Perforator Flaps Based on the Terminal Perforators of the Pectoral Branch of Thoracoacromial Vessels Axis: A Viable Option in the Head and Neck Reconstructions.

BACKGROUND: The purpose of this article is to develop a new method for elevating the pedicled terminal pectoral perforator flaps (PTPPFs) and to resolve the difficulties and controversies that shroud the anatomy of terminal pectoral perforators from the pectoral branch of the thoracoacromial axis. AIM: Anatomical study was conducted to assess the feasibility of perforator flaps based on the terminal perforators of the pectoral branch of the thoracoacromial vessel axis. The knowledge that gleaned from this anatomical study was applied in the clinical scenario. A clinical retrospective study was conducted to evaluate the outcome of PTPPFs for the reconstruction of postexcisional head and neck defects. MATERIALS AND METHODS: Thirty cadaveric specimens were examined for the anatomy of the terminal musculocutaneous pectoral branch perforators. Thirty-two cases (22 males, 10 females) of various head and neck postexcision defects were reconstructed with the PTPPFs in a single-stage manner. Pectoralis major muscle with its innervation was spared in all cases. All the secondary defects were closed primarily. RESULTS: The maximum cutaneous paddle size was 156 cm harvested on a single best terminal pectoral branch perforator. The average size of the cutaneous paddle harvested was 73.47 cm. The flap complications noted (9.3%) were trivial, and all the flaps survived well. The average institutional computed score for esthetic and functional recovery at the donor and reconstructed site done by 2 independent observers were 4.56 and 3.78, respectively. CONCLUSIONS: The recruitment of the chest skin on the terminal pectoral branch perforators resulted in a long pedicle flap with adequate qualities like color match, texture match, and pliability. This flap shall serve as a primary option for pedicle and free flap head and neck reconstructions.

Inferior vena cava thrombosis in a pediatric patient of amebic liver abscess.

Amebic liver abscess (ALA) in pediatric age group is rare. We describe a successful thrombectomy and open drainage of a large left lobe ALA associated with thrombus in the hepatic veins and inferior vena cava extending into the right atrium in a 6-year-old boy.

Acute gastric dilatation with necrosis and perforation: case report of a 16 year old girl.

Acute gastric dilatation with infarction, necrosis, and perforation is a rare event. Here, we are presenting the case of a 16-year-old girl who presented to the surgical emergency with vomiting, acute pain in the abdomen, and distension of abdomen. X-ray abdomen showed gas under the diaphragm and massively dilated gastric shadow. Emergency laparotomy was done in which massive dilatation of the stomach with necrosis and perforation was found. Total gastrectomy with esophagojejunostomy was performed and the patient survived.

Obstructive jaundice due to pancreatic pseudocyst in a pediatric patient.

Obstructive jaundice solely due to pancreatic pseudocyst is rare in pediatric patients. Successful management of a case by internal drainage is being described here. The role of intra-operative cholangiogram is being highlighted for deciding whether a simple drainage procedure would be required instead of a hepatico-jejunostomy.