Suhas V Abhyankar

Fat ful'fill'ment: A review of autologous fat grafting

For more than a century, clinicians have attempted to utilise fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft-tissue augmentation has become increasingly popular in recent years. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the authors have described their approach to fat transplantation.

SQUAMOUS CELL CARCINOMA OF THE PENIS AND SCROTUM IN A PATIENT WITH CHRONIC SCROTAL AND PENILE LYMPHEDEMA

Squamous cell carcinoma arising from tissue affected by chronic lymphedema is rare, though it is recognized that a variety of malignant tumors can arise in chronic congenital or acquired lymphedema. We describe, a case of scrotal and penile squamous cell carcinoma arising in a patient with a history of chronic scrotal and penile lymphedema of filarial origin. We here discuss the management and possible etiology of this unusual case.

Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural artery flap.

Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting.The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

A rare case of large verrucous hemangioma on the scalp

Verrucous hemangioma is an uncommon vascular malformation commonly seen in the lower limbs, histologically characterized by vascular proliferation and dilatation from dermis to subcutaneous tissue and proliferative reaction of the epidermis. Here we report a rare case of large verrucous hemangioma on the scalp which was excised and grafted. In a 6-month follow-up, the patient had no recurrence.

An arteriovenous fistula following chalazion excision

An arteriovenous fistula secondary to a chalazion is a rare occurrence. It may follow spontaneous necrosis or surgical trauma. Digital subtraction angiography and identification of the arterial feeders combined with direct puncture of the nidus and embolization is recommended, as surgical excision becomes much easier and results in a complete excision of the lesion. Conchal cartilage graft is a useful lining material for reconstruction of the tarsal plate due to its natural curvature. It restores lid integrity and ensures a stable and functional eyelid.

Leprosy: A neurological masquerador

A 20-year-old male farmer with injury to the left hand, associated with weakness of the hand muscles and numbness, underwent ulnar and median nerve repair. An ultrasonography after 3 months was performed due to persistent weakness and numbness after surgery, which showed mass in the median nerve for which the patient underwent excision of neuroma and sural nerve grafting. The patient again presented after 3 months with weakness and numbness, and a nerve conduction study showed non-functioning ulnar and median nerve. A re-exploration showed mass in the ulnar nerve, which on biopsy showed borderline tuberculoid leprosy. This case report reflects a case of pure neuritic leprosy that was missed due to trauma as it was in the early phase and could only be diagnosed at the 3 rd exploration of the hand.

Use of Infant Feeding Tube for Staged Flexor Tendon Reconstruction

A two-stage flexor tendon reconstruction using a silicone rod in the first stage and a free tendon graft through the pseudo sheath formed around the silicone in the second stage was described by Hunter and Salisbury for a neglected and failed flexor tendon reconstruction. We are describing a technique where we have used an infant feeding tube as a substitute for silicone rods, which substantially reduces the cost of procedure but delivers the same results.

Posterior scrotal artery flap to cover a groin defect: a new technique.

Commonly, a groin defect is reconstructed with flaps from ipsilateral thigh or lower abdomen. Here we present a case report of use of a pedicled flap from the posterior scrotum based on posterior scrotal artery to cover a groin defect exposing femoral vessels. Posterior scrotal artery, to best of our knowledge, has not been described in the literature to cover a groin defect.

Simple and effective method of heat therapy in lymphoedema

Heat therapy is a well known conservative management for lymphoedema. We are describing here a heat therapy apparatus which is easy to make, cheap, transportable, easily reproducible and maintenance free and found to be very effective.