A propeller superficial transverse cervical artery perforator flap for defect coverage of the submental area: a case report

Reconstruction of submental defects is a challenge that needs to be approached carefully, since many important anatomical structures are located in this small space. Both aesthetic and functional outcomes should be considered during reconstruction. In this report, we describe a case where a superficial branch of the transverse cervical artery (STCA) perforator propeller flap was applied for coverage of the submental area. An 85-year-old woman presented with a 3-cm ovoid mass on her submental area. We covered the large submental defect with a STCA rotational flap in a 180° propeller pattern. The flap survived well without any complications at 1 year of follow-up. A STCA propeller flap is a useful surgical option in reconstruction for defect coverage of the submental area.

Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

Background: Healing in Rhomboid flap for pilonidal sinus is always a problem. Different measures are applied to reduce the rate of wound infection with variable results. Objectives: To determine the effect of routine use of drain on the rate of early wound complications and additional interventions after Rhomboid flap. Methods: A retrospective chart review of all cases that underwent Rhomboid flap in five years in two tertiary care centres was done. Complication rates such as wound infection, wound disruption, and flap necrosis were evaluated. Results: A total of 38 cases of Rhomboid flap are included for analysis. Out of all cases 37 cases were done for Pilonidal sinus and one case for presacral dermoid cyst. In the first eight cases, flap was made without drain and subsequent 30 cases were done with two suction drains for five days. The rate of superficial wound infection in the group without drain was found to be significantly higher compared with flap with drain 5 (in 8) versus 2 (in 30) (62.5% versus 6.66%, p <0.5). Conclusion: Drain placement after Rhomboid flap is a good intervention to reduce wound infection.

Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

Earlier Corneal Topographical Changes After Different Pterygium Surgical Techniques: a Comparative Pentacam Scheimpflug Imaging Study

Purpose: To investigate earlier corneal topographical changes and visual acuity after different pterygium surgical techniques using the Pentacam Scheimpflug imaging system.Methods: This study enrolled 98 patients with unilateral primary nasal pterygium. Pterygium surgery with either a conjunctival autograft (group 1) or an anchored conjunctival rotational flap (group 2), with fibrin tissue adhesive was performed under topical anesthesia. Baseline and one-month post-operative best-corrected visual acuity (BCVA) in logarithm of the Minimum Angle of Resolution (logMAR) and anterior corneal astigmatism (ACA), flat keratometry (Kf), steep keratometry (Ks) and posterior corneal astigmatism (PCA) were analyzed.Results: Mean BCVA improved from baseline 0.119±0.113 to 0.082±0.086 logMAR in group 1, and from baseline 0.169±0.128 to 0.120±0.121 logMAR in group 2. There were no statistically significant differences between the two groups in pre-and post-operative ACA, PCA, Kf and Ks. (p=0.686; 0.9020.107; and 0.592, respectively). Intra-group analysis revealed statistically significant differences in both groups: ACA (p<0.001 for both groups), with a greater difference in group 1 (2.072), and Kf (p<0.001 for both groups), with a slightly greater change in group 2 (1.910). While there were no statistically significant Ks intra-group differences in both groups (group 1: p=0.091; group 2: 0.092), group 1 (0.0522) displayed more Ks changes. There were also no statistically significant intra-group PCA differences in both groups (p=0.061 for both groups). However, Group 2 (-0.020) displayed greater changes.Conclusions: Significantly improved anterior corneal topographical changes highly associated with conjunctival autografting. However, the conjunctival rotational flap was associated with relatively greater posterior corneal topographical changes.