Deemesh Oudit

A modification of the V-Y advancement flap to cover a defect of the outer canthus and both eyelids

We describe the use of a modified V-Y advancement flap from the lateral aspect of the outer canthus to cover a defect with three components on the lateral aspects of the upper and lower eyelids and the outer canthus of the eye.

The perioperative management of patients on antiplatelet agents and anticoagulants presenting for plastic surgical operations: a survey of current practice in the UK

A significant proportion of patients who present for plastic surgical procedures take aspirin or other antiplatelet agents (clopidogrel or nonsteroidal anti-inflammatory drugs) or are on anticoagulants (e.g. warfarin). Although there have been several reports in the literature regarding the perioperative management of patients presenting for dermatologic surgery, there have been no such reports pertaining to the wider scope of plastic surgical practice. In the absence of clear guidelines for the perioperative management of these patients presenting for plastic surgical practice, we have undertaken a pilot survey of the current practices of consultant plastic surgeons in the UK. The aims of this study were to determine whether there was uniformity of practice, and whether the modes of practice differed from those outlined in the literature for other related specialities. A postal survey of 235 plastic surgical consultants was conducted. The response rate was 48%. Overall, most respondents (84%) stated that their practice was primarily based on personal preference, and only 28% stated that it was based on the local Unit policy. Only 23% of the Consultants based their practice on evidence-based medicine. There appeared to be significant variations in current practice amongst plastic surgeons. Some aspects of practice were found to vary from those recommended in the literature for other related specialities. We hope that the findings of this study will highlight the significant non-uniformity of practice within this speciality and that this may form the basis for the development of clear guidelines of the entire spectrum of plastic surgery for the preoperative management of this group of patients in the future.

Patterns of sensory and autonomic reinnervation of long-standing myocutaneous microvascular flaps and split-skin grafts applied to fascial beds.

BACKGROUND There is a paucity of reports in the literature examining the pattern of sensory and autonomic neural recovery of myocutaneous microvascular flaps and skin grafts to the lower limbs after a prolonged period of time. OBJECTIVES To investigate the recovery of sensation and autonomic nerve activity in long-standing split-skin grafts applied to fascial beds and in myocutaneous microvascular flaps. METHODS THE PATIENTS WERE DIVIDED INTO TWO GROUPS: group A consisted of patients with a split-skin graft applied to a fascial bed (n=11) and group B consisted of patients with free microvascular flaps (n=4). Patients in both groups underwent various clinical subjective and objective tests, including the measurement of electrical resistance and thermal sensory analysis. Laser Doppler flowmetry was used to investigate the blood flow patterns. RESULTS Patients in both groups showed significantly reduced sensory modalities. However, the findings of both the electrical resistance and laser Doppler flowmetry were significantly different among the patients in group A compared with controls. In contrast, electrical resistance and laser Doppler flowmetry test results were similar in group B and controls. CONCLUSIONS Both split-skin grafts applied to fascial beds and microvascular flaps on the lower limb had poor sensory recovery. However, after 15 years, the microvascular flaps regained the ability to sweat and some degree of thermoregulatory function. This may imply that the long-standing myocutaneous free flaps regained some aspects of their autonomic innervation, whereas the split-skin grafts had not.