Indian Journal of Plastic Surgery最新文献

Introduction  The closure of extensive defects in reconstructive surgery is a common challenge. The keystone flap technique has gained popularity due to its adaptability and reliance on fascia, providing a reliable blood supply and offering a better match for skin color compared with skin grafts. However, keystone flap necrosis can occur due to tension and inadequate tissue perfusion. To address this, a modified keystone flap technique called the "doubled-handle saucepan" was developed, resulting in improved flap vitality and reduced tissue necrosis, particularly in mastectomy defects. Materials and Methods  We assessed 16 female patients who underwent "doubled-handle saucepan" keystone flaps after modified radical mastectomy (MRM). The average dimensions of wounds in this study were 23.1 ± 3.8 cm × 16.9 ± 2.9 cm, with the largest defect measuring 28.0 cm × 21.5 cm. The average size of the modified keystone flap was 36.3 ± 3.8 cm × 21.2 ± 2.2 cm. Results  Modified keystone flap demonstrated effective performance in managing extensive defects without any complication. The average operation time in our study was 124.3 ± 11.2 minutes. Conclusion  The "double-handled saucepan" keystone flap technique is a unique and dependable method derived from the original keystone flap, which effectively covers defects and maintains flap vitality without tension by ensuring vascularization at the skin bridge. This modified keystone flap technique proves highly effective for reconstruction after MRM, offering time efficiency and no need for a secondary donor site, making it an appealing alternative to free flaps or other local flap techniques in many cases.

In surgery for gynecomastia, it is not sufficient to just remove the gland or do a liposuction that addresses the front of the chest only as it is not aesthetically pleasing for the patient and the surgeon alike. Most patients expect to achieve a sculpted look, which includes not only the breast area but also the surrounding areas such as the sides, the axillae, and the infraclavicular region. To tackle these areas and achieve a well-sculpted and aesthetic look, we describe the 4Dx (4 Directions) technique of liposuction for gynecomastia. It also makes the procedure more objective for plastic surgeons while allowing for individualization of the procedure.

Background  Rhino-orbital cutaneous mucormycosis (ROCM) leading to orbital exenteration can be debilitating functionally as well as psychosocially. Orbital reconstruction following exenteration for mucormycosis has centered on volume filling with local, regional, or free flaps. This case series is built on the original idea of a bilayered operculum at the orbital inlet. Materials and Methods  The opercular approach comprises an inner layer of hinged orbital mucosa and an outer layer of nasofacial flap in most cases, or alternatives, for lining or cover. Results  Eight cases of ROCM treated using the opercular approach are presented with satisfactory results and minimal complication. Four of the eight patients treated by this method remained free of complications after 1year. Conclusion  This technique is simple, does not require microsurgical expertise, and is less time-consuming and less expensive.

The arcade of Struthers was first described by Kane et al in 1973 as a thickening of the deep investing fascia of the distal arm and superficial fibers of the medial head of the triceps muscle extending to the medial intermuscular septum. However, existence of anatomical structure remains disputed, lacking a unanimous consensus. This systematic review aims to provide an overview of all findings and conclusions on this subject. A literature search was conducted using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase, and Web of Science. The QUality Appraisal for Cadaveric Studies (QUACS) scale was used for quality appraisal. In total, 12 studies (including 348 arms) agreed with the existence of the arcade of Struthers and its role in ulnar nerve entrapment. One study agreed with the existence of the structure, but disagreed with its nomenclature. On the other side, five studies (describing 224 arms) were against the existence of the structure. In literature, studies can be divided into two groups. The first group agrees with the existence of the arcade of Struthers as described by Kane et al in 1973, emphasizing its role in ulnar nerve entrapment. The second group disagrees with the existence of the arcade of Struthers, and is further divided into those who believe the structure is best described as an accessory origin of the head of the triceps muscle and those who consider it a dissection artifact.

A 41-year-old man presented with sudden-onset swelling, redness, and pain in the right eye, 4 days after bilateral upper and lower eyelid blepharoplasty. The symptoms were preceded by a forceful nose-blowing episode. Upon examination, periorbital edema and subcutaneous crepitus were observed, along with limitations in upward gaze. Computed tomography revealed bilateral premaxillary and extraconal air accumulation. Since there was no optic nerve ischemia or orbital compartment syndrome, the patient was closely monitored. Spontaneous regression of the emphysema was observed during follow-ups. Orbital emphysema, although commonly associated with trauma, can also arise from compelling movements such as severe nose-blowing, as demonstrated in this unique case postblepharoplasty. The structural changes during surgery may contribute to weakened support, predisposing patients to emphysema following sudden pressure changes. Clinicians should be vigilant for periorbital edema and subcutaneous crepitus after facial surgeries, emphasizing the importance of timely imaging for diagnosis. Awareness campaigns advising against forceful actions like sneezing, coughing, and nose-blowing during the initial postoperative period are crucial to prevent potential complications.

Subconjunctival orbital fat prolapse is a benign condition where the orbital fat, which normally cushions the eye within its socket, protrudes or herniates through the conjunctiva, the clear membrane covering the sclera. It is a rare condition that occurs due to disruption of the orbital septum due to various causes. In this case study, we report the clinical findings, treatment, and insights gained from the diagnosis and management of a 59-year-old male patient with subconjunctival orbital fat prolapse.

We report a rare presentation of lipofibromatous hamartoma involving the superficial peroneal nerve with significant macrodactyly in a woman in her late 40s, with a follow-up period of 3 years. We discuss the clinical presentation, distinguishing features, and the surgical technique chosen for maximum functional outcome, along with a review of the literature. This case report attempts to understand the spectrum of disease represented by lipofibromatous hamartoma, its nomenclature, diagnosis, and management depending on the extent of tissue involvement. In this case, as there was macrodystrophia with osseous overgrowth and extensive lipomatosis, the challenges involved in planning surgery for a desirable aesthetic and mechanical outcome have been discussed.

Delayed tendon injuries of the hand often require auto tendon grafts, the success depending largely on tendon type, its own synovial cover or provided by tendon bed, and tendon bed vascularity. Tendon graft healing has been extensively studied, where tendon does increase its vascular response to trauma, attrition, or degeneration. Initially surviving through synovial fluid imbibition, followed by vascular invasion from surrounding tissues. Tendon grafts without synovial covering or in hypovascular/scarred beds have increased vascular response in the form of flimsy tissue which vascularises tendon grafts but later, they become adhesions, restricting tendon movement and final functional finger results. To overcome this hypovascular state, tendon grafts are substituted with vascularized tendon grafts. We present two cases of vascularized palmaris tendon graft in delayed tendon injuries of hand having hypovascular tendon beds, along with operative technique and results along discussion and conclusion.