Introduction:The thoracodorsal artery perforator (TDAP) flap has emerged as one of the ideal perforator flaps. We, hereby, describe its versatility in indications (free/pedicled), methods of harvest (patient position and paddle orientation) and perforator consistency.Materials and Methods:We have performed a total of six TDAP flaps-five free and one pedicled, over a period of 1-year from March 2014 to February 2015 at a single centre. Our indications have been: Reconstruction of oral cavity, breast and upper and lower extremities.Results:We had neither any failures nor any re-explorations. The average perforator length is about 6 cm and the pedicle length can be extended to 12-14 cm by including the thoracodorsal artery. There is inconsistency in perforator position; however, the presence of a perforator is certain. It can be harvested in lateral, prone or supine position, thus, does not require any position change allowing a two-team approach to reconstruction. The paddle can be oriented vertically or horizontally, both healing with scars in inconspicuous locations. Apart from providing a good colour match for extremities, this flap can be thinned primarily.Conclusion:The versatility of TDAP has several advantages that make it a workhorse flap for most reconstructions requiring soft tissue cover. Further, the ease of harvest makes it a good perforator flap for beginners. Its use in chimerism with the underlying latissimus dorsi muscle provides reconstruction for coverage and volume replacement.

Introduction:Replication of the exact three-dimensional (3D) structure of the maxilla and mandible is now a priority whilst attempting reconstruction of these bones to attain a complete functional and aesthetic rehabilitation. We hereby present the process of rapid prototyping using stereolithography to produce templates for modelling bone grafts and implants for maxilla/mandible reconstructions, its applications in tumour/trauma, and outcomes for primary and secondary reconstruction.Materials and Methods:Stereolithographic template-assisted reconstruction was used on 11 patients for the reconstruction of the mandible/maxilla primarily following tumour excision and secondarily for the realignment of post-traumatic malunited fractures or deformity corrections. Data obtained from the computed tomography (CT) scans with 1-mm resolution were converted into a computer-aided design (CAD) using the CT Digital Imaging and Communications in Medicine (DICOM) data. Once a CAD model was constructed, it was converted into a stereolithographic format and then processed by the rapid prototyping technology to produce the physical anatomical model using a resin. This resin model replicates the native mandible, which can be thus used off table as a guide for modelling the bone grafts.Discussion:This conversion of two-dimensional (2D) data from CT scan into 3D models is a very precise guide to shaping the bone grafts. Further, this CAD can reconstruct the defective half of the mandible using the mirror image principle, and the normal anatomical model can be created to aid secondary reconstructions.Conclusion:This novel approach allows a precise translation of the treatment plan directly to the surgical field. It is also an important teaching tool for implant moulding and fixation, and helps in patient counselling.

Introduction:Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union.Materials and Methods:This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels.Results:There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements.Discussion:MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions.Conclusion:Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.

A variety of non-neoplastic and neoplastic conditions involve the nasal cavity, paranasal sinus and are fairly common presentation encountered in clinical practice. Sinonasal lesions are a common finding in all age groups. The lesion of nose and paranasal sinuses are very deceptive so, the presenting features, clinical examination, nasal endoscopy, radiodiagnosis and histopathology are employed conjointly to reach a diagnosis. This cross sectional study was conducted between November 2014 and September 2016. 150 patients with nasal or paranasal sinus lesions attending ENT OPD were included. Among 150 patients there was a male predominance in all lesion except malignant lesions and most of the patients 72 (48%) were in the age group 11- 30 years. Mean age of presentation for benign lesions was 33.64 years and of malignant lesions was 49.14 years. The study showed that 96 (64%) of the nose and PNS lesions were of inflammatory nature followed by 22 (15%) benign, 18 (12%) granulomatous and 14 (9%) malignant, Inflammatory polyp being the most common diagnosis. Haemangioma was the most common benign neoplastic lesion whereas in granulomatous lesions most common diagnosis was tuberculosis. The maximum lesions 74 (49%) were in maxillary antrum. The most common clinical presentation was nasal obstruction, with unilateral nasal obstruction seen in 84 (56%) cases and bilateral nasal obstruction in 50 (33.3%) cases. Angiofibroma 6 (4%) was exclusively seen in adolescent males. Olfactory neuroblastoma 4 (2.6%) was diagnosed in females with mean age of presentation of 30 years. Sinonasal lesions display a complex and interesting spectrum of clinical, radiological and histopathologic features. The non-neoplastic lesions are numerous, the morphologic variants of neoplasms are many and most of them present as polypoid masses which are impossible to distinguish clinically. Hence a proper workup including histopathological and radiological categorization is essential in the management of these lesions.