Ankur Bhatnagar

Congenital urethrocutaneous fistula: Case report with review of literature.

We are presenting two cases of congenital urethrocutaneous fistula on ventral penile shaft. Congenital urethral fistula is an extremely rare, but easily manageable anomaly that may be confused with hypospadias. Awareness of the entity will avoid complications. This condition may be associated with other anomalies like congenital hernias and anorectal malformations. Treatment of this entity is individualized according to site of fistula, associated anomalies and condition of the distal urethra. All the principles of hypospadias surgery should be strictly followed.

Congenital cheek teratoma with temporo-mandibular joint ankylosis managed with ultra-thin silicone sheet interpositional arthroplasty.

Primary cheek teratomas are rare with < 5 reported cases. None had associated temporo mandibular joint ankylosis (TMJA). The fundamental aim in the treatment of TMJA is the successful surgical resection of ankylotic bone, prevention of recurrence, and aesthetic improvement by ensuring functional occlusion. Early treatment is necessary to promote proper growth and function of mandible and to facilitate the positive psychological development of child. Inter-positional arthroplasty with ultra-thin silicone sheet was performed. Advantages include short operative time, less foreign material in the joint space leading to negligible foreign body reactions and least chances of implant extrusion. Instead of excising a large bony segment, a thin silicone sheet was interposed and then sutured ensuring preservation of mandibular height. Aggressive post-operative physiotherapy with custom made dynamic jaw exerciser was used to prevent recurrence.

Aqueous intralesional bleomycin sclerotherapy in lymphatic malformation: Our experience with children and adult

Objectives: Lymphatic malformations (LMs) are aberrant proliferation of sequestrated lymphatic vessels during early embryogenesis and do not communicate directly with the general lymphatic system. The absence of vascular flow is the hallmark of LMs and is usually symptomless apart from painless disfiguring mass with concerns regarding cosmesis. Design: Sclerotherapy has gained prominence as a preferred treatment modality for macrocystic lesions. Here, we present our experience with use of aqueous bleomycin as intralesional sclerosing agent, an economical first-line treatment for macrocystic variant of LMs in children and adults. While bleomycin microsphere in oil has been commonly used in many previous studies, we have used aqueous bleomycin solution as the sclerosing modality which is easily available and economical. Materials and Methods: Twenty-seven patients of macrocystic LM including adults and children underwent bleomycin sclerotherapy under ultrasonography guidance. Number of sessions, dose administered, and the response to therapy along with all side effects were noted. Results: Sixteen patients received 3 or less sessions while rest needed 4–6 sessions of sclerotherapy for desired response. The response was excellent in 22 patients while 5 patients showed good response. Eleven patients developed minor side effects in form of fever, local infection, intracystic bleed, and local skin discoloration. Postsclerotherapy, surgery was performed in two patients. Conclusion: The better response in the present study can be attributed to targeting of individual cysts in multiloculated lesion, ultrasound-guided aspiration of the cysts content before drug delivery, and postprocedure compression which increases the contact time between cyst wall and bleomycin reducing the chances of postprocedure seroma formation. Since the drug acts on the endothelial lining of the cyst, volume of the cyst is the major determinant in response. Aqueous bleomycin had comparable results with oil-based microsphere establishing it as an economical alternative treatment modality.

Naso-orbital fistula and socket reconstruction with radial artery forearm flap following orbital mucormycosis

Invasive mucormycosis is an uncommon cause of orbital exenteration. Reconstruction of an exenterated orbit is a surgical challenge. The loss of eyelids, adnexal structures, and even surrounding skin causes significant facial disfigurement. The goal for reconstruction demands a symmetrical orbital cavity with good prosthetic rehabilitation. Multiple reconstructive options in the form of skin grafts, local flaps, and free flaps are available. However, none of them provide ideal reconstruction. Our patient not only had extensive soft-tissue loss and unstable lining but also a large naso-orbital fistula. Reconstruction for this complex defect was done using an adipofascial radial artery flap which not only closed the fistula but also provided soft-tissue bulk and good skin match. Radial artery forearm flap provides a simple, stable, and good reconstructive option postorbital exenteration.

Idiopathic polypoidal scrotal calcinosis leading to delay in diagnosis of testicular tumor

Idiopathic polypoidal scrotal calcinosis (IPSC) is a rare and benign condition with disputed etiology and it is characterized by multiple calcific nodular deposits in scrotal skin. Here we report a case of a 45-year-old male patient with testicular tumor and 7 years history of scrotal calcinosis is reported. Discussed is the delay in diagnosis of testicular tumor due to IPSC and difficulty in performing fine-needle aspiration cytology in such cases. In our case, no evidence of cystic structure was found around calcified materials. It was indicated that IPSC might be idiopathic. In addition, highlighted the importance of meticulous clinical examination to accurately diagnose the clinical entity and avoid delay in treatment. They are slow growing asymptomatic tumors. Complete excision of the lesion along with the involved scrotal skin with scrotoplasty of the residual scrotal skin is the treatment of choice. Reports of such rare calcified scrotal nodular lesions especially when associated with other malignant conditions need publication and the treatment protocol shared among the surgeons.

Congenital Lateral Upper Lip Sinus: A Rare Case

Congenital lateral sinuses of upper lip are malformations with uncertain etiology. These blind sinuses through orbicularis oris muscle have no intra-oral communication, with surgical excision being treatment of choice. We present our case referred to us as a patient of posttraumatic salivary fistula. Surgical management and possible etiology is discussed briefly. Also highlighted is the importance good history taking and meticulous clinical examination to accurately diagnose the entity in order to avoid expensive supportive radiological investigations.

Case 249: Intramuscular Mycetoma

History A 21-year-old man presented with swelling of the medial aspect of the left thigh of 1-month duration. There was no history of fever or penetrating injury in the left thigh. The patient had undergone renal transplantation 7 years earlier and had been taking immunosuppressants since transplantation. He had undergone two surgeries at the same site in the medial aspect of the left thigh in the past 3 years for a similar problem. At physical examination, there was swelling in the medial aspect of the left thigh, with mild tenderness. A surgical scar was noted anterior to the swelling ( Fig 1 ). No redness or discharging sinus was present. Laboratory results were as follows: hemoglobin level, 11.3 g/dL (normal range, 13.8-17.2 g/dL); white blood cell count, 9.7 × 109/L (normal range, [4-11] × 109/L); neutrophil, 75% (normal range, 48%-77%); lymphocyte, 22% (normal range, 10%-24%); eosinophil, 1% (normal range, 0.3%- 7%); monocyte, 1% (normal range, 0.6%-10%); serum creatinine level, 1.3 mg/dL (114.9 μmol/L) (normal range, 0.5-1.6 mg/dL [44.2-141.4 μmol/L]); and serum glucose (random) level, 82 mg/dL (4.5 mmol/L) (normal range, 79-140 mg/dL [4.4-7.8 mmol/L]). Radiography of the left thigh showed soft-tissue swelling in the medial aspect of the left thigh, without underlying bone involvement (not shown). Ultrasonography (US) and magnetic resonance (MR) imaging of the left thigh were performed. [Figure: see text].

Unusual site for cystic hygroma: A single centre experience

Journal of Cutaneous and Aesthetic Surgery October-December 2016, Volume 9, Issue 4 287 transfer using a pocket dermatoscope which gives a ×10 magnification (DermLite DL3, 3Gen Inc., USA) at least 3 months after the surgical procedure. Images were taken with a Sony Cybershot DSC‐W800 20.1 MP digital camera after attaching it to the dermatoscope with a universal adapter [Figures 1‐5]. The best colour match was seen with non‐cultured epidermal cell suspension followed by follicular unit extraction.

Intraoral excision of large submental dermoid

Sublingual dermoids are the rarest forms of craniofacial dermoids mostly seen in young individuals. Excision of large and deep submental dermoid is generally done via extraoral approach scarring the most prominent part of the face, which can lead to post operative scar hypertrophy and hyperpigmentation especially in non-Caucasian races. Presence of such scars leads to adverse psychological effects in young individuals. Excision via intraoral route, although technically demanding, can be simplified using basic principles of plastic surgery leading to optimal aesthetic outcome with least downtime. We excised a large sublingual dermoid extending deep to the mylohyoid muscle through intraoral approach with excellent cosmetic results. Clinicians dealing with such lesions should keep these principals in their armamentarium when dealing with this rare subset of cases.