Indian Journal of Plastic Surgery最新文献

We present the case of a 36-year-old male patient with a posttraumatic composite defect of the lower two-thirds of the anterior aspect of the left leg with exposed necrotic tibia in an old, neglected type 3b fracture of the tibia of 9-month duration. The options for definitive soft-tissue cover include microvascular free tissue transfer and cross-leg flaps. In trauma cases, the surrounding tissue is usually damaged, and the recipient vessels are frequently implicated, ruling out the use of a microvascular free flap. Cross-leg flaps are unachievable due to large defect sizes and lack of appropriate donor tissue. In this case report, we highlight the use of cross-leg microvascular free anterolateral thigh (ALT) flap cover for the composite leg defect. By presenting our case, we aim to advocate the clinical application of cross-leg free flap surgery in vessel-depleted limbs as a safe and viable option.

Traditionally, burn reconstructions have been performed by the use of skin grafting or local flaps. Recently free flaps are being used with increasing frequency. Although not very common in the head neck region, free flaps are mostly used for secondary reconstructions of cervicofacial contractures. We report the role of free flaps in postburn facial reconstructions, excluding neck and scalp burns. Sixteen free flaps used for postburn facial reconstructions were reviewed retrospectively, during the period between 2003 and 2023. The etiology, indications, timing, location, choice of the flap, type of reconstruction, and outcomes were analyzed. Indications and type of reconstructions were categorized to correlate with flap choice. The age of the patients ranged between 8 and 40 years. The etiology included electrical burns in six cases, flame burns in eight cases, and acid burns in two cases. Nine defects were in the central part of the face including the nose and the chin. Two primary and 14 secondary reconstructions were performed using free flaps from lateral thigh in 11 cases, lateral arm in 2 free flaps cases, radial forearm in 2 free flaps cases, and the posterior auricular flap in 1 case. There were no total flap failures. Secondary procedures were needed in 10 of 13 evaluable patients. Free flaps provide a good and safe option for selective postburn reconstructions in the face. The choice of flap mainly depends on the indication and type of reconstruction needed, apart from the availability of donor tissue and the surgeon's preference. Complex reconstructions may need larger and composite flaps to replace the components. Multiple secondary procedures are needed to achieve the objectives.

Chin augmentation can dramatically transform a patient's appearance. Various techniques are in use, each with their specific problems and limitations. We present the first case report from the Indian subcontinent using a custom 3D-printed, bioresorbable polycaprolactone implant. We demonstrate, by appropriate imaging, the replacement of the implant at long-term (22 months) follow-up by patient's own autologous bone formation. An excellent aesthetic result was achieved. Relevant points of technique, as well as pertinent properties of the material, are discussed. This material has been used in neurosurgery and in the management of orbital fractures. Yet, worldwide, very few (3-4) cases of chin implant have been done using this material. We believe this to be a useful and sustainable material, offering several advantages, as set out in the case report.

Childhood scars can lead to hideous aesthetic and functional deformities in young adults, which can be particularly distressing when involving the face and the breast in a female. Aesthetic restoration requires replacement of the whole or a part of the scarred skin by soft, pliable, and texture-matching skin, which nearly always is in short supply. Dermal regeneration templates (DRTs) can help in skin regeneration that is almost always aesthetically superior to most flaps. Aesthetic demands at the time of final restoration may require the regenerated skin to be moved as a local flap. As regenerated skin from dermal templates is known to match the vascularity of normal native skin, raising it as a flap should follow logically. This, however, has never been attempted to the best of our knowledge after a thorough literature search. We report a case of successfully using DRT-generated skin raised as a flap for aesthetic reconstruction of a postburn scarred breast in a young female. This adds a whole new dimension to the use of DRTs and points to a new field of research in scar management and aesthetic restoration.

Cleft foot is a rare congenital anomaly (syndromic/isolated). Although there have been published reports about this anomaly, none has so far described standardized treatment guidelines. In this case report, we describe the details of operative management of an isolated cleft foot in an 8-year-old girl with a brief review of literature, keeping in mind the aims of the treatment, governed by the local culture and preferred footwear design in the Indian scenario.

Background  Patients with congenital or acquired penile defects face significant psychological trauma. Various methods for penile reconstruction have been described of which the free radial artery forearm flap using the tube-within-tube design is found to be the most commonly used. We have assimilated the best practices described at different times in our bid to standardize the technique and have strived to make it reproducible. The reconstructed phalluses with this method can withstand the test of time, allowing the patients to lead a normal life. Materials and Methods  We conducted a retrospective review of the past 16 years and collected data for all radial forearm free flap phalloplasties. We have modified the design originally described by Biemer. The urethra is kept 1 cm longer than the shaft and the proximal 5 mm of the prospective urethra is not sutured to allow for spatulation of the urethral anastomosis. Results  A total of nine patients were included out of which six patients had congenital malformations, two had traumatic injuries, and one had penile carcinoma. Six out of the nine patients had implants placed which were wrapped in fascia lata graft. One of these patients experienced displacement of the implant which needed to be repositioned. Three patients faced postoperative complications. All patients had tactile and erogenous sensation at the tip of the glans at the end of 1 year and all patients could micturate while standing. One patient's esthetic and functional outcome was compromised. One of the married patients has fathered a child through normal sexual intercourse. Conclusion  Radial forearm phalloplasty done by this technique allows us to achieve consistently stable functional and esthetic outcomes. We firmly believe that this standardized protocol for penile reconstruction could be of great benefit to patients as well as to the treating reconstructive surgeon in their quest to achieve a completely rehabilitated patient.

The influence of Instagram, as a social media platform, in shaping perceptions of aesthetic surgery cannot be understated. The idea of a more "aesthetic" self cultivates a desire for cosmetic enhancements. This article underscores the profound impact of Instagram on aesthetic surgery, shedding light on both its fantasies and fallacies. Instagram, a medium for dissemination of content, often blurs the lines between fantasy and reality. Although the intent is to transfer credible information from the provider to the consumer, Instagram often contributes to the distortion of one's self-image and creates unrealistic expectations. Moreover, the glamorization of aesthetic surgery as a fast, effortless fix, often by commercially run enterprises, leads to misconceptions and impulsive decision-making. These fallacies are further compounded by the increase of misinformation and deceptive practices, presenting ethical challenges for influencers and surgeons alike. This study explores the ethical responsibilities of these "Aesthetic Instagrammers," emphasizing the necessity for transparency and ethical guidelines, while analyzing all the social media stakeholders and providing suggestions for better engagement.