Comparative study of use of 32-F, multi-perforated tube drainage of subcutaneous plane versus no drainage, in laparotomy

Background: We are concerned about the wound management and wound healing amongst post-operative patients, as wound complications increase the morbidity of patients post-surgery. Most common wound complications post-surgery are wound seromas, hematomas and surgical site infections (SSIs). SSIs lead to increased hospital stay and increased morbidity alongside increasing unnecessary patient suffering and a decreased quality of life. The underlying principle for the use of subcutaneous drains is based on the belief that removal of serum or debris and eradication of dead space in subcutaneous plane will bring down the rate of infection and wound complications.Methods: A randomized control study was conducted at the General Surgery Department at SGT Medical College, Gurgoan, Haryana. In total, 60 patients were selected (after taking informed written consent) among those admitted to the Surgery Department for laparotomy procedure. Patients were divided randomly into two groups i.e., group-A (study group) and group-B (control group). In group-A patients, subcutaneous wounds were closed over a drain (32-F multi-perforated drain), while in group-B patients no drain was used. Intra-operative and post-operative findings were recorded and analysed to draw study conclusions.Results: SSIs were observed significantly higher among patients without subcutaneous drain (group-B). Patients of group-B had significantly higher incidence of seroma and pus as compared to group-A patients. Experience of pain was reported higher among the patients without subcutaneous drain (group-B).Conclusions: Subcutaneous drains play an important role in reducing the incidence of SSIs, wound complications, wound pain; thereby lead to better healing of the surgical wound.

An unusual presentation of a giant pancreatic pseudocyst extending through the lateral abdominothoracic wall into the subcutaneous plane

Pancreatic pseudocysts are a common complication of pancreatitis affecting up to 40% of chronic cases. Typically, they are located within or abutting the pancreas and are self-limiting with the majority been smaller than 6cm, asymptomatic and resolving with conservative management. Here we present an unusual multiloculated giant pancreatic pseudocyst that originated at the pancreatic tail and extended through the lateral thoracoabdominal walls into the subcutaneous plane in a male with chronic alcohol pancreatitis. A literature search revealed no previous documented cases of this specific complication.

Thread Migration After Polydioxanone Thread Lift

Background: The thread-lift has gained popular interest as a minimally invasive procedure because it is simple and reliable. Additionally, it has shorter recovery time and fewer complications than facelift surgery. However, complications including hematoma, infection, facial asymmetry, thread exposure, thread migration, dimpling, alopecia, parotid gland injury, and scarring can occur. We report a case of thread migration after a polydioxanone (PDO) thread lift.Case presentation: A 40-year-old woman underwent a thread lift using a PDO cogged thread. Insertion sites were marked along the temporal hairline. The expected distal ends of threads were marked at least 1.5 cm apart from the nasolabial and marionette folds and 2.5 cm apart from the mandibular border. All threads were inserted into the deep subcutaneous plane. After 1 month, she complained of a foreign body sensation and pain just lateral to the left mouth corner. She showed a linear elevation with oblique direction, and a linear material was palpated with little mobility. The removed material was confirmed to be a part of the inserted thread.Conclusion:During thread lift, it is important to remove the cannula gently and straightly to avoid breaking the thread. Also, it is better to avoid strong manual massage on the path of the thread.

Rhinosporidiosis-an atypical presentation as a facial swelling in left cheek

<p>Rhinosporidiosis is a chronic granulomatous disease of mucous membranes caused by <em>Rhinosporidium seeberi</em>. Most frequently affected sites are nose and nasopharynx followed by eye.<strong> </strong>Report a rare case of 13-year-old female with rhinosporidiosis in a bizarre way of presentation as a cyst in left cheek. A 13-year-old female child hailing from West Bengal presented to ENT OPD with complaints of swelling in the left cheek for 6 months gradually increasing in size. On examination left side of cheek a cystic swelling extending from angle of mouth to lateral side of face was seen. Magnetic resonance imaging (MRI) neck plain and contrast showed large well defined T2 hyperintense cystic lesion in subcutaneous plane measuring about 5.7 cm (transverse)×6.0 cm (cephalocaudal)×5.5 cm (anteroposterior) with post contrast wall enhancement. Patient planned for excision and histopathological examination was consistent with rhinosporidiosis. Rhinosporidiosis continues to be a conundrum necessitating further literature and research on this. The difficulty in culturing the organism and its preternatural presentations add up to difficulties in diagnosing. Emphasise the quaint feature of its presentation as a cyst in cheek as primary site without any focus of infection in the respiratory tract and with negative history of traumatic inoculation.</p>

Minimally invasive fasciotomy using a lighted retractor in the treatment of chronic exertional compartment syndrome

Chronic exertional compartment syndrome can be a debilitating cause of lower leg pain that typically affects young, healthy people during a variety of aerobic activities. Conservative management has produced a poor success rate and numerous techniques for surgical decompression have been described. Many of these, however, involve blind fascial dissection which increases the risk of direct nerve injury or insufficient fascial release. We describe a novel technique of mini-open fasciotomy using a lighted retractor which enables direct visualization of the fascia and the superficial peroneal nerve using a single, small incision. By the use of a 3- to 4-cm laterally based incision, a lighted retractor with fiber-optic illumination is introduced into the subcutaneous plane and advanced distally and proximally. The retractor gently elevates the subcutaneous tissues while focusing light directly into the surgical area and a long Metzenbaum scissors is then used to release the fascia under direct vision. Fasciotomy using this technique avoids the risks of blind fascial release and is a straightforward, safe, and effective method for compartment decompression.

Gastric Lipoma

Lipoma, a universal tumor of adult fat cells is usually encountered in the subcutaneous plane. However no part of human body is spared of having lipomas. Gastrointestinal lipomas though rare, may prove to be more dangerous and needs special attention for diagnosis and treatment. Here, we report a 55 year old female with gastric lipoma who presented with upper abdominal pain, dyspepsia and acute upper gastrointestinal bleeding. Journal of Surgical Sciences (2014) Vol. 18 (2) : 74-77

Objectifying the Risk of Vascular Complications in Gluteal Augmentation With Fat Grafting: A Latex Casted Cadaveric Study

Background Fat transfer is the most popular means of gluteal augmentation. However, this procedure may be complicated by pulmonary fat embolisms (PFEs). Of 135 PFEs out of 198,857 cases reported by the Aesthetic Surgery Education and Research Foundation task force, 32 were fatal, contributing to the mortality risk of this procedure being as high as 1:2351. Objectives The aim of this study was to generate an anatomic map of the 3-dimensional location and variability in size of the gluteal region vessels. Methods Twenty cadaveric gluteal regions were dissected. The aorta, venae cavae, popliteal, and saphenous veins were cannulated and injected with colored latex. Dissection was performed subcutaneously, in the gluteus maximus (GM), and submuscularly to evaluate the number and vascular distribution of all the vessels. Vessels were mapped on an XYZ axis. Results The subcutaneous plane, containing 25 vessels on average, had the smallest vessel diameters (artery, 0.9 [0.3] mm; vein, 1.05 [0.22] mm). The GM vein diameter was 1.3 [0.3] mm. Branches of the inferior gluteal vessels had arterial and venous calibers of 2.2 [0.04] mm and 3.5 [0.99] mm, respectively. Superior gluteal artery and vein branches were 1.8 [0.2] mm and 3.85 [1.9] mm in diameter, respectively. Superior and inferior gluteal vein diameters were 7.61 [2.24] mm and 13.65 [6.55] mm, respectively. Conclusions The deeper and more medial planes of the gluteal region house larger, more prominent vessels. This research objectifies and is consistent with recommendations made by various recent task force reports to limit fat transfer to the subcutaneous plane.

Unusual location of a glomangioma: a case report

Glomangioma or glomus tumors are rare neoplasms of the glomus body, which are located in the stratum reticularis of the dermis throughout the body. With a female preponderance, 75% of them occur in the subungual region and present with non-specific pain as the main complaint. Extradigital glomus tumours are rare and present a diagnostic challenge, seen most commonly in males. We present a case of a 47-year-old male who presented with a painful swelling in the forearm. MRI showed a hypodense lesion in the subcutaneous plane. After a wide local excision, histopathology revealed sheets of round cells with intervening vascular channels, characteristic of a glomus tumor.