Composite defects of the leg often involve microsurgical reconstruction. Microsurgery is technically demanding in post-trauma situations in very young children. There is renewed interest in cross leg flaps in this scenario. Children aged up to 5 years, who had open fractures or exposed bones in the leg, were followed up prospectively. Eight children, with a mean age of 4 years, underwent nine flaps for extensive tissue defects over the leg and foot. Six of these flaps were cross leg flaps. No flap failed and all wounds acquired early stable cover. The cross leg flap is a useful alternative in the pediatric population in lieu of microsurgical tissue transfer.
Self-inflicted injury of the nose is extremely rare. It may be associated with severe psychopathology and suicidal ideation. The authors report a case of a 24-year-old man, who presented with soft-tissue loss over both the alae of his nose. He had cut off the alar rims with an ordinary razor blade. He was overtly concerned about his nose being excessively broad and fat. A diagnosis of body dysmorphic disorder with nonsuicidal self-injury was made. Patient was observed during 72 hours in hospital with psychiatric support and local dressings. The authors undertook primary nasal reconstruction with nasolabial flaps on both sides for coverage. In conclusion, self-inflicted nasal injury mandates a judicious balancing of psychiatric support and surgical reconstruction. This can prevent untoward sequelae including further self-harm and suicide.
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