Medial perforator flap for coverage of defects around the ankle

Wounds around the ankle with exposed bones, tendons and nerves are very common in our practice and their reconstruction remains a challenge for the plastic surgeons. They often lead to infection and mal-union if early vascularized cover is not provided. To evaluate efficacy of medial perforator flap for reconstruction of this difficult area. A total number of 40 patients with injuries around the ankle were studied between December 2004 to December 2006 and all of them underwent reconstruction with medial perforator flaps. The Medial perforator flap is a quick, versatile, reliable reconstructive option and has minimal donor site morbidity

Cleft lip and palate surgery "where do we stand in the 21st century?" based on study of referral patterns to a tertiary care cantre

A prospective study was carried out over the period of six years including 215 patients. The objective of this study has been to evaluate the types of the clefts, their predisposing factors, age at first presentation and need for revisional surgery and to compare these with published studies on the subject and to draw conclusion about the epidemiology and the facilities available for its surgical correction. Prospective, observational study. 215 patients were evaluated over a period of six years by filling a proforma, which was entered into database. Different parameters were evaluated. There are a significant number of cleft patients presenting for first time above the age of 10 years. A large number of inappropriately treated patients require revisional surgery because of lack of properly trained cleft surgeons. Due to lack of specialized cleft care teams in our country no patient in this study could get comprehensive care for this deformity. It is need of the hour to pr ovide multidisciplinary care to these patients

Transversely meshed skin grafting for aesthetically sensitive areas

Meshing of split thickness skin grafts [SSG] improves the chances of their 'take' by allowing blood and exudates to escape. Traditional wide meshing has a major disadvantage of having a cosmetically compromised checkerboard or lizard skin appearance. For which reason they can not be used on aesthetically sensitive areas like head and neck and extremities. Unmeshed SSG does not ensure adequate drainage and at times results in poor 'take'. Transverse meshing ensures better drainage and its cosmetic appearance is also comparable to that of unmeshed SSG. The objective of this study has been to analyze the advantages of this novel technique in skin grafting and see its efficacy over un-meshed grafts. An original article based on a prospective, observational study. A total number of 69 patients were studied between October 1999 and April 2003. Both male and female patients of all age groups were selected, ranging between 11/2 and 70 years. Patients selected for skin grafting inc luded those with wounds caused by burns, degloving injuries of the scalp, genitalia, hands and feet and post burn contractures of the neck and extremities, and flap donor sites [see table below]. Skin grafts were harvested with a pneumatic dermatome. A mesher board of 1.5: 1 expansion was cut into two equal halves which were placed side by side with the grooved side up. Skin grafts were applied and secured in the standard fashion. The patients were followed up on outpatient basis. Graft success rate was 93% with acceptable cosmetic appearance. There was a total loss of two grafts [2.7%] and partial loss of three [4.3%]. The healing of the graft was excellent. Transverse meshing is a new technique in meshed skin grafting with improved 'take' and acceptable cosmesis as compared to unmeshed skin grafts. This technique can obviate the need for two- stage skin grafting for areas where wide meshing is not desirable