Degloving injury of the distal aspect of the limb in a horse and preventing bone sequestrum formation using multiple, partial depth cortical fenestration

Exposed or denuded bone is a common complication of wounds of the distal aspect of the limb. This clinical report describes the treatment of an extensive laceration of the right hindlimb of a 12-year-old Hungarian Warmblood Horse gelding, which was managed initially by application of hydrogel dressings to enhance autolytic debridement, subsequently, by cortical fenestration of the denuded cortical bone and by stimulating the production of granulation tissue to cover the exposed bone. An early radiographic sign of sequestrum formation (discrete changes in the outer cortex) was not seen after the injury. Six weeks later, the wound was completely covered with vascularized, healthy-appearing bed of granulation tissue, which was prepared for grafting using the punch technique. A reinforced bandage was applied for the following 7 weeks; the grafts were accepted by granulation tissue. The horse was discharged 20 weeks after admission and the owners were advised to maintain stall rest with hand walking for two weeks. Four years later the owner reported that the wound had completely healed with a good cosmetic outcome and the horse was being used in a carriage.

Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report

Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome.

Osteoma of mastoid part of right temporal bone with right nasochoanal polyposis: a rare case report

<p class="abstract">Osteomas are benign mesenchymal osteoblastic tumors of lamellar bones. In our practice, they are usually seen in the paranasal sinuses, mainly involving the frontal and ethmoidal sinus. Osteoma of the temporal bone is uncommon and when they occur, they are most commonly seen in the external auditory canal. Mastoid osteomas are a rare entity with incidence of 0.1 - 1% of all benign tumors of skull. They are slowing growing and usually asymptomatic. We report a rare case in a 28 years female patient who presented to us with right postauricular bony swelling of size 2.5×3 cms along with bilateral nasal obstruction. Patient was analyzed for her clinical condition, imaging details, treatment and surgical plan. Diagnosis of right mastoid osteoma with right nasochoanal polyposis was made after non-contrast computed tomography of temporal bone and paranasal sinuses respectively. Complete surgical excision of the osteoma along with endoscopic removal of the polypoidal tissue was done with good cosmetic outcome without recurrence.</p>

Novel Therapy for Pseudocyst of Pinna – An Institutional Study

Introduction Pseudocyst of pinna is a cystic swelling with collection of serous fluid between the auricular cartilage and perichondrium. Successful treatment of pseudocyst of pinna is challenging because of its high propensity for recurrence and cosmetic deformity. None of the treatment modalities described in literature gives fully satisfactory result. So a novel treatment modality is required which gives good cosmetic outcome with zero recurrence. Materials and Methods A prospective study was done in the Department of ENT and Head and Neck Surgery of a Government Medical College, West Bengal from April 2014 to March 2017. The effusion was aspirated aseptically with sterilized 10 ml syringe with 18G IV needle. An equal amount of Inj. Dexamethasone and Inj. Gentamicin 80 mg in 1:1 ratio mixed in a new 10 ml syringe was injected into the swelling through the same prick point. Result Most of the patients in this study were males between 31-40 years of age and labourer by profession. Maximum number of patients had swelling involving concha. Only one case of one month old infant had bilateral involvement. All patients were cured without any recurrence or disfigurement. Conclusion The results of present study points to the fact that aspiration and instillation of equal amount of Inj. Dexamethasone and Inj. Gentamicin works very good in treatment of pseudocyst of pinna. This therapy is minimally invasive, less painful, cost-effective and less cumbersome for the surgeon. It gives faster recovery, good cosmetic outcome and recurrence is prevented.

A Modified Lateral Orbitotomy Approach to the Superior Orbital Fissure: A Video Case Report and Review of Anatomy

BACKGROUND The lateral orbitotomy approach (LOA) is often used for accessing the orbital contents and middle skull base; however, most prior descriptions of the LOA involve complete drilling of the lateral orbital wall. This practice requires retraction of the orbital contents and produces postoperative diplopia that the patient experiences for a limited time. OBJECTIVE To describe a modified LOA with partial sparing of the lateral orbital wall for accessing lesions of the superior orbital fissure (SOF). METHODS One patient with a progressively enlarging SOF lesion and visual loss underwent a modified LOA for resection. The orbital rim lateral to the SOF was removed as a bone flap, and the greater wing of the sphenoid inferior to the SOF was drilled to expose the lesion. The lateral orbital wall was thinned but was not completely removed. The orbital rim was resecured with miniplates and screws. RESULTS Gross total resection of the SOF mass was achieved without unnecessary exposure or retraction of the orbital contents. Histopathologic analysis of the resected mass was consistent with a cavernous hemangioma. The patient had a good cosmetic outcome without complication. CONCLUSION Modified LOA with partial sparing of the lateral orbital wall is a feasible approach for lesions of the SOF.

Using the head as a mould for cranioplasty with methylmethacrylate

ABSTRACTMethacrylate is a valuable tool to the neurosurgeon, even though it is currently being replaced by custom bone. During cranioplasty in the absence of custom bone, which is preformed based on the patients imaging, one has to make a cast to cover the cranial defect with or without the use of a mould. A good artificial skull outline is necessary for prevention of implant extrusion and acceptable cosmetic outcome. Using the patients head as a mould is a simple, cheap, and useful technique. An incision is made, and either a craniectomy or an attempt at skull elevation or separation of the scalp from dura is done based on the indication for the cranioplasty. The methacrylate monomer is mixed with its solvent. It is placed in between a sliced glove and then thinned out. Several layers of drapes are placed on the patients head, the acrylate which is in between the gloves is then placed on the drapes. As soon as it starts setting and the required shape obtained, it is removed and place on the sterile tray. It is then anchored and the wound closed. This technique produces good cosmetic outcome. However, the head must be properly protected from the risk of burns from the exothermic reaction. The technique is described in a 40‑year‑old driver who had a compound depressed skull fracture. He had a methylmethacrylate cranioplasty in the 9th week post trauma after allowing for wound healing. We recommend that this technique may be used in centers where custom bone is either too expensive or not available during cranioplasty in order to obtain a good outcome.

A single institution experience with skin sparing mastectomy and immediate breast reconstruction

INTRODUCTION Skin sparing mastectomies (SSMs) represent a surgical approach that preserves the natural skin envelope of the breast and, when combined with immediate reconstruction, offers a good cosmetic outcome. The aim of this retrospective study was to compare the risk of local recurrence (LR) in this series with the known rate of recurrence following a conventional mastectomy. METHODS A total of 108 patients with breast cancer who underwent an SSM and immediate breast reconstruction over a 6-year period were reviewed. RESULTS A follow-up of more than eight years showed that three patients (2.78%) had developed LR. CONCLUSIONS The rate of LR is low with SSMs and is comparable to that seen with conventional mastectomies.