Introduction:High-grade gynaecomastia (Simon IIb and III) has tissue excess (skin excess, enlarged areola, and displaced nipple), which is best managed surgically; however, results of conventional breast reduction surgeries and liposuction is not very good. Aim of our study was to describe a combined technique to manage these problems to produce a good result.Material and Method:This was a 2-year study among 12 patients of high grade gynaecomastia. Clinical and laboratory findings were normal. Pre-operatively in standing position, diameter of breast and areola, position of nipple, and amount of skin excess were marked. Under general anaesthesia, tumescent infiltration, circumareolar de-epithelisation of skin excess, and liposuction was completed. Redundant portion of the breast was sharply dissected and pulled out. Areola was fixed over pectoralis fascia at mid humerus level, just medial to the mid-clavicular line. Outer borders of the de-epithelised area were apposed by the purse-string effect of a subdermal suture, and further apposed by few half buried horizontal mattress sutures. Drains for 24 hour and compressive dressings for 6 weeks were used.Result:Mean age of presentation was 25.8 year; emotional discomfort was the chief complaint. Among 12 patients, 10 patients had bilateral gynaecomastia and 8 patients had enlarged and displaced nipple-areola complex. Average hospital stay was 2.41 days and recoveries were usually uneventful.Conclusion:The problem of tissue excess and tissue displacement in high grade gynaecomastia can be well managed by this combined circumareolar skin reduction and liposuction technique to achieve a scar-less flat male chest.

A 27-year-old female presented with complaints of pain in the left hypochondrium for the past six months. Pain was dull aching, continuous, without aggravating or relieving factors. No diurnal variations or associated fever reported. The patient belonged to a non-farming family, however, having a pet dog at home. Abdominal examination revealed mild splenomegaly. Laboratory tests, CBC, LFT & biochemistry were all within normal limits. Plain X-ray abdomen was unremarkable [Table/ Fig-1].An abdominal ultrasonography was carried out which showed two cystic lesions with multiple septations at the superior pole of the spleen. Contrast enhanced CT scan abdomen confirmed the USG findings [Table/ Fig-2], demonstrating splenomegaly with non enhancing cystic lesions having internal septations and suspicious daughter cysts within it, strongly suggestive of hydatid cysts.

Background: A post-burn flexion contracture of the knee joint is a disabling condition which interferes with an upright posture and a bipedal locomotion. Islanded perforator flaps have been used to resurface the tissue defect which is produced as a result of the contracture release. Despite their various advantages, they are limited by an increased tendency to undergo venous congestion. Perforator-plus flaps can be used to overcome this limitation, while retaining the merits of the islanded perforator flaps.Methods: Ninteen patients with post flame burn flexion contractures of the knee joints underwent surgical releases and coverages by various local fasciocutaneous perforator-plus flaps. The patients were followed up for 6 months and the various aspects of the functional and the aesthetic rehabilitations were assessed.Results: All the local fasciocutaneous perforator-plus flaps resurfaced the tissue defect over popliteal fossa with good colour and texture match and maintenance of the contour. None of the flaps had any significant early or delayed complications (which included venous congestions) which necessitated reoperations. All the patients were satisfied with the functional and aesthetic outcomes. Conclusion:Local fasciocutaneous perforator-plus flaps can be considered as one of the primary treatment modalities for the surgical release and reconstruction of post burn flexion contractures of the knee.

Abstract:A 45 year old female developed painless, enlarging induration at the site of an incisional scar. Although an incision biopsy was unrevealing, CT scan showed a large parietal mass infiltrating the omentum and right ureter with evidence of obstructive uropathy. With a diagnosis of abdominal desmoid tumor, surgery was undertaken. The involved structures, including the right rectus abdominis muscle, uterus and right adnexa, which were also involved, were removed. Histopathology report of the resected specimen revealed epithelioid granulomas with caseous necrosis with the final diagnosis of tuberculosis. The patient was subsequently started on antitubercular drugs and is doing well. Involvement of the anterior abdominal wall by tuberculosis, especially in immunocompetent individuals, is rare. This experience goes to demonstrate the seemingly endless forms and presentations of this ancient disease. Failure to have tuberculosis in the list of differential diagnosis is to set oneself up for disaster.