Unilateral reverse latissimus dorsi muscle flap for postoperative CSF leak and wound dehiscence in lumbosacral defects: a lifeboat approach.

A lumbosacral defect with cerebrospinal fluid (CSF) leak, particularly after breakdown of a repaired lipomeningomyelocele, is often a difficult problem to manage. Although several methods of local flap coverage have been used, local wound infection and tissue cellulitis associated with the wound dehiscence makes the repair prone to redehiscence. The associated CSF leak requires a good reliable closure as a matter of urgency. We describe two patients with lipomeningomyelocele, operated upon for tethered cord syndrome, who developed postoperative CSF leak and wound dehiscence. The associated wound infection and signs of meningitis made re-exploration, debridement and a dependable, well vascularized cover of the dura mandatory. The reverse latissimus dorsi flap provided a good vascularized seal. Both patients recovered rapidly.

Supernumerary nostril in association with incomplete naso-ocular cleft.

Supernumerary nostril is an extremely rare congenital anomaly with sporadic reports of its occurrence in the literature. Associated congenital anomalies have not been present in the cases described. The treatment is excision of the nostril, using the technique of a fistulectomy, and associated procedures to correct a bifid nasal tip or wide columella base. We describe our experience with this anomaly in an adult male, who had features of an incomplete naso-ocular cleft. We treated it by excising the accessory nostril, repositioning the displaced alar base, and providing skin and lining, which were both deficient, by local flaps.

Supernumerary limbs: a case report of a rare congenital anomaly.

We report a case of an 18-month-old female who presented with three supernumerary upper limbs of varying lengths on the right side. Each limb had a proximal, middle, and distal segment, and an intercalated elbow and wrist joint. A single digit was present in the superior limb, three digits in the middle limb, and two digits in the caudal-most limb. Right plagiocephaly, congenital torticollis, scoliosis involving the upper and mid thoracic region, and a hypoplastic right pectoralis major were the other abnormal features noted. Radiography showed two scapulae, humerus, a single forearm bone in each limb, and rudimentary metacarpals and phalanges. Limb duplication may rarely be encountered in parasitic conjoined twins. The role of mutagens, drugs, cellular contributions, and morphogens in the growth and differentiation of limbs has been studied in animals. It is rather difficult to deduce the time of action of the factors responsible for such a malformation.

Hair growth following scalp microvascular flap transfer for baldness due to burn injury.

A female patient, 8 years of age, presented with baldness of the right scalp following deep scalds from boiling soup landing on the head, neck, and chest. The depth of the burn was severe enough to cause baldness. She was primarily advised to wear a wig to address the problem of baldness on one side. Surgery was planned to use uninjured scalp skin to offer hairy skin coverage of the bald site. A left scalp skin flap (2.5 by 7 cm) based on the superficial temporal artery and vein was transferred to the bald area, with microvascular anastomosis to the superficial temporal vessels on the right side. There was complete survival of the flap with uneventful recovery and satisfactory growth of hair. Hair growth from the flap was comparatively thicker than from the rest of the scalp. This microvascular flap has produced sufficient hair to cover the entire area of the baldness and the patient does not need to wear a wig.