Oncoplastic Breast Surgery: a Single-Institution Experience.

Oncoplastic breast surgery involves immediate reshaping of the breast after tumor excision. It enables wider excision of the tumor while maintaining a satisfactory cosmetic outcome. One hundred and thirty seven patients underwent oncoplastic breast surgery at our institute between June 2019 and December 2021. The procedure performed was decided based on the location of tumor and volume of excision. All patient and tumor characteristics were entered into an online database. The median age was 51 years. The mean tumor size was 3.666 cm (± 0.2512). Twenty-seven patients underwent a type I oncoplasty, 89 patients type 2 oncoplasty, and 21 patients a replacement procedure. Only 5 patients had margin positivity out of which 4 patients underwent a re-wide excision with negative margins. Oncoplastic breast surgery is a safe and effective method to manage patients who need conservative surgery of breast tumors. It allows us to provide good esthetic outcome to the patients ultimately aiding in better emotional and sexual well-being.

Cadaveric Bilateral Proximal Forearm Allotransplantation.

Until, sometime ago, microsurgery meant mainly covering a defect or replanting severed parts back to where they belong. Now, restoration of original function and aesthetic consideration is a must in planning reconstructive procedure. Hand transplant combines hand surgery and microsurgery with complex multidisciplinary care.At the anniversary of our first cadaveric bilateral proximal forearm transplantation done in the country's government institute, we would like to share our experience in performing the surgery, outcomes so far, complications, and lessons learned, to contribute to the growing knowledge of vascularized composite allotransplant.

Intense pulsed light vs silicone gel sheet in the management of hypertrophic scars: an interventional comparative trial in the Indian population.

Introduction: Hypertrophic scars are abnormal scars that are a source of great functional, psychological and financial burden to the patient. Currently available treatment modalities are either very cumbersome to use or have not provided very satisfactory results. Intense pulsed light (IPL) therapy for the management of hypertrophic scars has been recently introduced. However, most of the studies available are from the Western population. In this trial, we aim to study the effect of IPL on the South Indian population with darker skin and compare it with an existing treatment modality (silicone gel sheet). Materials and Methods: This trial was an interventional clinical trial conducted from September 2015 to March 2017 on 28 patients with 65 hypertrophic scars. Each scar was divided into 2 equal parts (4.6 x 1 cm2). One half of the scar was treated to 4 sessions of 29J/cm2 of IPL at 3 weekly intervals. A silicone gel sheet (SGS) was applied over the other half and changed at 3 weekly intervals. The Vancouver scar scale was used to grade both halves of the scar before treatment, at each visit and 3 weeks after treatment completion. Results: Scars treated with IPL showed a significant reduction in the pliability (p=0.002) and hyperpigmentation (p=0.000) as compared to scars treated with SGS. Though the percentage reduction in the height of the scar was more in the IPL group (15.4% as compared to 4.6%in the SGS group), the result was not statistically significant (p<0.065). As most scars in our study showed normal vascularity at the beginning, the percentage reduction in vascularity between both groups was the same (p<0.597). The reduction in the median VSS score was more in the IPL group compared to SGS group (p=0.00). Conclusion: IPL therapy offers a safe and effective means of hypertrophic scar treatment, especially on large scars where other treatment modalities may not be feasible. Minimal side effects that occur can be prevented with proper pre, intra and post procedure cooling.

Effectiveness of Fibrin Glue in Adherence of Skin Graft.

BACKGROUND: Graft fixation is important for graft take. Fibrin glue has been proposed as an ideal material, because of its human origin and it provides firm adhesion in seconds or minutes. OBJECTIVE: To evaluate the efficiency of fibrin glue, in increasing the take of skin graft. Assessment includes surgical time taken for graft fixation, haematoma/seroma formation, engraftment and wound closure by day 14. METHODS: The study is an observational prospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, from January 2016 to June 2016. Sixteen patients who underwent split skin grafting were assessed during the study period. Fibrin glue was used on the recipient bed before grafting. RESULTS: Better haemostasis and graft adhesion, with a significant reduction of surgical time, were noted. CONCLUSION: The safety profile of fibrin glue was excellent as indicated by the lack of any related serious adverse experiences. These findings demonstrate that it is safe and effective for attachment of skin grafts, with outcomes at least as good as conventional methods.

Proposal of a new classification scheme for periocular injuries.

BACKGROUND: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. MATERIAL AND METHODS: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. RESULTS: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. DISCUSSION: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. CONCLUSION: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

Radiofrequency-Assisted Body Piercing.

The art of body piercing is ancient; however, nowadays it has evolved into a fashion statement. In the Indian subcontinent, ear and nose piercing hold religious and cultural significance in addition to being done for aesthetic reasons. Body piercing is routinely performed by railroading technique or by piercing guns; many modifications of the technique have emerged. Irrespective of the technique used, the main complications associated are intraoperative bleeding and postoperative infection. To overcome these problems, we describe a novel and simple technique of ear and nose piercing using the radio frequency cautery.

Diode Laser Ear Piercing: A Novel Technique.

Earlobe piercing is a common office room procedure done by a plastic surgeon. Various methods of ear piercing have been described. In this article, we describe a novel method of laser ear piercing using the diode laser. An 18-year-old female patient underwent an ear piercing using a diode laser with a power of 2.0 W in continuous mode after topical local anaesthetic and pre-cooling. The diode laser was fast, safe, easy to use and highly effective way of ear piercing. The advantages we noticed while using the diode laser over conventional methods were more precision, minimal trauma with less chances of hypertrophy and keloids, no bleeding with coagulation effect of laser, less time taken compared to conventional method and less chance of infection due to thermal heat effect of laser.

A Comparative Study of Lateral Sphincterotomy and 2% Diltiazem Gel Local Application in the Treatment of Chronic Fissure in ANO.

INTRODUCTION: Anal fissures are commonly encountered in routine clinical practice. Anal fissure has traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study we compare symptomatic relief, healing and side effects of topical 2% Diltiazem gel and lateral internal sphincterotomy in the treatment of chronic fissure in ano. MATERIALS AND METHODS: In this prospective trial, 60 surgical out patients and/or admitted patients with chronic fissure in ano were randomly divided into Group 1 (Diltiazem gel) and Group 2 (internal sphincterotomy) with 30 patients in each Group. Patients were followed up at weekly intervals for six consecutive weeks and biweekly for subsequent 3 months. RESULTS: Fissure was completely healed in 88.46% of patients in Group 1 and in 100% in Group 2. The mean duration required for healing of fissure was 5.04 weeks in Group 1 and 3.6 weeks in Group 2. 78.26% patients were free from pain in Group 1 whereas 85.18% patients were free from pain in Group 2. No patient had any side effects in either group. CONCLUSION: Topical Diltiazem should be considered as first line treatment in chronic fissure in ano. Internal sphincterotomy should be reserved for patients with relapse and therapeutic failure to prior pharmacological treatment.