HighlightsCutaneous actinomycosis presenting as tumoriform mass is rare.Histopathological confirmation is mandatory with visualization of sulfur granules which is seen only in 25% cases and can be missed in small biopsy specimen.Management of a classical case of cutaneous actinomycosis is high dose IV antibiotics for 4–6 weeks followed by oral penicillin or amoxycillin for 6–12 months.Surgical resection is a useful adjuvant therapy specially in large, disfiguring masses not responding to treatment and excisional biopsy is helpful in establishing histopathological confirmation.

BACKGROUNDPatient with burn scar of face, extremities, exposed part of abdomen in Indian clothing, seek consultation for aesthetic improvement of scar, even though there is no functional impairment. MATERIALS AND METHODS10 patients were studied from January 2007 to June 2016 for post-burn scar with tangential excision and thin split thickness skin grafting. Median time from injury to surgery was 66.2 months and mean follow up of 18 months. RESULTSTangential excision and thin split thickness skin grafting gave a fair aesthetic result with good overall patient satisfaction. The colour match was fairly good with no need for another operation. CONCLUSIONTangential excision and thin split skin grafting are good options for aesthetic reconstruction of burn scars. KEYWORDSPost-Burn Scar, Tangential Excision, Thin Skin Graft. HOW TO CITE THIS ARTICLE:Mehta J, Shahane PL, Zade M, et al. Aesthetic management of post-burn scar.

Background: Extensive soft tissue defects of leg, ankle and foot are challenge to reconstructive surgeons due to lack of local tissue. Microvascular flap coverage has become a standard line of treatment as large amount of tissue transfer is required. Large transverse fasciocutaneous cross leg flap remains an alternative for reconstruction of such extensive defects. We present our experience with this flap in 14 patients.Methods: A total of 14 patients were operated for large transverse fasciocutaneous cross leg flap cover for defects over leg (9), ankle and foot (3) and sole (2). Age group ranged from 4 years to 50 years with 4 patients below 12 years of age. Male to female ratio was 5:2. Flaps were divided at 3weeks and final inset was done.Results: 11 patients had complete flap survival. Two patients had marginal necrosis and one patient had superficial necrosis of proximal flap margin after flap division. One patient with partial skin graft loss at donor area required secondary skin grafting at the time of flap division. Average hospital stay was 34.5 days (range 10 - 50 days). The donor limb had no joint stiffness related to immobilisation and cosmetic outcome of flap and donor area was satisfactory.Conclusions: large transverse fasciocutaneous cross leg flap is safe, technically easy and is associated with minimal donor site morbidity. It offers the possibility of limb salvage in difficult situations.

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Background: Gynecomastia is a benign enlargement of the male breast usually bilateral sometimes unilateral resulting from proliferation of glandular component of the breast. It is defined clinically by presence of rubbery or firm mass extending from nipple. The glandular tissue grows under influence of hormonal stimulation and is tender. Gynecomastia frequently presents social. Psychological, difficulties as low esteem and shame to sufferer. During adolescence many young males have gynecomastia and they are eager to do surgery of gynecomastia. Aims and objectives of the study was to correct deformity restoring normal contour to the chest, maintaining viability of nipple and areola. Also avoiding excess scarring and preventing saucer type deformity. To relieve emotional discomfort, psychological distress, and intolerable pain, to relieve shame in going to society, social gathering even doing marriage. To study effect of adding liposuction to surgical excision. Methods: This is two-year study of 20 cases of gynecomastia. Clinical and Laboratory findings were normal. preoperatively patients are selected by their complaints, discomfort, psychological effects, shame, depression, anxiety and size of gynecomastia. In surgery, we have done is liposuction thoroughly after infiltration with adequate amount of ringer solution and Inj adrenaline 1:100000 concentration. In gynecomastia with group 1 and 2 we used websters incision, in group 2b we used extended websters incision if required. In very large gynecomastia with skin excess we have done breast reduction with liposuction and free nipple grafting in one case and medial pedicle based, superiorly based flap in two cases, two cases with circumareolar skin excision and liposuction in group 2 b case. In rest 16 cases we have done liposuction, excision through websters incision. Results: In our study of 20 cases done in two years, in our department of plastic surgery at NKPSIMS, one was unilateral and rest 19 were bilateral gynecomastia cases. In all cases liposuction as treatment modality used and has given satisfactory outcome in 18 (90%) cases out of 20, 3 (10%) cases want more liposuction and if possible re excision. Average hospital stay was 2 days. Post-operative recovery was good in majority cases but in 2 ((10%) cases post op numbness and ischemia at margin of areola occurred treated conservatively. In one case (5%). dehiscence of wound healed Conservatively. All cases of breast reduction were healed well. All cases benefited psychologically by surgery and their self-image in society improved lot. Conclusions: The problem of excessive fat and fibroglandular tissue is managed by liposuction and excision through websters incision. In high grade gynecomastia of grade 3 we have done breast reduction. This has corrected deformity, restoring normal contour to majority of patients and they improved psychologically, and their self-image improved and so their social life.