Noninfectious Corneal Disorders

This chapter discusses noninfectious corneal disorders, caused by an immune inflammation such as phlyctenular keratoconjunctivitis, marginal staphylococcal keratitis, peripheral ulcerative keratitis, Mooren's ulcer, interstitial keratitis, rosacea keratitis, etc. Mooren's ulcer, which is considered one of the most severe diseases, is presented with serial photos of follow-ups within 3 years with different complications, management of the condition, and results. A severe case of rosacea keratitis associated with anterior uveitis is included in this chapter too. Thygeson's superficial punctate keratitis case is shown as well, but the disease is very rare in Middle Eastern populations. The material in this chapter also includes filamentary, neurotrophic, and exposure keratitis. A rare disorder like anesthetic abuse keratopathy, caused by topical excess use of anesthetic drops, is presented with before and after treatment photos to illustrate that the condition, if treated appropriately, can leave minimal scarring.

Limberg flap as a Primary Treatment for Pilonidal Sinus at Nepal Mediciti Hospital: A Single Unit Experience

INTRODUCTION: Pilonidal Sinus is a common condition with estimated incidence of 260 per million population with more male predilection and is often seen in sacrococcygeal area but has also been described in other areas with hair. The Limberg rhomboid flap was designed by Limberg in 1946 for the closure of a sixty degree rhombus shaped defect with a transposition flap. We would like to share our single unit experience of Rhomboid Limberg flap for Pilonidal sinus in our hospital. METHODS: This is an ongoing prospective descriptive study in the Department of General Surgery and Digestive Diseases of Nepal Mediciti Hospital from October 2018. The demographic of the patients, presenting symptoms, duration of symptoms and previous interventions are recorded and the Rhomboid Limberg flap surgery is done under regional or general anesthesia in prone position. The patient is given intravenous antibiotic and is instructed to sleep laterally or in prone position for 24 hours. The dressing is removed and the wound is inspected for flap status in the next morning. The patient is discharged on 1st post-operative day on oral antibiotics for 7 days and is followed on 7th post-operative day for removal of suction drain and alternate sutures in the skin and remaining sutures are removed on 10th post-operative day. RESULTS: We have done 28 cases of Limberg flap for Pilonidal Sinus from October 2018 to December 2020 of which 24 were male patients. None of our patients had flap necrosis. One patient presented with accidental removal of suction drain on 5th postoperative day, however he didn’t develop any wound related complication. One patient had superficial wound dehiscence on 10th post-operative day which healed on its own with dressing. One patient developed seroma from 5th postoperative and was managed with dressing and antibiotics and it healed in 2 weeks. None of our patients have developed recurrence and their wounds have healed satisfactorily with minimal scarring and pain. All the patients were able to resume their regular activities within 21 days. All except 2 patients were satisfied with cosmetic outcome. CONCLUSION: The Limberg flap is ideal treatment for pilonidal sinus with minimal postoperative pain, short hospital stay, few complications, rapid return to normal activities, good cosmesis, and a low recurrence rate with short learning curve for young surgeons. Hence, Limberg flap should be routinely used as primary treatment for pilonidal sinus.

Electrodeposited Platinum Iridium Enables Microstimulation With Carbon Fiber Electrodes

Ultrasmall microelectrode arrays have the potential to improve the spatial resolution of microstimulation. Carbon fiber (CF) microelectrodes with cross-sections of less than 8 μm have been demonstrated to penetrate cortical tissue and evoke minimal scarring in chronic implant tests. In this study, we investigate the stability and performance of neural stimulation electrodes comprised of electrodeposited platinum-iridium (PtIr) on carbon fibers. We conducted pulse testing and characterized charge injection in vitro and recorded voltage transients in vitro and in vivo. Standard electrochemical measurements (impedance spectroscopy and cyclic voltammetry) and visual inspection (scanning electron microscopy) were used to assess changes due to pulsing. Similar to other studies, the application of pulses caused a decrease in impedance and a reduction in voltage transients, but analysis of the impedance data suggests that these changes are due to surface modification and not permanent changes to the electrode. Comparison of scanning electron microscope images before and after pulse testing confirmed electrode stability.

High-frequency radio wave electrocautery in modified Hotz operations for epiblepharon correction

To report the experience and advantageous effects of high-frequency radio wave electrocautery in modified Hotz operations for epiblepharon, We reviewed the records of all pediatric patients who underwent a modified Hotz operation with the use of high-frequency radio wave electrocautery (Ellman Surgitron Dual Frequency RF S5; Ellman International, Inc, Hewlett, NY) for epiblepharon between March 2016 and September 2019 at Korea University Guro Hospital. We evaluated the success rate, complications, recurrence rate and degree of satisfaction of our technique. Information from the medical records was collected, including demographics, ocular symptoms, severity of keratopathy, operation time, success/recurrence rate, and complications. 133 patients (98.52%) showed good correction of epiblepharon without complications or unpleasant cosmetic problems during 3 months of median follow-up period. Two patients (1.48%) showed recurrent corneociliary touch, but the degree was very mild and re-operation was not performed. One patient showed mild ectropion on his left lower eyelid, but the patient recovered well without operation. For complications, suture abscess and granulation were the most common, 3 cases in each, but all of those were temporary and resolved with conservative management. The approach with electrocautery for epiblepharon allows precise and fast incision of the lower eyelid, little bleeding, and minimal scarring. Surgical outcomes associated with the modified Hotz operation with electrocautery were consistent with previous studies.

A prospective study of outcome of double pigtail catheter drainage in the management of breast abscess: analysis of outcome

Background: Breast abscesses, localized collection of pus in the breast, are most common in young lactating women. Traditional treatment of breast abscesses is by surgical incision, digital disruption of septa, evacuation of contents with occasional placement of surgical drains, and administration of systemic antibiotics. Percutaneous large-bore needle aspiration with or without ultrasound guidance is generally employed as the first line treatment of breast abscesses. It is generally done for medium to large sized unilateral abscesses and requires repeated aspirations for complete resolution of the abscess cavity.Methods: We have conducted this prospective study at SMIMER Hospital, Surat, Gujarat, India from January 2020 to January 2021. After ethical approval a group of 25 patients with unilateral breast abscesses irrespective of the lactational status were treated by percutaneous double catheter drains inserted under ultrasound guidance under the effect of local anaesthesia and evaluated for 3 months.Results: The resultant cosmetic effect was good, with no reported recurrence on 3 month follow-up.Conclusions: Double pigtail catheter drainage in appropriately selected cases of beast abscess has superior outcome in compare to published result of other technique for drainage of beast abscess specially in minimal scarring, early resolution of abscess cavity and decreases in the total duration of treatment.

Adult spiny mice (Acomys) exhibit endogenous cardiac recovery in response to myocardial infarction

Complex tissue regeneration is extremely rare among adult mammals. An exception, however, is the superior tissue healing of multiple organs in spiny mice (Acomys). While Acomys species exhibit the remarkable ability to heal complex tissue with minimal scarring, little is known about their cardiac structure and response to cardiac injury. In this study, we first examined baseline Acomys cardiac anatomy and function in comparison with commonly used inbred and outbred laboratory Mus strains (C57BL6 and CFW). While our results demonstrated comparable cardiac anatomy and function between Acomys and Mus, Acomys exhibited a higher percentage of cardiomyocytes displaying distinct characteristics. In response to myocardial infarction, all animals experienced a comparable level of initial cardiac damage. However, Acomys demonstrated superior ischemic tolerance and cytoprotection in response to injury as evidenced by cardiac functional stabilization, higher survival rate, and smaller scar size 50 days after injury compared to the inbred and outbred mouse strains. This phenomenon correlated with enhanced endothelial cell proliferation, increased angiogenesis, and medium vessel maturation in the peri-infarct and infarct regions. Overall, these findings demonstrate augmented myocardial preservation in spiny mice post-MI and establish Acomys as a new adult mammalian model for cardiac research.

FACIAL WOUND ASSESSMENT KIT

Facial wounds are a frequent reason for emergency room visits. The goals of laceration repair are to achieve hemostasis, avoid infection, restore function to the involved tissues, and achieve optimal cosmetic results with minimal scarring. Therefore, these cases are most appropriately managed by plastic surgeons who have a thorough knowledge of anatomy, aesthetic sense, and meticulous expertise in atraumatic tissue manipulation, combined with the surgical skill to repair any structure. You need to know what to do and what not to do : whether to suture or leave open. What local anesthesia to use and how. What equipment to use (and have it available beforehand). Whether to give antibiotic therapy and what kind. How to avoid aesthetic or functional after-effects. Which dressing to use depending on the state of the wound. This article will serve as an aid to wound management and review repair techniques for high-risk areas of the face.

Surgical versus conservative management of tongue lacerations in the acute care setting: A systematic review of the literature

Objective The objective of this study was to determine whether suturing or conservative management of tongue lacerations results in differences in wound healing and functional outcome. The secondary aim was to identify whether antibiotics are required in the treatment of tongue lacerations. Methods Studies published between December 1954 and August 2020 were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science, and the Cochrane Library and evaluated for inclusion based on predetermined inclusion and exclusion criteria by two independent reviewers in accordance with PRISMA guidelines. Results The search yielded a total of 16,111 articles, 124 of which were evaluated by full-text review, resulting in 11 articles included in this systematic review representing 142 unique cases of tongue lacerations. At least 26 lacerations (18.3%) included penetration of the muscle layer of the tongue, and 24 (16.9%) were classified as full-thickness lacerations. Thirty-five of the 142 tongue lacerations (24.6%) were sutured. The remaining lacerations underwent some form of conservative management. The majority of studies reported excellent healing of tongue lacerations regardless of the management method, with minimal scarring and excellent return to normal functional status. No cases of infection were reported. Conclusions Current literature is inconsistent with regards to indications and guidelines for primary repair of tongue lacerations. The majority of tongue lacerations reported in the literature heal with excellent outcomes regardless of management method. Physician judgement along with patient and parental preference based on potential risks of the procedure should be used when deciding whether a tongue laceration requires primary repair. Tongue lacerations in otherwise healthy individuals are at very low risk of infection.

A Scarless Healing Tale: Comparing Homeostasis and Wound Healing of Oral Mucosa With Skin and Oesophagus

Epithelial tissues are the most rapidly dividing tissues in the body, holding a natural ability for renewal and regeneration. This ability is crucial for survival as epithelia are essential to provide the ultimate barrier against the external environment, protecting the underlying tissues. Tissue stem and progenitor cells are responsible for self-renewal and repair during homeostasis and following injury. Upon wounding, epithelial tissues undergo different phases of haemostasis, inflammation, proliferation and remodelling, often resulting in fibrosis and scarring. In this review, we explore the phenotypic differences between the skin, the oesophagus and the oral mucosa. We discuss the plasticity of these epithelial stem cells and contribution of different fibroblast subpopulations for tissue regeneration and wound healing. While these epithelial tissues share global mechanisms of stem cell behaviour for tissue renewal and regeneration, the oral mucosa is known for its outstanding healing potential with minimal scarring. We aim to provide an updated review of recent studies that combined cell therapy with bioengineering exporting the unique scarless properties of the oral mucosa to improve skin and oesophageal wound healing and to reduce fibrotic tissue formation. These advances open new avenues toward the ultimate goal of achieving scarless wound healing.

Clinical effect of Brisson operation modified by Y-shaped incision for treatment of concealed penis in adolescents

Objective To analyze the clinical effect of the Brisson operation modified by a Y-shaped incision in treating adolescent concealed penis. Methods We retrospectively analyzed clinical data of 27 adolescents with a concealed penis treated with the Brisson operation modified by a Y-shaped incision in our hospital from January 2017 to March 2020. Results The operation went smoothly in all 27 patients. Postoperative foreskin edema occurred in 12 patients and spontaneously resolved within 1 month postoperatively. Two patients developed postoperative retropubic infection. After administering antibiotics and symptomatic treatment, both patients’ conditions improved within 1 week. All operations obtained satisfactory results. Postoperatively, when the penis was in a non-erect state, it was clearly exposed without retraction or concealment; thus, demonstrating good surgical results. The prepuce was distributed naturally without obvious accumulation of redundant preputial tissue. The penile scar resembled that after circumcision. The postoperative follow-up period was 6 months, during which no patients developed recurrence. Conclusion The Brisson operation modified by a Y-shaped incision is effective for treating a concealed penis in adolescent patients. This technique may relieve the pathological abnormalities and retain the penile skin's integrity to the greatest extent with minimal scarring and a satisfactory appearance.