Makarand Tare

Scrotal reconstruction with a free greater omental flap: A case report

We report a case of Fourniers gangrene, where we used the greater omentum as a free flap for scrotal reconstruction and outline the advantages over previously described methods. The greater omentum was harvested using a standard open technique. The deep inferior epigastric vessels were passed through the inguinal canal into the scrotal area as recipient vessels. The detached greater omental flap was prefabricated into a three‐dimensional sac prior to inset and microvascular anastomoses. The flap was then covered by skin graft. The reconstruction had shown good early results with complete survival of the flap, as well as good functional and esthetic outcome at six months. The greater omentum can therefore be used as a free flap for scrotal reconstruction. It allows easy prefabrication and flap inset. The deep inferior epigastric vessels are also suitable recipient vessels.

Vascularised Achilles tendon graft reconstruction--by the tendon for the tendon.

The management of posterior heel defects whether the result of trauma or post-operative that result in a loss of the Achilles tendon and overlying skin is complex and challenging. Various techniques have been employed to reconstruct these compound defects often comprising of a free tissue transfer combined with a fascial tendon reconstruction. We present a single-stage method of Achilles tendon reconstruction based upon a local vascularised tendon graft combined with a free antero-lateral thigh flap transfer and a review of the current literature.

Deliberate self harm with mercury injection in forearm

Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am. 2007, 89: 255–60. Rehak DC. Pronator syndrome. Clin Sports Med. 2001, 20: 531–40. Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002, 359: 657–62.

A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound

The occurrence of calcific myonecrosis of the anterior compartment of the leg is rare. Common risk factors include a history of trauma, although little is known about the exact pathophysiology, latency period or triggering factors resulting in disease progression. Macroscopically, it begins with a single muscle being replaced by a fusiform calcified mass, which progresses peripherally.

Tips and tricks for getting more out of your delayed primary repair of ruptured flexor pollicis longus tendon

Primary tendon repairs are often difficult in patients with delayed presentation. Tendons are contracted and shortened with extensive scarring occurring along the path of the tendon. Pulleys and the wound bed can be filled with granulation tissue which obstructs the passage of the tendon. Many of such patients would then be treated with a two stage tendon reconstruction, which involves the insertion of a silicone rod for pseudosheath formation[1] before tendon grafting at a second stage. This however, would set the patient back for roughly six months, especially involving multiple visits to physiotherapy and being off work. We would like to describe several tips and tricks in our armamentarium and illustrate these using a case we recently encountered [Figure 1].

The exquisitely painful fingertip - subungual glomus tumours: Letter to the Editor

While most painful fingertips have a distinct causal history and/or associated symptoms, some can leave the practitioner at a loss during diagnosis. We present a rare differential that often has an indistinct history, subtle clinical signs and is commonly misdiagnosed, with average diagnosis time reported as 7 years (1). A 25-year-old patient presented with a several-year history of a gradually increasingly painful fingertip, just beneath her nail plate. There was no history of trauma or precipitating event she could recollect. She had been assessed by several practitioners over the years with normal radiology and ineffective neuromodulation, and analgesics offered little effect. On examination, she had a minimal area of slight blue discolouration under her nail plate, which elicited exquisite pain on palpation. This was diagnosed clinically as a subungual glomus tumour based on the symptom of exquisite pain in the fingertip without causal history and the subtle colour discolouration. Treatment was surgical excision under a digital nerve block with removal of the overlying nail plate. The lesion was characterised as a spot directly beneath the nail plate (Figure 1A), with a leash of proximal feeding vessels (Figure 1B). Excision was performed and the resulting defect closed directly (Figure 1C). Histology subsequently confirmed the clinical diagnosis of a glomus tumour, and on postoperative review, she was pain free. Glomus tumours were first described by Wood in 1812, with subsequent histological characterisation by Masson in 1924 (2,3). They are rare, typically benign tumours that arise from the neuromyoarterial structure of the glomus body, a structure believed to serve a thermoregulatory purpose (4). They account for 1–4⋅5% of hand tumours and are more common in women (1,5). Although within the hand, the most common site being subungual, glomus tumours may also be found under the