Intra-arterial drug injection: an effective treatment protocol

Intra-arterial drugs injection [IADI] either iatrogenic or self administered in drug abusers is a source of considerable morbidity. Most interventions are largely empirical. No prospective human studies have shown that any specific treatment is superior to another. The aim of this study was to evaluate the outcome of different modalities of treatments in patients with IADI. This study included 36 patients divided into 2 groups: Retrospective group [A] [from November 2002 to July 2004] enrolled 13 patients [10 males and 3 females] and prospective group [B] [from August 2004 to June 2008] enrolled 23 patients [19 males and 4 females]. Group A received systemic treatment only [heparin, dexamethazone, antiplatelet and prostaglandins] and group B received intra-arterial treatment [heparin and streptokinase] in addition to the systemic treatment Normal outcome [normal extremities] improved greatly in group B [52%] than in group A [23%] although, this failed to reach statistical significance. Intra-arterial cannulation and administration of heparin and streptokinase is a good option in treating accidental IADI resulting in better final outcome than systemic heparinization and early treatment is mandatory for a good outcome

Surgical management of cirsoid aneurysms of the scalp

Cirsoid aneurysms of the scalp are rare lesions, they can cause disfigured pulsatile masses, headache, excessive bleeding and tinnitus. These lesions are difficult to manage because of their complex vascular anatomy, high shunt flow and cosmetic disfigurement, many options have been described. We report our experience in the surgical management of these lesions. We treated 7 patients with cirsoid aneurysms of the scalp surgically. There were 4 females and 3 males with a mean age of 22 years. History of trauma was present in 3 patients. Frontal region was the site commonly affected. Superficial temporal and occipital arteries were the most frequent feeding arteries. The size ranged from 5 cms to 12 cms. Following investigations were done: X-R skull, duplex, and spiral CT angiography. Excision of the lesion was done in all patients after ligation of the feeding arteries. Except one patient had undergone prior ipsilateral external carotid artery ligation, non of the patients underwent previous interventions. All the patients had good cosmetic results and there was no recurrence during an average follow up of 18 months. Surgical resection of cirsoid aneurysms seems to be the most effective treatment with good results and patients satisfaction

Skew-flap below knee amputation

Major amputations may be necessary in patients with diabetic foot sepsis or advanced critical limb ischemia in whom no other treatment option is available. Preservation of the knee joint and sufficient stump length in these patients are very important for successful rehabilitation. In our study, skew-flap below knee [BK] amputation was done to preserve a functional BK stump for those who were unable to receive the conventional long posterior flap BK amputation. Between January 2003 and January 2008, we performed 33 skew-flap BK amputation in 32 patients. All the patients were unable to achieve a functional stump by using the conventional long posterior flap amputation because of damaged posterior skin flap by massive diabetic sepsis in 20 patients and advanced critical limb ischemia in 12 patients. Thirty-three skew-flap BK amputations were successfully done in 32 patients, the tibial stump ranged from 8-13 cm distal to the tuberosity. There was no hospital mortality, no major complications, wound healing was delayed in 2 patients and no patients required ream-putation. The median time to full stump healing was 16 days resulting in parallel-sided, hemispherical-ended stumps. No ulceration was encountered in the BK stumps during an average follow up of 7 months. Surgeons must be familial with alternative methods of BK amputation in different situation if a functional stump is to be preserved. Skew-flap is an excellent option for BK amputation, easy to learn and produces satisfactory shape of the stump allowing early rehabilitation

Skin and subcutaneous excision for morbid lymphedema of the leg: modified technique

Between February 1998 and February 2003, 14 patients with unilateral morbid lymphedema of the leg were managed by one stage posterior approach skin and subcutaneous tissue underneath flaps excision [modification of Homans operation]. There were 3 males and 11 females of a mean age of 36 years [range 26-58 years]. The follow up period ranged between 1-5 years [average 3.5 years]. All patients experienced a significant reduction in the extremity size, improved contour and a reduction in/or elimination of the incidence of lymphangitis/cellulitis. Three patients developed small areas of ischemic flap necrosis, which healed by secondary intention. No other significant complications were encountered. The postoperative results were maintained through the follow-up period