Post dermoid excision nasal tip deformity correction using gelatin sponge.

Reconstruction of the nasal tip after the excision of the dermoid cyst is difficult, especially if the size of the dermoid is large. Tip reconstruction using Interdomal sutures of alar cartilages and auricular cartilage graft has been used in such cases. We share a new method to manage the nasal tip defect following excision of nasal dermoid, using an absorbable gelatin sponge. A 13 years old female presented with a swelling tip of the nose for the past 2 years. The CT scan revealed a dermoid cyst at the tip of the nose over the alar cartilage with prominent buckling of the cartilages. The Dermoid cyst was excised through an open rhinoplasty incision. There was a defect of 2.2 cm diameter at the tip of the nose with deformed alar cartilages. A piece of absorbable gelatin sponge was folded, cut according to the shape of the cavity, and used to fill the cavity. The skin was draped over the cartilage and gelatin sponge. The post-operative period was uneventful. After 2 years of follow-up, the patient remained asymptomatic and satisfied with a nice contour of the nasal tip.

Etiopathological Factors Associated with Gynecomastia Patients Seeking Surgical Correction in the South Indian Population.

Background Although several medical conditions are associated with gynecomastia, around 60% of cases are idiopathic. The role of endocrine testing in idiopathic gynecomastia is controversial. This study was done to determine the etiological and lifestyle factors associated with different grades of gynecomastia. Patients and Methods This was a descriptive study conducted at the department of plastic surgery in a tertiary care hospital in South India between January 2014 and December 2016, among the patients seeking corrective surgery for gynecomastia. Results A total of 73 patients were included in the study with a mean age of 22.56 years. The majority of the patients displayed Simon's Grade IIa gynecomastia (56.2%). The etiological factors identified in this study were hormonal abnormalities (47.95%), hypogonadism (2.7%), and drug intake (1.4%). The most common hormonal abnormality discovered was high estradiol values (15.1%) followed by decreased testosterone levels (13.7%). The chi-squared test revealed no statistically significant relationship between the hormonal values, type of food, body mass index (BMI), or physical activity and the grades of gynecomastia. Conclusion Most of the patients (50.68%) in our study had idiopathic gynecomastia. The most common hormonal abnormality detected was high estradiol values. No correlation was found between the hormonal values, type of food, BMI, or physical activity and the grades of gynecomastia.

Objective Assessment of Microsurgery Competency-In Search of a Validated Tool.

Microsurgical skill acquisition is an integral component of training in plastic surgery. Current microsurgical training is based on the subjective Halstedian model. An ideal microsurgery assessment tool should be able to deconstruct all the subskills of microsurgery and assess them objectively and reliably. For our study, to analyze the feasibility, reliability, and validity of microsurgery skill assessment, a video-based objective structured assessment of technical skill tool was chosen. Two blinded experts evaluated 40 videos of six residents performing microsurgical anastomosis for arteriovenous fistula surgery. The generic Reznick's global rating score (GRS) and University of Western Ontario microsurgical skills acquisition/assessment (UWOMSA) instrument were used as checklists. Correlation coefficients of 0.75 to 0.80 (UWOMSA) and 0.71 to 0.77 (GRS) for interrater and intrarater reliability showed that the assessment tools were reliable. Convergent validity of the UWOMSA tool with the prevalidated GRS tool showed good agreement. The mean improvement of scores with years of residency was measured with analysis of variance. Both UWOMSA ( p -value: 0.034) and GRS ( p -value: 0.037) demonstrated significant improvement in scores from postgraduate year 1 (PGY1) to PGY2 and a less marked improvement from PGY2 to PGY3. We conclude that objective assessment of microsurgical skills in an actual clinical setting is feasible. Tools like UWOMSA are valid and reliable for microsurgery assessment and provide feedback to chart progression of learning. Acceptance and validation of such objective assessments will help to improve training and bring uniformity to microsurgery education.

An Easy Technique for Negative-Pressure Wound Therapy for Extremities Using Collagen Powder and Sterile Gloves.

Negative-pressure wound therapy (NPWT) has become the standard of care for wound management. Application of NPWT to the hand and foot is technically challenging due to difficulty in obtaining a proper air seal. The cost of the treatment is another negative factor affecting NPWT in developing countries. We describe an easy and economical technique for the application of NPWT to the extremities using collage powder and sterile surgical glove. Collagen creates a physiological interface between the wound surface and the environment and is also non-immunogenic, non-pyrogenic, hypoallergenic, and pain-free. We used this method in 20 patients. In all cases, we could achieve a proper air seal and significantly reduce the cost. The median duration of NPWT application was 9 days. This combination turned out to be a good alternative to traditional VAC with respect to the duration and cost of treatment and also ergonomically better in the management of extremity wounds.