Spring-Assisted Cranial Expansion for Multisuture Craniosynostosis: First Case Report from the Indian Subcontinent.

We present a first use case report from the Indian subcontinent of a 5-month-old child with multisuture craniosynostosis with raised intracranial pressure managed by spring-assisted cranial expansion followed by traditional fronto-orbital advancement and cranial vault remodeling. We emphasize the advantages of spring-assisted cranial expansion in extremely young infants with raised intracranial pressure over posterior vault distraction osteogenesis and open posterior vault remodeling.

Pollicization of Middle Finger in a Cleft Hand Associated with Acrorenal Syndrome.

Introduction Acrorenal syndrome is autosomal recessive inherited disorder commonly associated with congenital renal disorders and ipsilateral hand/foot anomalies. The hand and foot deformities corrections are challenging to achieve a good functional and cosmetic result. We described a case of acrorenal syndrome with suppressed radial elements and absent thumb in whom we were able to reconstruct the hand. Case Report A 5-year-old girl presented to us with right renal agenesis and right hand/foot deformity. The hand showed a cleft hand with central deficiency, index finger hypoplastic, and syndactylyzed to middle finger, absent thumb. The hand was nonfunctional because of absent thumb. To improve the functions, it was decided to proceed with thumb reconstruction. The middle finger was pollicized to regain tripod grip and thereby the functions was enhanced. Discussion The cleft hand belongs to "failure of finger ray induction group" in classification by "International Federation of Societies for Surgery of the Hand (IFSSH)." Absence of thumb and first web space makes it a strong indication for surgical reconstruction. In our case, thumb was addressed by pollicization of middle finger and we were able to provide a good tripod grip.

Tracheoesophageal puncture site closure with sternocleidomastoid musculocutaneous transposition flap.

INTRODUCTION: Tracheoesophageal voice prosthesis is highly effective in providing speech after total laryngectomy. Although it is a safe method, in certain cases dilatation or leakage occurs around the prosthesis that needs closure of tracheoesophageal fistula. Both non-surgical and surgical methods for closure have been described. Surgical methods are used when non-surgical methods fail. We present the use of the sternocleidomastoid musculocutaneous (SCMMC) transposition flap for the closure of tracheoesophageal fistula. MATERIALS AND METHODS: An incision is made at the mucocutaneous junction circumferentially around the tracheostoma. Tracheoesophageal space is dissected down to and beyond the fistula. The tracheoesophageal tract is divided. The oesophageal mucosa is closed with simple sutures. Then SCMMC transposition flap is raised and transposed to cover sutured oesophagus and the defect between the oesophagus and the trachea. RESULTS: This study was done prospectively over a period of 1 year from June 2012 to May 2013. This technique was used in patients with pliable neck skin. In nine patients, this procedure was done (inferior based flap in nine cases) and it was successful in eight patients. In one case, there was dehiscence at the leading edge of flap with oesophageal dehiscence, which required a second procedure. In two cases, there was marginal necrosis of flap, which healed without any intervention. Nine patients in this series were post-radiation. CONCLUSION: This method of closure is simple and effective for patients with pliable neck skin, who require permanent closure of the tracheoesophageal fistula.

Estimation of dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiothearpy - A phantom dosimetric study with radiochromic film.

The objective of this study was to investigate the dose enhancement to soft tissue due to backscatter radiation near metal interfaces during head and neck radiotherapy. The influence of titanium-mandibular plate with the screws on radiation dose was tested on four real bones from mandible with the metal and screws fixed. Radiochromic films were used for dosimetry. The bone and metal were inserted through the film at the center symmetrically. This was then placed in a small jig (7 cm × 7 cm × 10 cm) to hold the film vertically straight. The polymer granules (tissue-equivalent) were placed around the film for homogeneous scatter medium. The film was irradiated with 6 MV X-rays for 200 monitor units in Trilogy linear accelerator for 10 cm × 10 cm field size with source to axis distance of 100 cm at 5 cm. A single film was also irradiated without any bone and metal interface for reference data. The absolute dose and the vertical dose profile were measured from the film. There was 10% dose enhancement due to the backscatter radiation just adjacent to the metal-bone interface for all the materials. The extent of the backscatter effect was up to 4 mm. There is significant higher dose enhancement in the soft tissue/skin due to the backscatter radiation from the metallic components in the treatment region.

Total upper and lower eyelid reconstruction using deltopectoral flap.

Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.