Twenty volunteers were recruited to compare a novel, silicone ring tourniquet (the Hemaclear® tourniquet) with a pneumatic tourniquet. After application of the tourniquets, the pain and paraesthesia experienced by the participants was scored at 1 minute, 5 minutes, and 10 minutes. This was repeated with the tourniquets on the forearm. On the upper arm, the silicone ring tourniquet was associated with a significantly lower pain score than the pneumatic tourniquet. The incidence of paraesthesia was also lower with the silicone ring tourniquet. When applied to the forearm, there was no statistically significant difference in pain scores between the two types of tourniquets. However the incidence of paraesthesia was again lower with the silicone ring tourniquet.

Background: Blood loss and problems associated with blood transfusion in burn wound excision is a major challenge a surgeon has to face. Topical application of antifibrinolytics has been used in many surgical fields. This study was conducted to assess the reduction of blood loss in burn wound excision by topical application of tranexamic acid. Materials and Methods: This Prospective observational study was conducted in a tertiary care hospital between February 2018 and May 2019. Results: In this study, we observe that by adding 0.5% tranexamic acid to 1 in 200,000 adrenalin topical solution, blood loss can be reduced while burns excision and skin grafting. In this study, after the application of tranexamic acid, the average blood loss per unit area reduced by 36% with significant P < 0.05. Conclusions: The use of tranexamic acid is effective and safe to use for topical use in concentration of 0.5% for reduction of blood loss in burn wound excision. However, further study with larger study group, should be done to confirm the findings of this study and further authenticating the results.

Background Scalpel is the most common and oldest instrument used by surgeons for incision and to perform the surgery. A lot of improvement has occurred in the design of scalpel from the flint knife to the modern Bard-Parker handle with blades. The quest for improvement and finding a better instrument is neverending. In this study, we present an alternative scalpel to the no. 15 blade most commonly used by plastic surgeons. Material and Methods Consultants and residents in plastic surgery department used a no.15 blade and a 15-degree straight keratome on randomly selected patients and used subjective numerical rating scale to assess the ease of incision and dissection. The data were collected and statistically analyzed. Results In this study, 89 patients were included out of which 68 cases were operated by the consultants and 21 cases were operated by residents. The average score of ease of incision using a no. 15 blade by the consultants was 6.52 and by the residents was 6.125. The average score of ease of incision using a 15-degree straight keratome by the consultants was 8.74 and by the residents was 8.84. p-Value was statistically significant when no. 15 blades and 15-degree straight keratome were compared. Conclusion 15-degree straight keratome is an excellent scalpel that can be used in preference to no. 15 blade as it is difficult to use.

Background. Gynecomastia, benign enlargement of the male breast is the most common breast pathology amongst males. The most widely used modality of treatment is liposuction under general anesthesia. To date however there is no published study that specifically addresses to use tumescent anesthesia & use of tranexamic acid in it for excision of gynecomastia. Objective. To evaluate the efficacy of tumescent anesthesia in surgical excision of gynecomastia. Methods. A 4-year study with 100 patients of gynecomastia aged 14 to 47 years were enrolled with follow up for 3 months. All patients were given tumescence anesthesia in each breast comprising subcutaneous infiltration of 500 ml RL, 20 ml 0.5% bupivacaine, 30 ml 2% lignocaine, 1 mg adrenaline & 1 gm tranexamic acid. Breast tissue was excised in each breast by a single infraareolar incision & patients were assessed for intra-op pain and post-op pain by using numeric rating scale (NRS). Results. Bilateral presentation was there in 69 patients and 31 unilateral with 4 recurrent cases. Size of gland excised were 12-14 cms in 53 cases, 15-18 cms in 38 & 19-20 cms in 9 patients. Average surgical time required for each breast was 30 minutes. Intraoperative pain NRS-0 for 66, NRS-1 for 31 & NRS-5 for 03 patients. Postoperative pain for first eight hours was NRS-0 for 69 and NRS-1 for 31 patients. Conclusion. Tumescent anaesthesia for surgical excision of gynecomastia using a periareolar incision is a minimally invasive bloodless and painless technique in which ductal and stromal tissue can be removed resulting in a high level of patient satisfaction. In todays covid era it avoids the use of general anesthesia and electrocautery.

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