Post mastectomy breast reconstruction with autologous latissimus dorsi flap: a study of 30 cases

Background: There is a growing demand for breast reconstruction and among the plethora of breast reconstruction techniques, the latissimus dorsi (LD) flap is a versatile, reliable means for soft tissue coverage, providing form and function with acceptable perioperative and long-term morbidities for a variety of breast defects. The aim of this study was to find out the advantages of immediate breast reconstruction in terms of postoperative morbidity and patient satisfaction with respect to her expectations.Methods: The study was conducted in the Department of General Surgery at Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar. Thirty female patients who had undergone immediate breast reconstruction with latissimus dorsi flap after modified radical mastectomy attending surgery department from November 2017 to September 2019 were taken. The follow up was done to find out post-operative complications and a statistical scoring was done according to rating scale of quality of life.Results: Most common complication after breast reconstruction with LD flap was found to be seroma formation (50%) followed by wound infection and flap necrosis 25% each while flap necrosis >20% was not found in any case. For emotional feeling regarding health, social activities, overall health and quality of life; there was significant improvement after surgery.Conclusions: It can be concluded that immediate breast reconstruction with autologous latissimus dorsi flap is the treatment of choice following mastectomy in cases of breast carcinoma, whenever possible.

To Evaluate The Results Of Complete Exenteration Of Mastoid Air Cell Tracts Underlying Cholesteatoma With Canal Wall Down Mastoidectomy

Chronic Suppurative Otitis Media(CSOM) is long standing infection of mucoperiosteal lining of middle ear cleft. CSOM is classified into Tubotympanic or Safe and Atticoantral or Unsafe type. Atticoantral type involves the pars flaccida and is characterized by formation of a retraction pocket in which keratin accumulates to produce cholesteatoma. Mainstay of the management of atticoantral disease is surgery of mastoid and middle ear. Majority of otolaryngologists find the Canal wall down , open cavity operation with wide access to be the safest and simplest means of managing middle ear cholesteatoma. In present study , results of complete exenteration of mastoid air cell tracts underlying cholesteatoma with canal wall down mastoidectomy are studied.

Role of CT in evaluating upper aerodigestive tract injuries.

This study was aimed to assess the role of CT in upper aerodigestive tract injuries. Twenty six patients presenting with upper aerodigestive tract injury were examined by CT. Nineteen patients had blunt trauma to the neck while seven had penetrating injury. Most of the patients presented soon after injury. Symptoms included respiratory distress (14), neck tenderness (18), hoarseness (7), haemoptysis (2) and odynophagia (3). Soft tissue injuries were seen in 8 patients, aryepiglottic fold edema in 4, aryepiglottic fold haematoma in 1, vocal cord edema in 2 and pyriform sinus obliteration in 5 patients. Supraglottic injuries were seen in six patients, glottic injury in 8 patients and subglottic injuries in 4 patients. Tracheal injuries were seen in 8 patients and included cricotracheal separation (1), tracheal tears (5) and tracheal narrowing (4). Hypopharyngoesophageal injuries were seen in 2 patients. CT was helpful for localization of foreign bodies in 2 cases. CT is useful in deciding management of patients with upper aerodigestive tract injuries obviating the need of open exploration in patients with minimal mucosal injuries, undisplaced fracture and sealed tears. It is particularly helpful in cases when indirect laryngoscopy was not possible.

Myringoplasty for chronic otitis media.

METHODS: 25 children in the age group of 8-14 years suffering from chronic suppurative otitis media were taken up for myringoplasty using onlay technique under general anaesthesia. RESULTS: All selected cases had a central type of dry perforation, good cochlear reserve and healthy middle ear mucosa. Cases having enlarged adenoids, infection in nose or throat, any traumatic perforation or previous attempt at closure were excluded from the study. It was found that there was 76% take up of graft after two months who also had improvement in hearing. CONCLUSION: We conclude that myringoplasty stands a good chance in children.