Medial plantar artery flap: a versatile workhorse flap for foot reconstruction, our experience

Soft tissue defect in the foot is commonly seen as it is more prone to trophic ulcers since it is the main weight bearing area of the body. Reconstruction of the weight bearing area of the foot requires the provision of a stable, supple, durable and preferably sensate skin coverage. Following Sir Gilli’s principle of replacing like with like, medial plantar artery flap provides an anatomically similar, glabrous skin for coverage on the plantar surface. In the present study, we share our clinical experience with the use of medial plantar artery flap for coverage of soft tissue defect over sole of foot. At our institution, a total of 10 patients presented with soft tissue defect of the sole, underwent medial plantar artery flap coverage. All the 10 patients were diagnosed cases of type 2 DM. patient outcome was assessed according to patients’ age distribution, duration of surgery, hospital stay, and post operative complications. Out of all the 10 patients, 5 were male and 5 were female. All the flaps healed uneventfully without major complications like partial flap necrosis. Donor site was covered with split thickness skin graft. There was suture site dehience in 2 cases which healed with secondary healing. Medial plantar artery flap has been described as an optimal reconstructive option for this type of soft tissue defect.

Use of dorsalis pedis artery flap in coverage of distal lower leg defects

Soft tissue defect in the distal one third of leg have always posed a challenge for reconstructive surgeons. Such wounds are difficult to manage due the tenuous blood supply, limited subcutaneous cover over the tendons and bones. The aim of our study is to investigate the outcome of Dorsalis pedis artery flap for the coverage of such defects. In the present study, we share our clinical experience with the use of dorsalis pedis artery flap for the coverage of defect in the distal one third leg. This is a series of 4 cases where dorsalis pedis artery flap was used to cover lower one third defect. One case had focal squamous cell carcinoma due to long standing post burns contracture in distal one third of leg anteriorly. Other 3 cases had chronic non healing ulcer in the malleolar region. Patient outcome was assessed according to patients’ age distribution, duration of surgery, hospital stay, and post-operative complications. All 4 patients had excellent outcome with no major donor site complications, infection, and graft loss. Donor site was closed with split thickness skin graft. One patient developed a minor raw area over the dorsum of foot which healed secondarily. Although a potential risk in applying this flap is insufficient venous drainage, no problems with blood inflow or outflow were encountered in the present case series. The flaps survived, and the patient had good postoperative outcome. Hence dorsalis pedis flap can be used for the coverage of the distal foot as a good option.

Targeting CYP450 modulation to decrease the risk of induced cataract in the experimental model.

Background: Diabetes is one of the major causes of cataract. Some drugs prescribed for the treatment of diabetes are the modulators of CYP450, which may alter the risk of cataract. Objective: To study the effect of CYP450 modulation in galactosemic cataract. Materials and Methods: Male Sprague-Dawley suckling rats were allotted to four groups (n = 6), as follows: Group 1: Normal control, Group 2: Galactose control, Group 3: CYP450 inhibitor pretreated and Group 4: CYP450 inducer pretreated. Cataract was induced in animals of all groups except group 1 by feeding them galactose (50%), 21 days after parturition. From the eighteenth day of life, CYP450 inhibitor (nifedipine; 8.1 mg/kg) and CYP450 inducer (pioglitazone; 3.8 mg/kg) were given orally to groups 3 and 4, respectively. The maturation pattern of the cataract was observed by an operating microscope, every third day. Biochemical changes in the lenses of all groups, for example, CYP450 activity expressed as µM NADPH oxidized / unit time, alterations in the levels of total proteins, soluble proteins, and reduced glutathione (GSH) following the induction of cataract, were estimated. Results: The microscopic examination of the lenses indicated that CYP450 inhibitor pre-treatment delayed (fourteenth day) the occurrence of cataract, while CYP450 inducer pretreatment demonstrated an early (ninth day) cataract as compared to galactose control rats (twelfth day). A significant decrease and increase in CYP450 activity was observed with the CYP450 inhibitor and inducer pre-treatment, respectively. There was no alteration in the GSH level, but a significant increase in total and soluble protein was found in groups 3 and 4 as compared to group 2. Conclusion: CYP450 may have a role in the initiation of cataract without any effect on the maturation pattern, as revealed by the delayed occurrence of cataract with the CYP450 inhibitor and an early onset of cataract with the CYP450 inducer.

Study of pulmonary function tests in 2000 healthy persons in Gujarat.

This paper reports the results of spirometric studies done in the state of Gujarat in view of deriving the ventilatory norms. The study included a total of 2000 healthy nonsmoker individuals with 1369 males and 631 females. The study was done over the period from September, '92 to July, '93. The observations were tabulated, data fed on computers and the normal values for the parameters viz peak expiratory flow rate (PEFR), forced expiratory volume--1st second (FEV1) and forced vital capacity (FVC) were derived at.