We hereby report a case of avulsion amputation of the hand through the distal carpal row. The severity of the injury was such that it had avulsed the soft tissues from the forearm and the skin from the level of the arm as though a full sleeve of a shirt was being ripped off. Due to the extensive damage in multiple planes, the amputated part could not be saved. The below-elbow amputation stump though was covered with a new local flap based on the interosseous membrane and the periosteal flaps from the radius and ulna. The stump healed well and the patient recovered the full range of elbow movements.

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Background: The islanded pedicled perforator-based propeller design flap is a versatile local flap for reconstruction of defects of lower limbs from knee to leg to ankle to foot. Patients and Methods: All patients with small-and moderate-sized defects in lower limbs which required a flap cover are included in the study. Between October 2014 and September 2015, prospective study of patients undergoing perforator-based propeller flap procedure was performed. Patients were evaluated for defect size, defect location, procedure done, and donor site cover. Results and complications of the propeller flap were also analyzed. Atotal of eight flaps were done to cover defects of lower limbs. Results: Out of the eight flaps, seven were islanded on posterior tibial artery, one on the lateral geniculate artery perforator. Four flaps were used to cover lower one-third leg, three for middle one-third leg, and one for knee. The flap dimensions ranged from 3 cm×7 cm to 7 cm×19 cm. The median angle of rotation was 160°(ranging from 60° to 180°). Sixty-three percent of patients had associated fractures. Seven flaps survived completely and one flap had partial necrosis, which was managed with secondary split skin grafting. Conclusion: The islanded propeller design pedicled perforator flaps provides reliable coverage for small-to medium-sized defects for lower limbs, particularly lower one-third leg defects. This flap can provide an esthetically acceptable result as well.

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Introduction: Achilles tendon injuries have been on the increase worldwide, especially in the last two decades. The classification of the injury has not been explicit and the management protocols are confusing, especially with respect to specific injuries. There is a need to have a look at the current trends in the management of this common injury in order to create awareness and stimulate the need for standardization of the treatment protocols, possibly reaching a consensus. Materials and Methods: Information on the types of the injury, classification, and treatment modalities were obtained by searching the Pubmed, Medknow, Google Scholar, and other publications. These were collated and analyzed. Results: In most of the information on Achilles tendon injuries, these were inappropriately equated with Achilles tendon ruptures, which are actually supposed to be a subset. In the same vein, the diverse treatment options available were mainly those extensively used in ruptures. These procedures range from open surgery and minimal access surgery to close or conservative management followed closely with physiotherapy. Conclusion: There is a subtle misconception in the literature that we reviewed where Achilles tendon injuries were considered the same as Achilles tendon ruptures but this is not so. There are other injuries with different pathomechanisms and therefore, different managements. There is a need to include these other injuries and also broaden the management options. Minimal access surgery is preferred in ruptures.

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This is a case report to highlight the atypical presentation of hand ulcers caused by herpes simplex virus (HSV) in immunocompromised patients. We report a case of a 43-year-old right-handed female who developed a nonhealing and progressive ulcer involving the left middle finger and extending to the palm for which she was referred to our facility. Initial clinical diagnosis following examination was squamous cell carcinoma. However, carefully observed similar new lesions she developed while being investigated was in favour of HSV infection. She had remarkable response on acyclovir which substantiated the diagnosis. Awareness and a high index of clinical suspicion are required of physicians who may come across similar lesions.

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Background: Radial forearm free flap is the work horse in head and neck reconstruction. The venous drainage of the flap is by both superficial and deep group of veins. Aim of the Study: To compare the efficacy of venous drainage by single superficial vein (cephalic vein) with dual vein (cephalic vein & venae comitantes) in radial forearm free flaps and its impact on flap survival. Patient and methods- A total of 154 patients undergoing radial forearm free flap for reconstruction following resections of head and neck cancer were studied prospectively . In group 1 (75 cases) only cephalic vein was used as the draining vein and in Group 2 (79 cases) both cephalic vein & one venaecomitantes were used as the draining vein. Patients with non availability of cephalic vein as a result of chemotherapy or injury were excluded from the study. Data were retrieved frompatients' files and analyzed using SPSS computer software version 15.0. Observation and Results: The flap survival rate was 97.33% (73/75) in Group 1 versus 98.73% (78/79) in Group 2. The result is analysed statistically by using SPSS computer software version 15.0. and the P value > 0.50 (c² with Yates' correction=0.00206555, df=1) stastically not significant. Conclusion: Though two vein anastomosis may provide a more fail safe theoretical advantage, single superficial vein (Cephalic) provides effective and adequate drainage with less operative time and no additional morbidity.

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Background: Tie-over dressing is an established method of fixation of skin grafts in areas of body where immobilization is difficult toprevent hematoma and seroma formationin addition to avoid shearing motion of the graft. Traditionally, using multiple silk sutures does this. This is a one-time procedure and refixation is difficult if we need to repeat the procedure. Methods: We assessed our initial experience with a repeated tie-over dressing method using cap and collar of normal saline bottles used for irrigation and silk suture threads infourpatients over the anterior chest wall. These patients underwent recurrent keloid excision with reconstruction by skin graft and postoperative radiotherapy. After the graft is applied on the floor, tie-over stitches are taken and paraffin gauze is applied over with adequate padding; the tie-over sutures are passed through the collar and the cap is tightened over it to complete the dressing. The cap can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. Results: The skin graft take in all the patients was complete without any seroma or hematoma. An innovative tie-over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation, is reported here.

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Marjolin's ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. Treatment modalities of Marjolin's ulcers include wide local excision, block dissection of the regional nodes, amputation in advanced lesions of limbs, radiotherapy, and chemotherapy. Wide local excision, together with skin grafting, is usually considered appropriate in the treatment of Marjolin's ulcers. For lesions that are located at critical places skin grafting cannot be done because either the excised bed will not take the graft or skin grafting can be done but due to the unstable nature is often avoided preferring a flap cover. Defects over the knee is challenging especially when the defect is quiet large and the surrounding skin is scarred and unhealthy. In such situations neither any local fasciocutaneous flap nor muscle flap is possible, the only option left are in the form of free tissue transfer. But if this type of situation can be managed by transferring tissue from the upper part of the thigh in the form of pedicled flap then other complex reconstructions can be avoided. We describe a case of a 45-year-old male with Marjolin's ulcer over the post burn scar of right knee for 5 years duration with no regional or distant metastasis managed with wide local excision and cover with reverse vastus lateralis musculocutaneous flap. The post op outcome is uneventful with better patient satisfaction.

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Albinism is a rare autosomal recessive disorder occurring as a result of decrease or absence of tyrosinase enzyme resulting in a reduction in melanin synthesis. This is characterized by depigmentation, nystagmus, and photophobia and decrease visual acuity. Malignant melanoma though on the increase worldwide, it is very rare in the albino who have deficient melanocytes that express melanin. We present a case of malignant melanoma in a 26-year-old male undergraduate albino.

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