Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.

, a total of 695 patients with hernia and intestinal obstruction were considered retrospectively. Of these, 545 patients were hernia cases (both elective and emergency), and the rest were intestinal obstruction cases, from other causes. Among the hernias most were inguinal hernias (397 patients) and internal hernias were constituted by 6 cases. All of them presented as acute intestinal obstruction, constituting 1.8% of acute intestinal obstruction cases [Table/ Fig-1].CASE 1: Patient presented to our emergency department with features of intestinal obstruction. History of similar complaints were present previously which had subsided on its own. He was dehydrated and tachycardia was present. Abdomen was distended with diffuse tenderness and guarding. X ray abdomen showed multiple air fluid levels and dilated bowel loops. He was posted for emergency exploratory laparotomy. Intraoperatively ileum was found herniating through the left paraduodenal fossa with constricting band formed by inferior mesenteric vein and the proximal small bowel was found dilated [Table/ Fig-2]. The contents of the hernia were reduced and the inferior mesentric vein was preserved. Defect was closed with the free peritoneum to the lateral border of duodeno-jejunal flexure, retroperitonialising the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on day 7. CASE 2: Patient presented to our casualty with features of intestinal obstruction. He was febrile and dehydrated, tachycardia was present. Abdomen was distended, with diffuse tenderness, guarding and rebound tenderness. X ray abdomen showed multiple air fluid levels and dilated small bowel loops. He was posted for emergency exploratory laparotomy. During laparotomy ileum was found herniated in the left paraduodenal fossa with 50 cm of ileum found gangrenous within it and proximal segment dilated 4]. The constriction band was formed by inferior mesenteric vein. The contents were reduced, gangrenous bowel was resected and an end to end ileo-ileal anastomosis was done in two layers. The defect was closed with peritoneum to the DJ flexure after preserving the inferior mesenteric vein. Postoperative period was uneventful and he was discharged on postoperative day 9.CASE 3: A chronic liver disease patient admitted in medicine ward presented to emergency department with features of intestinal obstruction. X ray abdomen showed multiple air fluid levels and Contrast Enhanced Computerized Tomography (CECT) abdomen showed encapsulation of distended bowel loops in an abnormal location in the left hypochondrium, with hepatomegaly and ascites [Table /Fig-5]. She was transferred to the surgery department for emergency exploratory laparotomy. Intraoperatively ascites was present. Liver was massively enlarged and ileum was found herniating through the left paraduodenal fossa and covered by peritoneal sac and the constricting band was formed by the inferior mesenteric vein causing obstruction [Table/ Fig-6]. Sac was opened, contents were reduced and the defect was closed w...

Background: Fat grafting was developed in recent years with refinement mainly based on Coleman technique. The method consists of taking fat removed by liposuction under low pressure, fat processing and then placement of fat on the treated area.Methods: Patients who presented with depressed or retracted scars were considered. 12 patients were selected for the study as one year. Patients were given fat injection by Coleman’s technique and were evaluated at 1, 3 and 6 months. Patient and observer scar assessment score (POSAS) was used for evaluation.Results: The present study infers that there is a significant decrease in POSAS score on both the patient and observer side after fat injection for retracted scars. The overall patient score decreased from 5.75 (±0.866 SD) pre-operatively to 3.17 (±1.115 SD) post-operatively with a p value of less than 0.005. The difference between the scores is 2.58 which are comparable to other studies. The overall observer score decreased from 4.25 (±1.422 SD) pre-operatively to 2.58 (±0.996) post-operatively with a p value of less than 0.005. The difference between the scores is 1.67 which is comparable to other studies.Conclusions: Autologous fat grafting seems to be a promising and effective therapeutic approach for scars with different origins such as trauma, burns, post-surgery. In general, we can affirm that treated areas regain characteristics similar to normal skin, which are clinically perceptible, leading not only to aesthetic but also functional results.

BACKGROUND Hospital-associated infections are an important cause of patient morbidity and mortality. Cell phones and pens are ubiquitous accessories of doctors and other Healthcare Workers (HCWs) in a hospital as well as outside for various purposes. But, they may serve as reservoirs of infection allowing the transportation of the contaminating bacteria to many different clinical environments. The aim of the study is to find out the prevalence of various bacteria in mobile phones and pens of doctors and other staff working in operation theatres of Government Medical College, Kottayam, Kerala, for a period of one year. MATERIALS AND METHODS 400 samples of microbiological swabs were collected from pens and mobile phones of medical personnel working in the operation theatres of Government Medical College, Kottayam, for one year. If growth was present in cultures, identification of organisms and sensitivity to routine antibiotics was checked by disc diffusion method according to the organism isolated. RESULTS About 2/3rd of mobile phones and pens carried by healthcare workers inside operation theatres contained bacteria, of which, skin commensals prevailed in number. Presence of faecal microflora and multidrug-resistant bacteria detected in some of the samples are alarming. CONCLUSION This study emphasises the need for creating awareness among healthcare workers regarding the role of mobile phones and pens as carriers in transmission of nosocomial infections.

Background: Exact aetiology for keloid formation is yet unknown. The prime goal of the therapy is to decrease the process of scarring. Many modalities of treatment are available for keloids. With current treatment modalities, recurrence rates approaches 75%. This study was conducted to find out whether application of Epidermal growth factor will reduce recurrence rates of keloids, after surgical excision.Methods: An observational study was conducted by collecting details of 40 patients who underwent surgical excision of keloids followed by epidermal growth factor application over the wounds. The patients have been followed up to 6th months post excision and recurrence rates of keloids as well as overall scar quality were analysed.Results: Out of 45 patients included in the study, 16 (35.6 %) were males and rest females. The median age of the study population was 18.0 (with an IQR 16.0; 26.0). Out of 45 patients, 12 patients had family history of keloids (73%). Out of 45 patients, 8 had keloid tendency which amounts to 82%. Out of 45 patient who underwent treatment, 22 patient developed recurrence which is 48.9% Out of 45 patients included in the study, 16 (35.6 %) were males and rest females. The median age of the study population was 18.0 (with an IQR 16.0; 26.0). Out of 45 patients, 12 patients had family history of keloids (73%). Out of 45 patients, 8 had keloid tendency which amounts to 82%. Out of 45 patient who underwent treatment, 22 patient developed recurrence which is 48.9%.Conclusions: There is a dearth of randomized controlled trials supporting the efficacy of epidermal Growth factor in preventing keloid recurrence. The subjective improvements seen in some cases are encouraging. This study will be a foundation for future studies and will highlight the breadth of knowledge yet to be explored by this therapy.