Karapandzic Flap for Functional & Cosmetic Reconstruction of Lower Lip Cancer with Review of Literature

The incidence and prevalence of lip and oral cavity cancer has increased over the last decade, worldwide and in India. It ranks at 1st position in males in india, all ages, in 2020. Lips are essential organ of the body which carries dynamic role in facial expression, speech, sensuality, deglutition. Resection of central, large, lower lip cancer creates a more than 2/3rd large defect. Covering of this defect with maintenance of oral competency is a difficult task for a treating surgeon. Number of techniques are described for covering of large lower lip defects. Out of these techniques, karapandzic flap is a successful, accepted, simple, easy to learn reconstructive procedure with good cosmetic results. It is a modification of Gillie’s fan flap and it involves unilateral or bilateral full-thickness circumoral advancement-rotation flaps. The feature which distinguishes it from other techniques is preservation of neuro-vascular integrity, symmetry and oral competency. We are reporting a case of an elderly gentleman with large, central, lower lip cancer who underwent oncological resection with reconstruction by karapandzic flap technique.

DISTAL RADIUS RECONSTRUCTION USING FIBULAR GRAFTS

Giant cell tumor (GCT) of bone is a locally aggressive tumor of bone. GCT involving the distal radius poses certain unique challenges in management. The resection of the tumor will almost always end up requiring a reconstructive procedure of the joint, for which several different methods of reconstruction have been explored. We present a case of a 29 year old lady with distal radius GCT. We performed a wide resection of the tumor, reconstructed the distal radius with free bula graft and did a wrist arthrodesis using locking compression plate. We found that it provided a stable, painless wrist joint and good functional outcome.

“FEMALE EPISPADIAS WITHOUT EXSTROPHY: A RARE CLINICAL REPORT’’

Female epispadias case without exstrophy are quite rare. A 8-year old girl presented with complaint of primary total incontinence. Physical examination revealed skin excoriation in the external genitalia due to prolonged urine contact, non-fused labia minora, and very short urethra. Bladder capacity was found to be sufcient in intravenous urogram. Our approach was to use single stage reconstructive procedure that enables correction of the urinary incontinence and enhance good aesthetic appearance.

THE ROLE OF FISTULOCLYSIS IN THE TREATMENT OF PATIENTS WITH ENTEROATMOSPHERIC FISTULAS

ABSTRACT Background: Enterocutaneous fistulas represent a connection between the gastrointestinal tract and adjacent tissues. Among them, there is a subdivision - the enteroatmospheric fistulas, in which the origin is the gastrointestinal tract in connection with the external environment through an open wound in the abdomen. Due to the high output in enterocutaneous fistulas, the loss of fluids, electrolytes, minerals and proteins leads to complications such as sepsis, malnutrition and electrolyte derangements. The parenteral nutrition has its secondary risks, and the fistuloclysis, that consist in the infusion of enteral feeding and also the chyme through the distal fistula, represents an alternative to the management of these patients until the definitive surgical approach. Aim: To evaluate the current evidence on the fistuloclysis technique, its applicability, advantages and disadvantages for patients with high output fistulas. Method: A systematic literature search was conducted in May 2020 with the headings “fistuloclysis”, “chyme reinfusion” and “succus entericus reinfusion”, in the PubMed, Medline and SciELO databases. Results: There were 29 articles selected for the development of this narrative synthesis, from 2003 to 2020, including reviews and case reports. Conclusion: Fistuloclysis is a safe method which optimizes the clinical, nutritional, and immunological conditions of patients with enteroatmospheric fistulas, increasing the chances of success of the reconstructive procedure. In cases where the definitive repair is not possible, chances of reducing or even stopping the use of nutrition through the parental route are increased, thus representing a promising modality for the management of most challenging cases.

The aortal arch plasty in a new-born babies, using “end-to-side” anastomosis

Objective. To analyze the immediate and late follow-up results of the aortal arch plasty, using anastomosis «end to side». Materials and methods. In 2010 - 2019 yrs period in Amosov National Institute of Cardio-Vascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery in 75 new-born babies, suffering coarctation and hypoplasia of one or several segments of aortal arch its reconstruction was done, using ‘end-to-side” anastomosis. Into the investigation only the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 41 (54.6%) boys and 34 (45.4%) girls. Average age of the patients was (2,5 ± 1,2) mo, and average body mass - (3.3 ± 0.6) kg. The main diagnostic method for the failure determination and immediate and late results studying was echocardiographic investigation. Results. Hospital lethality have constituted 6.6% (5 patients died). The lethality causes were not connected with the aortal arch reconstructive procedure, using anastomosis «end to side». Duration of follow-up was 1 mo - 9.3 yrs, (2.8 ± 2.5) yrs at average. In late follow-up period 1 patient died. In 11 (14.6%) patients in postoperative period the aortal arch restenosis have developed. In 7 patients restenosis was eliminated endovascularly, using balloon dilatation. In 4 patients the aortal arch surgical replasty was done. Tracheal and the main bronchi compression, neurological complications in late follow-up period were not observed. Conclusion. After plasty for the aortal arch hypoplasia, using anastomosis «end to side» in new-born babies good immediate and late follow-up results were noted, what witnesses its efficacy. In accordance to results of the investigation accomplished such kind of anastomosis applied may be used in patients, suffering hypoplasia of proximal aorta or in tubular hypoplasia of all aortal arch.

Subglottic Stenosis in Children: Preliminary Experience from a Tertiary Care Hospital

Introduction. This retrospective study describes our experience in the evaluation and management of infants with subglottic stenosis. Materials and Methods. The study included 10 patients aged between 1 wk and 18 months with 6 cases having congenital subglottic stenosis and 4 cases having acquired subglottic stenosis. Results. 6 patients had grade I, 3 patients had grade II, and 1 patient had grade III subglottic stenosis. Tracheostomy was required in 4 patients at the time of presentation. 7 patients were treated successfully with Bougie dilation followed by topical application of mitomycin, whereas 1 patient who failed to serial dilation needed open reconstructive procedure. Laser excision of the anterior subglottic web was performed in one patient. Another patient with underlying cerebral palsy could not be operated upon and was managed with tracheostomy. Conclusion. Subglottic stenosis may be effectively man-aged with endoscopic surgical techniques, although the number of such sittings required varies with the type and severity of stenosis. Open surgical procedures need to be individualised as per the needs of the patient only after all the other endoscopic possibilities have been exhausted.

Rappresentare l’architettura fortificata per narrare e valorizzare il territorio della frontiera alessandrina

Representing fortified architecture to narrate and enhance the Alexandrian territory borderThe Piemonte cultural territory is also characterized by the significant presence of complex defensive systems, grouped by types and orographic configuration. Specifically,this paper will address asystematic and unitary re-reading of the territory of the Alessandria area, which includes: the sixteenth-century Cittadella di Casale, of the Gonzagas; the Citadel of Alexandria (1732), by Giulio Ignazio Bertola; Valenza and its fortifications (from the “Spanish” period with interventions by Gaspare Beretta, also interested in the fort / Castello Tortona); that of Gavi (restored “in the modern” by Gaspare Maculano known as Fiorenzuola, the friar who condemned Galileo). Following thirty years international research, the objectives of the work are twofold: the first aims to physically connect in this system a “network” of thematically dedicated tourist itineraries, through documentary paths that reconstruct historical events, construction phases and transformation, (in similitude with the ECCOFORT project, in the province of Verona). Following other works, by the authors already dedicated to the Alexandrian, through the advanced 3D modeling (like the one carried out in the reconstruction of the fort of Gavi) the second objective of the present contribution will follow the same restoring and reconstructive procedure. Through digitalized anastylosis, even dynamized, the Castle of Tortona will be rebuilt on the basis –among other things– of the conspicuous documentation (dated 1799, the year of the Napoleonic siege, followed by demolition, in 1801) found at the Osterreichisches Staatsarchiv, Kriegsarchiv of Vienna. The critical reconstruction is now made possible thanks to the precious wealth of knowledge, matured over the decades by Marotta, Zerlenga, Abello: with (indexed) data, including metrics, graphics and visual returns. Drawing between real and virtual, it will be possible to reconnect individual episodes, comparable and critically selected information, by means of congruently connected interventions, both physically and digitally. Finally, in a project of knowledge, conservation and valorisation, the “local” dimension dialogues and integrates with the European dimension.

Role of Hemoglobin Spray in Wound Bed Preparation

Wound is a common problem following burn, trauma or infection. There are various methods to limit the infection and to cover the raw area. Before definitive cover, the wound bed must be ready to accept the reconstructive procedure. Various methods help in wound bed preparation. Recently hemoglobin spray has been advocated to hasten the wound bed preparation. In this article, we share our experience of using innovative hemoglobin spray in wound bed preparation.