V.Y. fasciocutaneous flap for coverage of ischial sores a reliable simple procedure for a major problem

Despite a wide variety of flap options, ischial ulcer remains the most difficult ulcer to treat. This article describes a reliable simple procedure for coverage of ischial ulcer. This study was conducted on 15 patients with grade III and IV pressure sores. All patients was initially debrided and all suspicious viable tissues excised, packs with betadine and hydrogen peroxide were applied twice daily for a period of 5-10 days. V-Y fascio-cutaneous flap was done in all cases, no weight bearing allowed for a period at least two weeks until complete healing occurred. Superficial infection occurred in 3 cases and responded to repeated dressing, Wound gaping occurred in 2 cases one of them required secondary suture done under local anaesthesa, no flap loss occurred in all cases, One year follow up showed no recurrence. The technique has the merits of simplicity and rapidity which are a great value in these compromised patients

Scalp reconstruction after extirpation of large advanced tumor [experience in 10 cases]

This study was conducted on ten patients with large scalp tumors Seven patients [70%] were advanced basal cell carcinoma eroding calvarium and reaching the dura matter in 2 patients. The other patients were sqamous cell carcinoma [30%]. Wide local excision was done with minimum safety margin [>/= 1cm] the eroded bones and dura mater was excised by neurosurgeon. Immediate reconstruction of the dura and bone was done using fascia lata and bone cement. Cutaneous coverage was achieved by free lattissimus dorsi in 3 patients. radial forearm flap in 1 patient, local bilobed and trilobed flaps in 5 patients and split-thickness skin graft in the remaining one. No flap loss occurred, infection occurred in 2 patients, gaping in one patient that required secondary procedure and donor site seroma in one patient. Mortality was 20% and recurrence in one patient. in spite of the relative risk of mortality and morbidity yet surgical excision offers the only remaining chance for those desperate patients with extensive tumors for whom no adjuvant measures are available. Those patients were always ready to get rid of offensive odor, repeated bleeding and disfigurement associated with the tumor