Introduction:Vascularized composite tissue allotransplantation is a relatively new concept, which was unavailable in the Indian subcontinent till a bilateral hand transplant was carried out successfully in January 2015.Materials and Methods:The setting up of the transplant programme involved obtaining legal clearances, creating public awareness, harnessing the institutional facilities, drawing up protocols, assembling the surgical team, managing immunological issues, rehabilitation and preparing the ancillary services.Results:Both, the first and second bilateral hand transplants were resounding successes with both the recipients getting back to their original daily routines.Conclusions:The organisation of the hand transplant programme was a large task, which necessitated intensive planning, and cooperation from various teams within and outside the institution. Exemplary team-work was the key to the phenomenal success of these path breaking endeavors in the subcontinent.

Introduction:This article deals with two patients who underwent bilateral hand transplantation following amputation of both upper limbs at the distal third of the foream.Materials and Methods:The first patient had a history of loss of hands in a train accident , with possiblity of a run over element during the injury. The second patient lost his both hands in a mine blast. The preoperative work up included detailed clinical and psychological evaluation. The donor retrieval was similar in both the cases and the donors were housed in our own instittution. The donor preparation, recipient preparation and the transplant procedure was similar except for the need of primary tendon transfers in the left hand of the first patient.Results:The first patient needed a free flap transfer to cover compromised skin flap on the left hand on the second day. The second hand transplant was uneventful. Both the recipients are now back to their normal daily routines.Conclusions:Hand transplantation is a potentially life altering procedure, but to optimise the results, it is imperative that there is a meticulous planning and diligent execution with utmost importance to the detail coupled with a synchronised team effort.

Cervical ribs, also known as Eve's ribs, are rare and found in 1% of population. They are more common in females and more common on right side. They are asymptomatic in 90% of cases. Cervical rib fused with transverse process of sixth vertebra is rarer. We present a case of dry gangrene of lateral three fingers with right radial and subclavian artery thrombosis with rest pain, due to right cervical rib fused with transverse process of sixth vertebra. After development of line of demarcation of the dry gangrene, patient was operated for excision of cervical rib and sixth cervical vertebral transverse process followed by Ray's amputation of right second finger. Postoperative course was uneventful. Patient was discharged with oral anticoagulation and a healthy wound in right hand.

Objective: To compare the efficiency and effectiveness of Active laceback ligatures with that of Mulligan bypass arch for the amount of retraction, tipping and rotation. Materials and Methods: 20 patients were selected for the study who required upper 1 st premolar extraction for decrowding. All patients were treated with 3M Gemini-MBT 0.022" metal brackets. Patients were divided into 2 groups of 10 patientsin each group. Group 1 was treated with active laceback ligature and group 2 with Mulligan bypass arch. Changes were measured on the cast with a digital vernier caliper. Student 't'test was used to determine the mean differences between the two groups for the amount of retraction, tipping and rotation. Results: Significant distal movement of Canine occurred in both the groups. Movement of canine was more in group 2 but distal tipping of canine and distopalatal rotation of the molar was more in group 1. These differences were mainly attributed to the arch wire material and type of force. Conclusion: Mulligan bypass arch group provided a more controlled and faster tooth movement when compared to active laceback ligature.

Background: Despite recent technical advances, reconstruction of lower third of leg wounds with soft tissue defects remains a challenge to the Plastic Surgeon. This is due to the inherent anatomical and structural configuration, including the limited vascularity of the skin of the lower third of the leg. Maintaining maximal function without compromising the aesthetic appearance of the leg is the goal of reconstruction.Methods: This was a retrospective study conducted in the Department of Plastic Surgery, KIMS Hospital, Bangalore, from January 2016 to January 2018. Patients with soft tissue defects involving lower third of leg requiring flap cover were included in the study. Orthopedic intervention was done as required. All patients underwent loco-regional or free flap cover as clinically indicated. Outcomes were studied.Results: Total of 20 patients were included in the study. Most common presentation was due to road traffic accidents (RTA). Right leg was involved in 12 cases and left in 8 cases. Fracture was present in 7 cases, exposed bone without fracture in 11 cases, exposed tendons alone in 1 case and exposed implants in 1 case. 3 Patients required orthopaedic intervention along with the flap procedure, and 4 had already undergone orthopaedic stabilisation. Most commonly performed procedure was muscle flap (45%), followed by perforator-based fascio-cutaneous flap (25%). No major complications were observed in the post-operative period.Conclusions: Lower third of leg reconstruction is a challenge, but a wide variety of options ranging from loco-regional to free flaps can be employed, depending on the situation. In present study, various types of flap cover were adopted to cover the lower-third of leg defects, depending on the nature of the wound. Present study delineated that muscle flaps - particularly the reverse hemi-soleus flap, are an ideal flap for lower third of leg defects with fracture site exposed and wound infected. Local muscle flaps have the advantage of being single-staged, faster to perform and technically easier, compared to free flaps, which have long been considered the gold standard.