ABSRTACT: Covering of large wounds after mastectomy in locally advanced Ca breast with skin that can withstand radiotherapy is a challenge to the surgeon. Here this study we used a local advancement flap from the adjacent area called Thoraco-Abdominal Flap (TA flap) for such giant defects. This is based on superficial and lumbar arteries and is thick to with stand consequent RT. MATERIALS AND METHODS: Of the total 107 cases of LABC 32 had post mastectomy defects of larger than 12 cm and could not be closed by simple approximation. Among the 32 cases 17 cases are covered by split thickness skin grafting. 15 cases are covered by TA flap. These cases are assessed for mean operating time, mean blood loss, post-operative stay, flap necrosis and viability of the flap after radiotherapy. RESULTS: There is minimal extra time or blood loss in these cases. All the flaps healed well except for small edge necrosis in 4 cases. In all the patients we could start radiotherapy in the fourth week of surgery and all the flaps withstood RT well. After further evaluation probably this can be recommended as procedure for giant post mastectomy defects particularly for those who require RT early.

Surgical feeding gastrostomy (FG) is still done for inoperable carcinoma esophagus, corrosive poisoning for enteral feeding. Conventionally a Malecot's catheter or G-tube are used for FG. The Malecot" tube frequently gets frequently blocked. Commercial G-tubes are expensive and not easily available. As an alternative we used cuffed endotracheal tube which is self-retaining and has got a wide diameter throughout and an opening near the tip both of which make it unlikely to get blocked. MATERIALS AND METHODS: A total of 42 cases of ca esophagus/ corrosive injury needed FG in two years period. Of which in 23 cases we used endotracheal tube. All the patients are evaluated for quantity and quality of feed that can be given, peristomal pain, peritubal leakage and infection, slipping of tube, and tube blockage. RESULTS: In all patients in whom ET tube was used quality and quantity of feeds were more, no slipping of tube and no blockage. In three cases there was minimal leakage which reduced in three days. Peritubal pain due stiffness of tube could be overcome by immersing in boiled saline. Overall patient satisfaction is good which made us to recommend as an economical alternative to costly commercial G-tube.