Background: Dog bite patients are frequently encountered in our hospital seeking immediate as well as delayed reconstruction. More than two third of dog bite injuries involve head, neck and scalp region. Facial dog bites present a challenge for the surgeon, as they lead to cosmetic disfigurement and psychological trauma to the patient. Following thorough washout and debridement, we have used various reconstructive techniques for definitive management of wounds like- primary repair, V-Y advancement flap, nasolabial flap, SSG, FTG and Karapandzic flap. Purpose of the present study is to share our experiences in management of dog bite wounds on the face in both adult and paediatric patients with available reconstructive options to maximize the functional and cosmetic outcomes by using basic principles of surgery.Methods: Present study was a single centre retrospective study conducted in a tertiary care centre from February 2013 to January 2018. Total 497 patients of dog bite who presented in the emergency department were enrolled. Out of them 310 patients had involvement of head, neck and scalp requiring surgical intervention in any form.Results: In last five years, we have encountered mid face predilection in face, head and neck cases. Out of 310 cases, lip (25.16%) and cheek (24.51%) were involved in majority of the patients. Flap cover surgery is required in majority of the scalp and nose group of patients, as there is less mobility of tissue present in surrounding region, while cheek and lip were managed with primary closure in most of the patients.Conclusions: Although most of the dog bites are preventable, but cases of dog bite are increasing continuously. Child should never be left alone with dogs and, if they are fear of dogs, it’s better not to obtain dogs. As far now, it’s a major concern for treating physician or surgeon to provide optimal cosmetic as well as functional outcome. Early surgical intervention for wound management gives better results with the use of basic principles of plastic surgery.

<p class="abstract"><strong>Background:</strong> The lateral supramalleolar flap is based on a perforator of the peroneal artery, emanating at approximately 5 cm above the lateral malleolus on the anterior aspect of lower third leg.</p><p class="abstract"><strong>Methods:</strong> Our technique of harvesting the supramalleolar flap is by using a fasciocutaneous pedicle and minimal perforator dissection. We have done 45 cases in the last 7 years and have got favourable results with this technique.<strong></strong></p><p class="abstract"><strong>Results:</strong> We have not had a single case of total flap necrosis of a supramalleolar flap in our experience over the last 7 years. We routinely perform this flap when the reverse sural flap territory is not available.</p><p class="abstract"><strong>Conclusions:</strong> The lateral supramalleolar flap is a useful flap for coverage of lower third leg, ankle and dorsal foot defects. If raised as described, the reliability of this flap is increased.</p><p> </p>

Delay in treatment of head and neck cancer leads to stage migration and increased morbidity. Due to the COVID-19, surgical care has been severely affected. We continued our oncology services during the pandemic. We present here the pattern of presentation of head and neck cancer patients to the hospital and strategy to continue services. A retrospective audit of patients registered under Head and Neck Disease Management Group during lockdown, 23rd March to 31st May 2020, was done. Four categories were made new registrations, post-surgical patients, emergency department visits and follow-up presentation. Of the 693 patients assessed, a majority were with oral cavity cancer (80%). Seventy-eight percent of patients presented with stage IV disease. There were 382 new registrations, of which 68% were symptomatic. Of the 69 patients that underwent surgery, 17 patients were on adjuvant treatment. A total of 60 patients presented to emergency department during this period, maximum with complaints of dyspnoea (67%). One hundred eighty-nine patients were follow-up patients of which 43% were symptomatic. Among these, 12 patients were diagnosed with recurrence. Various administrative and clinical policies were formulated to continue cancer care during this time. Surgical services need not be halted during the COVID-19 pandemic. Following scientific rationale and treatment strategies, safe oncosurgical care can be delivered during pandemic.

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