Optimizing Flap Measurements for Tongue Reconstruction: Harnessing the Power of the Pythagorean Formula.

Head and neck reconstruction, particularly tongue reconstruction, remains a formidable challenge. However, crafting a three-dimensional structure from a basic flap necessitates precise dimensions to avoid excess or insufficiency. At the same time, the tongue also has to be accommodated inside the oral cavity to prevent protrusion or repeated injuries due to tooth bites. This study aims to showcase the practicality of employing Pythagoras's formula in both preoperative and intraoperative settings to the required flap dimensions for partial and hemiglossectomy tongue defects. Between 2020 and 2022, we have undertaken 53 tongue reconstructions to address defects resulting from partial or hemiglossectomies. Among these cases, 51 were managed with free radial artery flaps, while in two we utilized anterolateral thigh flaps for reconstruction. Our study excluded cases involving minor tongue defects amenable to primary closure. By treating the length of the tongue defect as the hypotenuse, Pythagoras's formula is applied to calculate the optimal length and width of a free microvascular flap. The tongue reconstruction is performed, and microvascular anastomosis is carried out in the neck. An addition was made for associated buccal mucosa defects, if any. All flaps survived without any complications like bleeding, wound dehiscence, and partial or complete flap necrosis. Tongue movement was adequate, with good swallowing and good speech. The application of Pythagoras's formula provides a dependable method for determining flap size pre- and intraoperatively in cases of partial or hemiglossectomy tongue defects, leading to favorable functional and aesthetic results.

Wide Excision with Immediate Reconstruction of the Mandible Using Free Fibular Flap in Ameloblastoma of the Mandible-A Need of Time: Our Experience of 37 Cases.

Background Ameloblastoma is a benign yet locally aggressive odontogenic tumor of the jaw with high recurrence rates. Despite many studies, the search is still on for the treatment approach which can render the acceptable recurrence rates with good functional and esthetic results. Methods In this prospective study, we operated on 37 patients of mandibular ameloblastoma between 2009 and 2018. Two patients were treated with curettage and chemical sterilization of the cavity. Resection of a tumor with a 2-cm margin was performed in the rest of 35 patients. The mandibular defect was primarily reconstructed with the microvascular free fibular flap in 29 patients. Results The follow-up ranged from 6 months to 7.7 years with a mean of 5.1 years. A tumor recurred within a year in all two patients (100%) treated with curettage. Out of 35 radical excisions, only one patient (2.85%) developed recurrence 3 years after the disease-free interval. Good mouth opening, intelligible speech, satisfactory lower jaw shape, and facial profiles were achieved in all 29 patients who were treated with primary free fibular flap. Conclusion We prefer wide excision with 2-cm margins on each side of a tumor with the primary reconstruction of the mandible in all cases of mandibular ameloblastoma. The free fibular microvascular flap is our treatment of choice as all defects of the mandible can be reconstructed with the free fibular flap. Wide excision is the key to prevent a recurrence.

Surgical revirgination: Four vaginal mucosal flaps for reconstruction of a hymen.

INTRODUCTION: Over centuries, virginity has been given social, religious and moral importance. It is widely believed as a state of a female who has never engaged in sexual intercourse, and her hymen is intact. Hymenoplasty for torn hymen is carried out not only for the sake of cultural and religious traditions but also for the social status and interpersonal relationships. MATERIALS AND METHODS: 2.5 cm long and 1 cm wide four vaginal mucosal flaps were raised from the anterior vaginal wall just behind labia minora. Two flaps were based proximally, and their two opposing flaps were based distally. These flaps were overlapped in a crisscross fashion and were sutured with 5/0 Polyglactin (Vicryl(®)) sutures leaving no area raw. The donor area was closed primarily. When some remains of a torn hymen were found, one to three vaginal mucosal flaps were added to its remains as per the need for reconstruction. RESULTS: We operated upon 11 patients. In nine cases, the hymen was reconstructed with four flaps. In remaining two, it was reconstructed from the remains using vaginal mucosal flaps. All flaps healed without any infection or disruption. Sutures got absorbed in 25-35 days. In all cases, this newly constructed barrier broke with only moderate pressure at the time of penetrative sex serving the purpose of the surgery completely. CONCLUSION: Erasing evidence of the sexual history simply by 'Surgical Revirgination' is extremely important to women contemplating marriage in cultures where a high value is placed on virginity.

Use of indigenously made negative-pressure wound therapy system for patients with diabetic foot.

OBJECTIVE: Negative-pressure wound therapy (NPWT) is a well-known treatment modality for chronic, difficult, nonhealing wounds. Unfortunately, many commercially available negative-pressure therapy systems for wounds are expensive, require hospitalization, and may not be available throughout the world. The authors have designed a less expensive and effective NPWT system from components readily available in the hospital. DESIGN: The system is assembled from ethylene oxide sterilized polyurethane foam, transparent adhesive dressing, and a simple negative suction drain system, which is being routinely used in surgical cases. The multiple holes suction tube is inserted between 2 layers of polyurethane foam and is put on the wound, which is sealed by adhesive dressing. The negative pressure is created using a closed wound suction set. The dressing is changed every third day or as needed. MAIN RESULTS: The authors have used this system in 11 patients with diabetic foot. The mean time for preparation of wound for surgery with this system was 7 days (5-9 days). The raw areas were either secondarily closed or were covered with split-thickness skin graft. The mean hospital stay for debridement and definitive surgical procedure was 11 days (8-15 days). CONCLUSION: In the authors' experience, the NPWT system developed from off-the-shelf components reduces the length of hospital stays and therefore cost, without any compromise on quality. It leads to a quicker wound closure and reduces the need for multiple surgeries or flaps. This modification presents a simple, cheap, and effective alternative to commercially available NPWT machines.

Successful management of cutaneous mucormycosis by delaying debridement.

Mucormycosis is a frightening medical condition which has baffled clinicians all over the world. Cutaneous mucormycosis is, in particular, extremely invasive, leading to high rates of morbidity and mortality. Timely intervention with antifungal drug Amphotericin B and early radical debridement are keys for favorable outcome.Three consecutive patients died of cutaneous mucormycosis despite being treated with Amphotericin B and an early extensive debridement. With disappointing results in these patients, the treatment protocol was changed. Instead of early aggressive surgical intervention, the debridement was withheld for minimum 10 days or more, until Amphotericin B started to show its effect. Debridement was carried out conservatively after 10 days. The resultant raw area was covered with the split-thickness skin graft later.The concept of "Delay the Debridement" was efficacious in the successive 5 patients with minimum morbidity and less reconstructive requirements. Our study contradicts the popular wisdom of the necessity of early vigorous debridement. We think that the timing of debridement is one of the most important determinants of mortality.The scientific reasons for delaying the debridement have been discussed. This appears to be the first report of successful management of cutaneous mucormycosis by delaying the debridement.