Electrical injuries due to high-tension voltage (>1000 volts) cause destruction at the point of contact with massive necrosis of deeper structures such as muscles, vessels and nerves. Rhabdomyolysis due to massive breakdown of skeletal muscles may lead to acute renal failure secondary to myoglobinuria. The study was undertaken to observe the correlation of renal complications with extent and progression of tissue damage in high-tension voltage electrical burns. Renal biochemical parameters as predictors of acute renal failure were also studied. Thirty two patients of high tension voltage electrical burn injuries presenting during one year period 1-1-2001 to 31-12-2001 were studied. Low-tension voltage electrical injuries (<1000 volts) mimic thermal burns were excluded from the study. The electrical wound assessment and the renal biochemical parameters were done daily for the first seven days and then on alternate days for another seven days. Assessment of progression of wounds and correlation with the renal biochemical parameters was done. Patients who died following electrical burns were subjected to autopsy and histopathological examination of both kidneys. Out of the thirty-two patients, six (18.75%) went into acute renal failure. Five out of these six patients died because of renal failure (mortality rate 83.33%). There was definite progression of electric burn wounds. There was no correlation between progression of electrical burn wounds and acute renal failure. Serum creatinine was found to be the most important biochemical parameter as a prognostic indicator of acute renal failure.

In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively. We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

The perception of plastic surgery in society is limited and underestimates the versatility of the specialty. A survey was conducted in order to assess knowledge and to provide some initial evidence for education about the scope of plastic surgery amongst the public, medical and nursing students and general practitioners. A questionnaire was devised and four population groups of respondents were surveyed at random in one district. The results reveal that the majority of the public needs more information about the benefits that our specialty can offer them. Plastic surgeons are mainly associated with burns and cosmetic surgery and they are not necessarily identified as primary surgeons for procedures fundamental to our specialty. If patients are to receive the best treatment available, it is essential that we educate the public about our clinical interests and activities.

CONTEXT: The most revolutionary concept in rhytidectomy is the role of Sub Muscular Aponeurotic System (SMAS), even if many alternative approaches have been proposed. The main aim of face lift is to bring back the time, preventing the "lifted-face" appearance. SETTINGS AND DESIGN: The authors present their personal experience with different levels of undermining, i.e. subperiosteal forehead lift, subcutaneous midface lift with SMAS plication and platysmal suspension, and discuss the anatomical and biomechanical elements of rhytidectomy. RESULTS: Optimal aesthetic results were achieved by repositioning the neck, face and forehead tissues in a global and harmonious fashion, without distorting face characteristics and disguising surgery trails as much as possible. CONCLUSIONS: Different levels of undermining can give good and stable aesthetic results minimizing the risks and preventing face distortion.

The results of patients operated on by Nepal Cleft Lip and Palate Association (NECLAPA) surgeons for congenital macrostomia were prospectively studied between January 2000 and December 2002. There were four males and three females with a median age of 10 years. Three had an associated branchial arch syndrome. In all patients an overlapping repair of orbicularis oris was done. Six patients had a straight line closure with excellent cosmetic results and one a Z-plasty with a more obvious scar. All had a normal appearing commissure. Overlapping orbicularis repair with straight line skin closure for this rare congenital anomaly is recommended.

Since the first five basic principles of Plastic Surgery were stated by Ambroise Pare in 1564, and revised to thirty-three by Millard in 1986, the importance and application of these principles has not changed, although their application may vary from patient to patient. The very fact that these principles are applicable even today indicates the depth of understanding and foresightedness of those who formulated these principles. In spite of newer developments in plastic surgery, these principles have stood the test of time and have proved useful even today. This article discusses these principles and elucidates their relevance in the context of the practice of current plastic surgery.

Index case of injury to the breast by a sugarcane crushing machine is being reported.

Abdominal and groin flaps are the main workhorse for soft tissue defects in hand injuries. A simple and easy method is being described for immobilising the upper limb following abdominal and groin flaps for soft tissue defects of the hand using commonly available clavicular braces. This is devoid of all the problems of immobilisation using the common methods such as adhesive plasters and pin fixators and has its own advantages.

CONTEXT: Anthrax is a very rare disease in Europe and the United States. AIM: A case of cutaneous anthrax of the hand with a wide skin defect is presented and some clinical observations highlighted. CASE REPORT: A 56-year-old male patient with cutaneous anthrax attended our infectious diseases department with a swelling up to the upper arm. An urgent fasciotomy was undertaken with a diagnosis of compartment syndrome. A black eschar had formed on the dorsal surface of the hand. A superficial tangential escharectomy was performed. RESULTS: Viable fibrous tissue, about 4 to 5 mm in thickness over the extensor tendons, was found under the eschar. At the postoperative 2-year follow-up, remarkable healing was observed via skin grafting. CONCLUSIONS: Hand surgeons should be cautious against the compartment syndrome that may accompany cutaneous anthrax of the hand. A consistent viable fibrous tissue can be found below the eschar. The mechanism for the involvement of the hand dorsum needs further concern.

Earrings-related complications are mostly caused by piercing. To our knowledge, there is no report regarding embedded earrings without the effect of piercing in the English-language literature. In this report, we describe two cases of embedding of earring pins while wearing but not having resulted from piercing.

The history of the Department of Plastic Surgery, K.E.M. hospital, Mumbai, is presented from its inception in 1961, to date. The initial struggle, hard work and complete dedication have been mentioned. Fond, cherished memories of personalities, faculty and students along with their contributions are revived.