Injuries causing major loss of the scalp

Long hair worm by females in a majority of the rural population increases the hazards of descalping injuries. Sixteen cases seen over a period of 5 years are reported in this paper. Agricultural machinery accounted for 50% of these injuries. Females were most commonly involved [75%] and 25% were males. Nearly all cases presented had at least 3rd of the scalp avulsed, 50% being total scalp avulsions with bone exposed in 37.5% of total 6.3% with bone, dura loss and exposed brain tissue. Flap transposition, advancement and rotation were the procedure of choice for most minor cases. In major cases with one third or half scalp loss, multiple flap techniques were applied. The method of chiseling the outer table of the exposed bone down to bleeding points and immediate applying of a split thickness skin graft is presented as procedure of choice for wound closure. In neglected cases multiple holes of the outer table of the skull and secondary split thickness graft on growing healthy granulation tissue. Fascial lata graft was used for dura repair and four flaps reconstruction to replace the scalp loss with split thickness skin graft to cover the residual postoperative scalp defect

out come of primary nerve repair at the forearm

Eighteen injured peripheral nerves at the forearm level were repaired primarily either by immediate or by delayed primary repair according to the mechanism of injury, the presence of contamination and /or skin loss. Nine nerves were cut sharply and were immediately repaired of which four nerves achieved excellent results, three achieved good results and the results were poor in the remaining two nerves. In nine nerves, there were laceration, contamination and /or skin loss and they were repaired by delayed primary neuropathy after one week from the time of injury. Two nerves achieved excellent results, five nerves achieved good results and two nerves achieved poor results

Tram flap transfer after suction assisted lipectomy the rat model

20 rats have been used in 2 groups. In the control group TRAM flap has been elevated and sutured into the original bed over a silastic sheet. In liposuction group 6 weeks following liposuction of the abdomen of the rats, flaps were elevated as in the control group. 15 days later, the viable surface area of the skin paddle was measured. Microangiography was also done at this time. The observation showed that the mean surviving surface area of the flaps in the liposuction group is greater than the control. Suctioning of the skin paddle of the flaps with a non-traumatizing cannula may exert a delay effect that results in increasing the viability of the flaps

Primary reconstruction of human bite wounds of the face

The human bites is the worst of all bites, and primary repair of human bite wounds was not favored in all patients. Primary reconstruction of 37 human bite wounds of the face without clinical infection has been carried out successfully third day post bite. It was considered that debridement of wound edges to eliminate the devitalized tissue is the key to success

Histopathological study of the formed capsule over the expanders in reconstructive surgery of the scalp injuries

This study was done on 12 patients with post-burn alopecia of the scalp. Tissue expander techniques were performed on those patients using the balloon expander. The expanders were inflated weekly with saline under the hair bearing area, in the subgaleal and the supra- periosteal plane. The aim of this work was to study the tissue response around the expanders, which is called the formed capsule. The histopathological study showed that the capsule is formed of four zones inner cellular zone, central zone of fibrous tissue and elastic fibers, transitional zone of hyalinized fibrous tissue, and outer zone of newly formed blood vessels. Every zone has its clinical significance, particularly the inner one, which contains inflammatory cellular reaction, in playing a role in infection resistance. The outer one, the vascular zone, adds blood supply to the overlying hair bearing area of the scalp

Split thickness skin grafting plus dural closure in management of myelomeningocele

This study was designed to evaluate post operative and long term follow up wound healing after using two methods of repair [direct closure or covering by split thickness skin grafts. Long term follow up revealed a higher incidence of chronic skin ulceration the split-thickness skin graft group as compared with the primary closure group. All skin breakdowns appeared in the presence of C.S.F. leakage and or the presence of Gibbus deformity. A thoracic or thoracolumbar myelomeningocele repair with split thickness skin graft was more likely to be complicated by skin problems than the defects in the lumbar lumbosacral or sacral region. This relationship was secondary to the frequency of gibbus deformity in the more cephalad defects than caudal defects