The main indications of calling in the plastic surgery team were to overcome these technical hurdles: (1) in cases where the caliber of the vessel was less than 2 mm in size; (2) dissection (separation of mucosa and adventitia) of the recipient vessel wall; (3) donor pedicle being so short that possibility of revision of the anastomosis seemed unlikely, necessitating single, sure-shot anastomosis without a chance of revision. The problems encountered by our microsurgical team were: (1) a special set of instruments was warranted because of the depth of the hepatic artery; (2) anastomosis had to be done in standing, stooped position with unsupported hands; (3) excessive movements due to respiration and profuse fluid collection in the field added to the hurdles encountered. All patients were prospectively followed by color Doppler ultrasound protocol for the first 5 days after surgery. Hepatic artery thrombosis was encountered in one case on postoperative day 10, which was successfully treated by thrombolytic therapy, but unfortunately the patient died of multiorgan failure on posttransplant day 30.

Background:In the context of different grafts being used for dorsal augmentation, diced cartilage with glue has gained worldwide acceptance.Aims:To develop a system of tools to objectively evaluate the desired dimensions of the required graft for dorsal augmentation and to prepare a corresponding customized-glued-diced cartilage construct.Materials and Methods:A modification of the diced cartilage glue technique called Autogenous control augmentation system (ACAS) was used in ten patients.Results:Of the ten patients, in which this technique was used, eight underwent primary rhinoplasties and two underwent secondary rhinoplasties between July 2017 and December 2017 with a follow-up ranging from 3 to 8 months. In all the cases, the dorsum is straight, and height is maintained.Conclusion:The technique has all the advantages of the diced cartilage glue. The shape resembles alloplastic implant with height and width varying from radix to tip. There is tapering of the cephalic and caudal ends for more natural results. The brow tip aesthetic lines are better defined. The limitation of this study is short follow up.

Most fungal infections found in wounds are secondary or superadded, and are generally benign in their clinical course in healthy individuals, with the exception of mucormycosis. This is a life-threatening infection caused by fungi of the order Mucorales. Primary cutaneous disease may occur following traumatic implantation of spores, or use of contaminated bandages, or as a complication of extensive burns, diabetic acidosis and other specific immunocompromised conditions. The clinical spectrum is highly non-specific and is often triggered by seemingly innocuous trauma. The superficial vesicles or patchy erythema rapidly degrade to haemorrhagic necrosis and rapidly progressive gangrenous lesion. The problem with diagnosing mucormycosis remains, therefore, that the condition has poor clinical indicators and requires reliance on microscopy and fungal culture. Management starts with a clinical suspicion, taking into account the risk factors and lack of response to first-line agents, as well as an aggressive clinical course. Treatment is multimodal, with medical correction of the risk factors and optimisation of limiting factors, such as diabetes, neutropenia and immunosuppressants. Treatment generally involves radical and repetitive surgical debridement, intravenous amphotericin B with monitoring of the nephrotoxicity, along with adjuvant modalities, such as hyperbaric oxygen therapy, colony stimulating factor, interferons gamma and white blood cell transfusion. Successful courses of therapy typically last 4–6 weeks and require cumulative doses that are equivalent to >2g of amphotericin B deoxycholate.

Two patients with accidental radiation injury presented at the Sir Ganga Ram Hospital. The first patient, a 41-year-old male, presented with a large necrotic patch on his right gluteal region, which was debrided. Due to the progressive nature of the injury, he developed further necrosis and a non-healing ulcer over the right gluteal region, which was further debrided and covered with a tensor fascia lata flap. Further necrosis over the ischial region was debrided and covered with a pedicled gracilis muscle flap, following which he again required debridement and flap cover for the residual area, which then finally healed. The second patient had a history of radiation exposure followed by a non-healing ulcer on right arm. He was managed by debridement and flap coverage in a single sitting. These two cases suggest that wide excision, thorough debridement and coverage with vascularised tissue are effective in treating radiation ulcers and emphasise that all radiation sources and their management should be strictly controlled.

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