Alopecia secondary to repaired occipital encephalocele - role of tissue expander in hair restoration.

Partial scalp alopecia is a common problem that can lead to severe social and psychological problems. Tissue expansion, although an old concept, provides a surgical alternative to manage areas of alopecia. We describe a case of alopecia secondary to repaired occipital encephalocele that was successfully treated using tissue expansion technique.

Lower eyelid reconstruction following a traumatic full thickness loss.

Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.

Soft tissue reconstruction following hemipelvectomy: eight-year experience and literature review.

BACKGROUND AND OBJECTIVES: Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction. METHODS: A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications. RESULTS: Thirteen patients were included with median age of 39 years (range 13-78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. CONCLUSIONS: Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.

A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars.

BACKGROUND: Despite widespread beliefs regarding the use of topical tocotrienol in the prevention of hypertrophic scars, there is very little evidence from well controlled and randomised clinical trials to justify its benefits for surgical scars. OBJECTIVE: This study was conducted to evaluate the efficacy of topical tocotrienol in preventing the development of hypertrophic scars. METHODS: A prospective, randomised, double-blinded study was performed on 122 patients with recently healed (<2 weeks) surgical scars, who were randomised into either a treatment group with 5% topical tocotrienol or a placebo group. The patients were required to apply the preparation to their scars twice a day for 6 weeks starting at 2 weeks after surgery. Assessments of the scars were performed at weeks 0, 2, 6 and 16 following the onset of topical application using three methods: a clinical assessment using the Patient and Observer Scar Assessment Scale (POSAS), a photographic scar assessment by two independent assessors using a visual analogue scale and laser Doppler imaging (LDI). Data analysis was performed on 85 patients (tocotrienol group: 45 patients; placebo group: 40 patients), who had completed four assessments. RESULTS: There was no statistically significant difference in scar parameters between the tocotrienol and the placebo groups in the POSAS, photographic scar assessment or mean flux of LDI (p>0.05) categories. The mean LDI flux showed a decreasing trend over time, which was positively correlated with vascularity (correlation coefficient=0.325, p=0.008) and total scores (correlation coefficient=0.248, p=0.034) of the observer scar assessment scale on week 0. No significant adverse effect was observed. CONCLUSIONS: Twice-daily application of 5% topical tocotrienol had no significant effect on the appearance and vascularity of scars over 4 months post-surgery. LDI has a promising role as a scar assessment tool.

The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction.

Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

Proton pump inhibitors: a survey of prescribing in an Irish general hospital.

Prescription rates and attendant costs of proton pump inhibitors (PPIs) continue to rise. The aim of this study was to assess the extent and appropriateness of PPI prescribing in an Irish general hospital. Using a structured pro forma, we conducted a 1-day comprehensive survey of the prescription charts of all inpatients. Of the 157 inpatients, 48 (30.6%) were on PPI therapy and omeprazole was the most widely prescribed PPI. Rabeprazole, the least expensive PPI, was the least prescribed. Prescription of PPI therapy was for an approved indication in 32 patients (66.6%) but was for an unapproved or unknown indication in 16 (33.3%). Prescribing had been initiated in hospital in 34 patients (70.8%) but only one-third of the patients on PPI therapy had undergone endoscopy. Over 90% of patients were on additional, often multiple, prescribed medications. Our results suggest that PPIs are overprescribed in hospital practice, and there is scope to improve the quality and cost-effectiveness of PPI prescribing.