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The present case is a unique presentation of a patient who developed a small lump in her breast during her first pregnancy but it was only during her third pregnancy that it increased in size and became a huge fungating mass. Although, gigantic sizes of this pathologic entity have been reported, the present case had the involved breast hanging till below the inguinal ligament and required sling to support the breast. Since the pre-operative diagnosis was suggestive of cystosarcoma phylloides, no attempt at reconstructive surgery was contemplated.

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Closed rupture of the FDP tendon is rare. However, whenever they occur the most common site of rupture is the tendon-bone insertion, less frequent site is at the musculo-tendinous junction. Midsubstance ruptures are even more unique and are usually due to underlying pathology such as fracture, cystic degeneration, rheumatoid arthritis, or sequel following local steroid injection. This report describes a closed rupture of FDP tendon of little finger. Mechanism of injury, diagnosis and management are discussed.

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Local management of chronic wounds and ulcers remains one of the most costly unsolved problems in health care today. With proper clinical management, most chronic wound healing problems can be resolved and healing expected, though recurrence may be common. The recent logarithmic growth in our knowledge about wound healing and the appreciation of the importance of a moist environment in optimal wound healing has led to the introduction of new and exciting therapeutic modalities. In view of the many practical disadvantages as well as the serious complications of currently available moisture retentive dressings when applied to chronic contaminated wounds, a prospective multicenter clinical trial was conducted from December 1999 to November 2000 to evaluate the safety and efficacy of a newly introduced moisture retentive ointment (MEBO: Moist Exposed Burn Ointment) (Julphar – Gulf Pharmaceutical Industries, UAE) in the local wound care of problematic non-healing wounds. The active component of the ointment is ß-sitosterol in a base of beeswax, sesame oil and other components. Though it was not a comparative study, the ointment was found to induce rapid reduction in ulcer size even after a prolonged stagnant state with other therapeutic modalities without complications such as skin maceration, unmanageable excessive exudation, and wound infection. As expected with such chronic wounds, the healing potential of local ointment application is limited by the mere size of the original defect and the underlying pathologies and associated diseases. however, the safety and practicality of simple ointment application was found to be a valid alternative treatment for local management of chronic wounds.

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Over a period of twelve years, a strategy of reconstruction of digital injuries has been evolved in our unit which now allows us to reconstruct most defects of the digits with more predictable and, hopefully, better results than in the 1980s. This policy includes much of the philosophy and techniques of earlier and contemporary surgeons, with local modifications which we believe are improvements of the earlier techniques and a few new procedures. Wherever possible, the extraordinary capacity of the digital skin to regenerate has been exploited and homodigital techniques of reconstruction are used to limit the total injury of the trauma and reconstruction to the damaged digit. The techniques which we currently use are summarised in this article.

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The treatment of head and neck cancer remains a challenge. Despite advances in surgical reconstructive techniques, most patients will require adjuvant therapy in the form of radiotherapy or chemo-radiotherapy to improve locoregional control. The short- and long term side effects of radiotherapy can be difficult to treat. In this review the causative effects and pathogenesis of osteoradionecrosis of the mandible will be highlighted. In addition, preventive measures and clinical features of radiotherapy induced damage will be presented. Finally, medical and surgical management of osteoradionecrosis, as well as, reconstructive surgery of the mandible will be discussed. At the end of this paper the reader should have up to date knowledge concerning the etiology, prevention, diagnosis and treatment of patients with osteoradionecrosis of the mandible.

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Three cases of Median facial dysplasia are presented with their classification, embryological basis and management strategy.

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Objective: To analyse the various factors affecting pregnancy rate after microsurgical tubal recanalisation. Design: Prospective study, follow-up of 5 years in patients treated with tubal microsurgery. Setting: Referral Tertiary Care Hospital. Patients: Fifty women underwent microsurgical tubal recanalisation procedure. Principles of microsurgery were followed throughout the procedure meticulously. Interventions: Microsurgical tubal recanalisation. Main outcome measure: Pregnancy rate. Results: With microsurgery, an overall 60% pregnancy rate was achieved. In these patients, pregnancy outcome was in form of intrauterine pregnancy (96.66%), ectopic pregnancy (3.33%), term viable pregnancy (96.55%) and spontaneous abortion (3.45%). Conclusions: The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation & the remaining length of the tube after recanalisation. The microsurgical technique should be available at specialized centres to improve the success of family planning services.

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An abscess is a common occurrence. The gold standard for treatment is incision and drainage. Here a simple technique of a small puncture followed by drainage and irrigation done under local anesthesia is described. Sixty-four patients were treated between 1990 and 2006. Barring two, which were taken off the study, all healed completely without recurrence. The advantages of this procedure are that it is simple, can be done as an office procedure enabling a quick return to work and results in faster, scar free healing. It also allows better pain management.

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Speech is a complex process. The evaluation of speech in an individual with cleft palate is difficult, and the existing classification of phonemes is complicated. Sanskrit, an ancient language, has an arrangement of alphabets that is orderly and scientific and therefore provides a simple means to understand the production of phonemes and memorize them. This article demonstrates the inherent advantage of this arrangement of Sanskrit alphabets to effectively analyze defective cleft palate speech and provides a tool for surgeons to decide a course of action in their routine clinical practice. Improved insight into the speech defect by the surgeon also facilitates better coordination with the speech language pathologist in assessment and treatment of a child with cleft palate.

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Creation of a nipple-areola complex often represents the final step in a long and troubling reconstructive process for women with breast cancer. After this hard time, the procedure of choice needs to be convenient, painless and reliable. C-V flap technique for nipple reconstruction, designed especially for later areola tattooing, is a quick and effective form of nipple reconstruction using local tissue and reported that it could serve this aim. Nipples of 12 patients whose mastectomy sites were reconstructed with TRAM flaps were reconstructed with C-V flaps, but their areolas were skin grafted from distant areas instead of tattooing. At the follow-up evaluations, patients’ satisfaction was high in projection, pigmentation, sensation and overall parameters. We concluded and agreed that C-V flap technique was a very reliable method of nipple reconstruction, even when combined with areola grafting.

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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.

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Transection of plastysmal bands has required a surgical approach that leaves scars and limits patient activities for a period of time. The author has developed a simple method to transect the platysmal bands under local anesthesia without resorting to skin incisions. The transection is performed with the use of a Vicryl® suture that is inserted through the skin, around the platysmal band, and then out through the original entry point. A back and forth motion of the suture cuts through the band.

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Tissue adhesive is one of the alternative to conventional suturing and has some added advantages. Fibrin glue has been used in obtaining haemostasis following trauma to spleen and liver. It has also been used in repair of dural tear and bronchial fistula. Fibrin glue is a biological tissue adhesive based on the final stage of coagulation wherein. Thrombin acting on fibrinogen converts it into fibrin. Thus, it has two components, one is fibrinogen and another is thrombin. We have prepared both components of fibrin glue. Fibrinogen was obtained from patient’s own blood and thrombin from fresh frozen plasma of screened healthy donor. The glue was used in 20 cases requiring skin graft or flap. The results were compared with conventional suturing method. Use of the fibrin glue is simple, safe, cost effective, and rapid technique to fix the skin grafts and flaps with avoidance of peroperative bleeding and postoperative collection. It also has better overall results.

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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.

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Eccrine Porocarcinoma is a rare neoplasm arising from sweat glands. It was first described by Pinkus and Mehregan as 'Epidermotropic eccrine carcinoma'. It may occur de novo or as a malignant transformation of an eccrine poroma. It is commonly found in older age group and in the lower extremities. Clinically, it may present as a verrucous plaque, polypoid growth or an ulcerative lesion of long duration. Local recurrence and metastasis to skin, lymphnodes, viscera, and bone may occur. Treatment is wide local excision. Metastatic lesions can be treated with chemotherapy. We report a case of eccrine porocarcinoma of the scalp in a 50 years old female who presented to us with a bosselated, firm, painless, non-tender, freely mobile swelling over left fronto-parietal region of 12 years duration. It was excised and histopathological diagnosis was Eccrine Porocarcinoma. In literature, scalp porocarcinoma is a very rare tumor.

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Sixteen patients with distal hypospadias were treated by tubularised incised plate (TIP) repair as described by Snodgrass.1 Coronal hypospadias constituted most of the cases (56.2%). Patient age ranged from 1.2 to 4 years. Complications occurred in two cases (12%). One patient developed urethrocutaneous fistula (6 %) and meatal stenosis (6 %) occurred in another case. Cosmetic and functional results were excellent in fourteen cases. TIP repair is the optimal technique for virgin cases of distal hypospadias.

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The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management.

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The structural integrity of the chest and abdominal walls and perineum is frequently altered by cancer extirpation. Advances in reconstructive surgery and the availability of innovative techniques have helped the cancer surgeon to proceed with radical excisions with minimum morbidity. The ability to harvest flaps from distant sites and the availability of good prosthetic materials have now become part of the routine armamentarium of the plastic surgeon engaged in reconstructive surgery of these areas. Newer technologies incorporating tissue engineering may allow the reconstructive surgeon to achieve better functional and aesthetic rehabilitation of these patients.

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This new classification is based on the analysis of the following: 1. The study of Embryological developments of the normal structures and the clefts in the head and neck regions, 2. The Clinical presentation of Clefts in the head and neck regions in our series of 146 cases, 3. The study of clefts under Rare craniofacial, Branchial [Cervical] and Classifications by various Authors and 4. The review of Literature pertaining to the clefts in head and neck regions. The documentation of commonly diagnosed and treated cleft lip and palate anomalies have remained unsatisfactory. As the regular cleft lip and palate falls within the purview of this new classification, a separate classification of Rare Craniofacial clefts can be avoided. This is an attempt made to bring all varieties of cleft deformities in the head and neck region under one Classification and to plan and execute better techniques in the field of assessment and management.

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Segmental mandibulectomy leads to a great deficit in the form and function of the patient. Vascularised bone flaps have become the choice of the method of reconstruction of the mandible in an oncologic setting. Fibula osseous or oseteocutaneous flaps have become the favored method in centers across the world. This article reviews certain pertinent and practical points with regards to fibula flap reconstruction of the mandible. Methods of osteosynthesis, merits of inclusion of the FHL muscle in the flap and use of osteointegrated implants are discussed in detail. The reader will also be able at the end to understand the role of pre operative vascular imaging, steps taken when there is an irreversible flap failure and steps to maintain and rehabilitate occlusion as practiced in the author's service.

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Post-mastectomy breast reconstruction has become the standard of care in the western world. Breast reconstruction using autologous tissue can be performed in a safe, reliable and predictable fashion. The ultimate goal is to reconstruct a symmetrical autologous tissue mound comparable in shape, size and volume to the opposite breast without compromising the oncology clearance. Abdominal tissue remains the first choice for breast reconstruction though other alternatives are rapidly evolving.

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