Reconstructive Surgery Camp for Leprosy Deformities in a Tertiary Hospital: An Example of Service Delivery at Low Costs.

INTRODUCTION: Seventy percent of all cases of leprosy in the world occur in India. 8,462 new cases of disability were reported in India between 2010-11. Reconstructive Surgery Camps (RSC) provide free of cost plastic surgical expertise to patients of leprosy with deformity. AIM: The aim of this article was to report the outcomes of a RSC in a tertiary level university hospital in India. We also described the types of deformities in the patient group and the cost of conducting such a camp. MATERIALS AND METHODS: The RSC involved 130 patients with leprosy related deformities operated by a team of plastic surgeons in a tertiary university hospital over 5 days. Health workers of the National Leprosy Elimination Program identified patients at community level. The camp was funded by the central government of India and the patients were provided incentives for undergoing treatment. RESULTS: Plantar ulcer was the commonest deformity (51.5%) while lagopthalmos (9.2%) was the least common deformity in the patient group. The overall complication rate in our study was around 10.6% (n=11). The total cost of this camp was 730,000 rupees (£7029.9). CONCLUSION: Reconstructive surgery in a camp setup is a low cost alternative of correcting leprosy related deformity. It also provides valuable practical experience in reconstructive surgery to surgical trainees. Tertiary hospital based camps for conducting large-scale surgeries may be a cost effective alternative to reduce waiting lists in public health sectors. Long-term studies monitoring patients operated in a camp setting would be worthwhile.

Pneumobilia with gastric outlet obstruction.

Complications of peptic ulcer disease (PUD) like gastric outlet obstruction (GOO) and biliary fistula have become extremely rare with the advent of proton-pump inhibitors.This is a case of PUD presenting with GOO, a cholecystoduodenal fistula discovered incidentally on upper gastrointestinal endoscopy, and the presence of pneumobilia on a contrast-enhanced CT of the abdomen. A gastrojejunostomy with internal pyloric exclusion was performed. Since the patient did not have any signs of biliary tract disease,we decided not to operate on the fistula to prevent injury to the bile duct. The patient had an uneventful recovery.

Extraskeletal osteosarcoma of the larynx: an extremely unusual tumour.

Osteosarcoma of the larynx is probably the rarest mesenchymal tumour of the larynx, with only 16 cases reported so far. The majority of them occur in males between the sixth and eighth decades of life. Patients usually present with non-specific symptoms such as dysphonia and upper airway compromise. The most common site of distant metastasis is the lung. Clinically, the tumour follows an aggressive course and is associated with high mortality. The case we present is unusual as it occurred at a young age (38 years) as compared with the norm and it did not arise from the endolarynx, unlike many of the other cases. This was the only known case where a Pearson near-total laryngectomy was performed whereby the patient's natural speech mechanism was preserved. This surgery was possible because the contralateral half of the larynx was clearly disease free and the interarytenoid region was uninvolved. The patient underwent postoperative adjuvant external beam radiotherapy beginning 4 weeks after surgery. The patient is doing well after 15 months of follow-up and shows no signs of recurrence.