, we have compiled an exhaustive list of android smartphone applications, which we feel can help our day to day functioning. The apps have been extensively reviewed and neatly described along with all their potential uses. In addition, we have made an effort to highlight 'non-medical' or efficiency apps which can improve departmental functioning. These apps have not been described in prior articles, and their functionality might not be known to all. We believe that the technology savvy plastic surgeon can make maximum use of these apps to his benefit.

Spreadsheet software to assess locomotor disability to quantify permanent physical impairment.

CONTEXT: Assessment of physical disability is an important duty of a plastic surgeon especially for those of us who are in an institutional practice. AIM: The Gazette of India notification gives a guideline regarding the assessment of the disability. However, the calculations as per the guidelines are time consuming. In this article, a spreadsheet program which is based on the notification is presented. The aim of this article is to design a spreadsheet program which is simple, reproducible, user friendly, less time consuming and accurate. MATERIALS AND METHODS: This spreadsheet program was designed using the Microsoft Excel. The spreadsheet program was designed on the basis of the guidelines in the Gazette of India Notification regarding the assessment of Locomotor Disability to Quantify Permanent Physical Impairment. Two representative examples are presented to help understand the application of this program. RESULTS: Two spreadsheet programs, one for upper limb and another for the lower limb are presented. The representative examples show the accuracy of the program to match the results of the traditional method of calculation. CONCLUSION: A simple spreadsheet program can be designed to assess disability as per the Gazette of India Notification. This program is easy to use and is accurate.

Radial Artery Forearm Flap Anomaly: A Rare Anomaly and the Importance of the Proximal Exploratory Incision.

During a free radial forearm flap harvest, we encountered a variant anatomy of the arterial system. The brachial artery was found to travel with the median nerve and bifurcate 10 cm below the antecubital fossa, under cover of the pronator teres. The radial artery then emerged from the pronator and continued on its usual path. This anomaly has been reported only once thus far. We report this case to highlight our practice of always starting with a proximal exploratory incision to identify the anatomy before raising the flap, which is what enabled us to adapt to this variation with a satisfactory outcome.

Bifid liver in a patient with diaphragmatic hernia.

Liver malformations including lobe and segmental abnormalities are rare. We report a 65-year-old lady with complaints of breathlessness and fullness after meals for two months. Investigations revealed a diaphragmatic hernia on the right side with a bifid liver; the right lobe of the liver was among the hernia contents. The lady is asymptomatic after surgical repair.

Three-flap cover for total hand degloving.

Re-surfacing after a total hand degloving injury is one of the most difficult management problems in hand surgery. We present one such case that was managed using three flaps for cover. The radial forearm flap is very thin and pliable, resulting in satisfactory coverage of first web space and the thumb remnant, and facilitates a mobile thumb. The groin-hypogastric flap covered the remnant fingers admirably. The patient had a good first web and could use the hand to lift objects and hold a pen to write legibly within 2 months of the injury.

A mathematical model to predict the change in direction of the common limb in Z plasty.

The Z plasty is a common procedure used in scar revision. It is used to break the line of a scar. It can also be used to change the direction of a scar. This article presents a mathematical model to help select an appropriate angled Z to enable the planned change in the direction of the final scar.