ABSTRACT
Aetiology of the scalp defects may be burns, trauma, avulsion, infection, resection for neoplasm or congenital defects, the goals & principles are similar, and their repair is dependent upon their location, size and depth. In the case of the scalp, the repair of even small defects is complicated. We wanted to assess the epidemiology, etiological factors, type and site of distribution, various modalities, overall cosmetic effect and function of both donor as well as recipient sites of scalp defects. We also wanted to evaluate the epidemiological and aetiological factors influencing the various modalities of scalp defect management and the overall cosmetic effect on both donor as well as recipient site. METHODSA descriptive study was conducted at Sham Shah Medical College and associated SGM Hospital, Rewa, which is also known as Vindhya region of Madhya Pradesh. A total of 44 cases of scalp defects, that were treated in the department of surgery over a period of 18 months from May 2018 to November 2019 constitute the material of this study. Patients were included in the study after obtaining an informed consent. One-year follow-up of the patients was done, RESULTS26 cases [59.01%] of scalp defect were repaired with transposition flap; rotation flap was done in 2 cases [4.45%], bipedicled flap was done in 2 cases [4.45%], double opposing rotational flap was done in 01 case [2.27], S.T.G. was done in 7 cases [15.9%], and primary closure was done in 6 cases [13.63%]. In our study 59.09% cases are due to trauma and occur in second to fourth decade out of which 26 patients have exposed bone, and out of 26 patients, 09 patients have fracture of bone. CONCLUSIONSScalp reconstruction depends on the nature and the region of the defect. A range of reconstruction techniques have been described. The quality of the residual scalp is critical for performing a local flap. Local flaps are the reference for the reconstruction of such defects. Knowledge of scalp anatomy is essential for preparing these flaps. The parietal zone is the location offering the greatest flap mobilization possibilities. A review is provided of the different techniques for the reconstruction of large scalp defects.
ABSTRACT
Background: Cholelithiasis is the most common biliary pathology. The definitive treatment for cholelithiasis is either open/ laparoscopic cholecystectomy (LC). The objective of this study was to predict difficulty in doing LC based on clinical and ultrasonographic parameters. Materials and Methods: A hundred patients admitted with a diagnosis of cholelithiasis in surgical wards in the Department of Surgery, Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa, from June 1, 2018, to May 31, 2019, were included in the study. All necessary investigations were carried out. X-ray, ultrasonography (USG) abdomen, and blood investigations were done. Patients underwent LC, and a careful record of pre-operative and post-operative findings was made and carefully filled in the pro forma. Results: In the present study, body mass index >27.5 kg/m2 (27%) shows a correlation with predicting difficult LC and conversion to open procedure. Clinical parameters such as guarding and rigidity (8%) with mass (12%) were a sign of acute inflammation, associated with ultrasonography findings favor for difficult cholecystectomy. Gallbladder wall thickness (38%) and pericholecystic fluid collection (16%) in USG are strong predictors of difficulty. Conclusion: Clinical and USG findings help to predict difficulty in laparoscopic cholecystectomy and leading to the conversion of LC to open cholecystectomy.