D P Mohapatra

The reconstructive microsurgery ladder in orthopedics

It was interesting to read the article titled ‘‘The Reconstructive icrosurgery Ladder in Orthopedics’’ [1]. The authors have viewed the history of microsurgery in orthopedics and introprimitive binocular microscope to operate on patients with chronic otitis in 1921 [8]. In 1946, Perritt applied the use of the microscope to ophthalmology [9]. It is true that Jacobson and Suarez were the first to utilise the microscope to perform microvascular anastomosis. They were also the ones who introduced the diploscope, a stereoscopic microscope for microvascular anastomosis [7], thus setting the stage for modern microvascular surgery.

New regenerative approach to atrophic rhinitis using autologous lipoaspirate transfer and platelet‐rich plasma in five patients: Our Experience

Dear Editor, Atrophic rhinitis (AR) is a debilitating chronic nasalmucosal disease of unknown aetiology. The condition is characterised by progressive nasal mucosal atrophy, atrophy of the underlying bone of the turbinate, abnormal widening of the nasal cavities with paradoxical nasal obstruction and formation of viscid secretions and dried crusts leading to a characteristic fetor (ozaena). Atrophic Rhinitis was first described by Fraenkel in 1876, but the aetiology of the disease is still a matter of dispute. Various methods of treatment, both medical and surgical, have been tried without much success. However, clinical features of the disease can be attributed to the destruction of the normal respiratory epithelium and metaplasia to a nonciliated squamous epithelium and loss of mucociliary clearance. Thus the curative treatment of AR should address the reversal of this basic pathologic alteration in its microanatomy. Promotion of regeneration of normal nasal mucosa must be the aim of any treatment for long-lasting success. The aim of this article is to present a new regenerative approach to reverse atrophy of nasal mucosa by grafting autologous of lipoaspirate.

Algorithm based on eighteen patients with acquired traumatic earlobe defects not associated with jewellery

Dear Editor, Acquired earlobe defects are quite common. These may range from the ubiquitous split ear lobule to loss of portion of the earlobe or to more complex defects involving part of the ear helix. Simple earlobe defects can be closed primarily. Reconstruction of the latter types of defect is more difficult. While the surgical options available for these earlobe defects are many and varied, no specific algorithms could be found in the English literature that would help in the selection of a flap design for a particular defect. This study proposes to introduce a new classification scheme for acquired earlobe defects and suggests an algorithm to aid in the treatment planning of such conditions.

Role of jet force technology in wound management

Aim: The aim was to study the role of jet force technology (JFT) in wound management. Methods: This is a retrospective analysis of 18 cases of chronic nonhealing wounds in which JFT was used. Chronic wounds which had already undergone surgical debridement but which were not ready for reconstruction (skin graft/flap) secondary to a persistent bacterial load or infection (tissue culture positive) were included in the study. Patients were divided into two groups. Group 1 included those patients who were poor candidates for anesthesia or who refused for reconstruction and were managed with JFT only. Group 2 included those patients who were cleared for anesthesia and who were and who were managed with JFT and skin graft or flap coverage. The time to negative wound cultures after JFT and the total duration of healing were noted. Results: In both the groups, all tissue culture positive chronic wounds became negative after 2 ± 1 weeks and were ready for reconstruction. In Group 1 (6 patients), the wounds completely healed in 5‐6 weeks with JFT only. In Group 2 (12 patients), the wounds completely healed in 3‐4 weeks with JFT and skin graft/flap. Conclusion: Hydrotherapy with JFT helps in the removal of contaminants, debris, and microbial colonization of the wound leading to spontaneous wound healing and facilitating wound bed preparation for wound coverage by a skin graft or flap.

Diode and Nd:YAG laser in a case of refractory acne keloidalis nuchae

Acne keloidalis nuchae (AKN) is a disease of unclear etiology that mainly affects males. Medical treatment of AKN is difficult, with refractory cases often requiring ablation by laser or surgical resection. We report herein, a 23-year-old male with refractory AKN treated successfully with combined laser ablation, using an 810-nm diode laser and a 1064-nm Nd:YAG laser.

Unburied K-wire induced injuries: taking the edge off

Unburied K-wires left projecting from the fingers after hand surgery can lead to inadvertent injuries if left open, especially in children or disoriented patients, particularly at the time of reversal of anesthesia and in the immediate postoperative period. Different ways have been described to circumvent this. Many surgeons twist the K-wire on itself along with capping of the wire tip, but this requires considerable twisting force on an already inserted K-wire, which can lead to malalignment or even refracture.[1] Furthermore, the bent K-wire acts like a hook, catching onto dressing materials or clothes and subsequently may migrate out.