Limbal conjunctival approaches to extraocular muscles in the surgical treatment of previously operated strabismus

Purpose. Тo analyze clinical efficacy of the surgical treatment of previously operated strabismus using limbal incisions which are lengthening the conjunctiva and Tenon's capsule. Material and methods. The study included 440 patients (440 eyes) with previously operated strabismus at the age of 4 to 68 years old. The main group included 240 patients (240 eyes) who underwent strabismus surgery by limbal approach; the control group included 200 patients (200 eyes) who underwent surgery by paralimbal conjunctival approach. Horizontal strabismus occurred in 146 patients (60,8%) in the main group and in 158 (79%) in the control group. Horizontal strabismus in combination with vertical strabismus was found in 94 patients (39.2%) in the main group and in 42 patients (21%) in the control group respectively. The following approaches were applied: Y-shaped limbal approach, T-shaped incision of the conjunctiva, lower limbal peritomy, circular limbal approach with an additional horizontal incision towards the muscle being strengthened. Results. Good cosmetic result in the main group was achieved in 94.7% of cases, in the control group in 87% of cases, р<0.001. Re-surgery in the long term period was required for 39 patients (19.5%) in the control group and 14 patients (7%) in the main group, р<0.001. Conclusion. Limbal approaches performed to lengthening the conjunctiva and Tenon's capsule on the side of the weakened muscle and shortening on the side of the muscle being strengthened, are enhancing the effect of recession and resection, thereby contributing to the achievement of the state of orthotropy in 83% and have a good cosmetic result in 94.67% of cases. Key words: limbal conjunctival approaches, limbal conjunctival incisions, strabismus, children.

The use of xenopericardium in reconstructive surgery in patients with breast cancer

Objective: to analyze the possibility of using xenopericardium for breast reconstruction in cancer Materials and methods: the article presents a clinical case of a patient diagnosed with breast cancer who underwent a subcutaneous mastectomy with simultaneous reconstruction with an endoprosthesis and a xenopericardium to strengthen the lower slope of the breast. Results: in our study, a good cosmetic result was obtained, and the presence of xenopericardium does not affect the conduct of postoperative courses of chemotherapy and radiation therapy. Conclusion: we present the first experience of using bovine pericardium in Russia for breast reconstruction in patients with breast cancer. Xenopericardium BioLAB-PP/PA of domestic origin was used to strengthen the lower slope of the reconstructed MJ using a silicone implant.

Assessment of risk of loss of the implant in two-stage breast reconstruction

Surgical treatment remains one of the leading methods in the treatment of breast cancer. Every year, the number of breast reconstruction operations is steadily increasing. But the number of possible complications associated with performing such operations also increases. Breast reconstruction using an expander may be one of the acceptable options for patients who are planning radiation therapy. The article analyzes the results of two-stage reconstructive plastic surgery on the breast in the complex treatment of patients diagnosed with breast cancer. In 90.5 % of cases, a good cosmetic result was obtained. The risk of losing the implant after chemotherapy was 4.8 % and 13.9 % for chemotherapy combined with radiation therapy, respectively. Two-stage breast reconstruction can be used with careful selection of patients.

A RARE CASE OF MULTIPLE EPIDERMOID CYST OF THE SCROTUM IN 44-YEAR OLD MALE PATIENT

Multiple epidermoid cyst is relatively rare condition now a day. They are asymptomatic, but cosmetically unaccepted. Once infected cause fatal complication like Fournier`s gangrene and septicemia. They are successfully managed surgically by complete excision with good cosmetic result and minimum morbidity. Here we report a case of 44 years old male patient with symptom of multiple epidermoid cyst over scrotum for last 10 years.In this case complete excision of scrotal wall with cyst followed by mobilizing scrotal skin and primary suturing was done.

Reconstructive microsurgery in upper limb reconstruction: 30 years’ experience of a single surgeon

The reconstruction of compound tissue defects in upper extremity injuries often represents a challenge. The goal of reconstruction is to obtain not only a good cosmetic result, but also the best possible function. Microsurgery highly contributes to the management of upper limb simple or complex defects by offering a large number of surgical possibilities. Due to advances in understanding of blood supply to tissues and microsurgical techniques in the last 50 years, microsurgeons have renounced more and more to the use of traditional flaps in favour of the more reliable perforator flaps. This article presents the experience of a single surgeon performing post-traumatic upper limb reconstructive microsurgery over the last 30 years.

Cosmetic aspect of proctological surgeries

Although it may seem that the aesthetic appearance of a wound after proctological surgery is of secondary importance relative to the cure of disease, it may affect proper healing, treatment efficacy and the maintenance of anal function. Cosmetic correction of the anal region primarily includes removal of marginal anodermal folds and correction of deformities after proctological surgeries. We present indications for the removal of hypertrophied anodermal folds, as well as situations when such surgery should be abandoned. The most common deformities after proctological surgeries include keyhole deformity, which forms after anal fissure surgery with posterior sphincterotomy and surgical treatment of anal fistula with Hippocrates’ drainage, as well as deformities due to abnormal wound healing. In addition to poor cosmetic result, deformities may lead to functional complications in the form of anal leakage, underwear staining and poor gas continence, which requires surgical correction. Another group includes patients with anal deformity due to scars after multiple proctological procedures, but with no functional defects. The management in these patients largely depends on their mental attitude to these defects and usually no surgical treatment is implemented. Good cosmetic result after proctological surgery often corresponds with good functional outcome and patient’s postoperative satisfaction.

Multiple Lower Eyelid Nodules In Breast Cancer Patient With History Of Dermal Fillers: A Case Report

Background: Dermal filler injections have been associated with several complications, including migration to other areas and forming nodules due to the presence of foreign bodies or granulomatous reactions may develop, which encapsulates the filler. Fillers might also be associated with malignancy. The presence of such complications must be removed with reconstructive surgery. Methods: We present a case of breast cancer patient with a history of dermal filler injection to the lower eyelid. The nodules in the lower eyelid was surgically removed, and the lower eyelid, particularly the muscle, was reconstructed to provide a good cosmetic result. The nodules were also pathologically examined to confirm the diagnosis. Reconstruction of the lower eyelid was conducted with care by noting the aesthetic aspects. Results: A local muscle flap was easy to harvest and handle, and provided good results. It is also important to consider malignancy to treat the patient thoroughly. The pathology examination confirmed the diagnosis of metastasis. This case is unique because the nodules developed in the patient may be associated with metastasis of the cancer or the dermal filler injection. Conclusion: Our reconstruction technique leads to a good cosmetic result. There are no sign of complications and recurrence at 3 months following the procedure.

One Stage Reconstruction and Refinements for Frontonasal Encephalocele

Background: The successful correction of frontonasal encephaloceles was shown to depend on a detailed understanding of the pathological anatomy, careful planning of the bone movements to correct these deformities, and attention to detail regarding the placement of scars, positioning of the medial canthi and the nasal reconstruction. Objective: We reviewed our experience at the paediatric neurosurgery department of national institute of neurosciences, Dhaka, Bangladesh and discussed our evolution toward a definitive, single-stage correction, including refinements. Methodology: This was a clinical trial which was conducted in the Department of Paediatric neurosurgery at National institute of Neurosciences & Hospital, Dhaka, Bangladesh fromMay 2014 to April 2019 for a period of five (05) years. Paediatric patients with frontonasal encephalocele were operated. Post-operative outcomes were observed. Result: A total number of 6 patients were operated. All were under 1 year. 3 were male and 3 were female. We operated 6 cases of successful one stage operation for frontonasal encephalocele in very young children. A good cosmetic result had been achieved after operation. Conclusion: In conclusion, a one-stage repair with both a transcranial and external approach is effective surgical management for the frontonasal encephalocele paediatric patients. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 111-117

Application of the pinwheel flap for closure of a large defect of the scalp

A 74-year-old man had a resultant large oval scalp defect of 12×6 cm (72 cm2) following an excision of a stage IIIA melanoma. We decided to cover the defect with the pinwheel flap, with the aim to provide a good cosmetic result, preservation of hair follicles and minimal donor-site morbidity. This local flap has been traditionally used for much smaller defects. Four L-shaped flaps were designed at equal distances on the vertical and horizontal axes of the defect. The L-shaped flap had a length of 1.5 times the half diameter of the defect (4.5 cm). The incision was made through galea aponeurosis and subsequently undermined at least 3 cm to assist flap advancement. Z-plasties increased the rotation of the flap when it was required. This yielded an excellent reconstructive result at 1-year follow-up, demonstrating the usefulness of the pinwheel flap in large defects on the scalp region.

A study of reduced port laparoscopic cholecystectomy

Background: The objective was to study various technical feasibility and safety, benefit of three port cholecystectomy over four port cholecystectomy.Methods: Total 25 patients have taken part in study with valid consent, in B.J. Medical College, Ahmedabad. All patient study regarding operative time, conversion rate, inta-operative complication, immediate postoperative complication, postoperative pain, requirement of postoperative analgesic, hospital stay, feasibility and safety.Results: Out of 25 patient mean ages 39.5 ranging from 25 to 60. Female 88%, male 12% are in this study. 72% patient have multiple stone, 28% have single stone. 96% and 4% patient has distended and contracted GB respectively. 92% patient have normal GB wall and 8% have thickened GB wall. 8%, 68% and 20% patient were discharge on 3rd, 2nd and 1st postoperative day respectively. Mean postoperative day was 4 ranging from 1 to 10. Conversion rate to open procedure is 12% in this study.Conclusions: Three port cholecystectomy is safe procedure in expert hand. It has less requirement of analgesic with less hospital stay with good cosmetic result.