Background:Congenital pseudarthrosis is one of the greatest challenges of paediatric orthopaedic practice. Treatment options and literature addressing this condition are numerous, reflecting the difficulty in management. We aimed to study the effectiveness of free fibula transfer as a primary modality of treatment in children with this condition in terms of achieving length, union, and normal axis of the involved leg.Materials and Methods:During the period of 2001 to 2010, 26 children with congenital pseudarthrosis of tibia between age group of 2-8 years were evaluated and were reconstructed using contra-lateral free fibula graft, and then patients were followed up for 5 years subsequently. Patients were examined and time of bony union, weight bearing ability and walking without support were noted. Any complication directly or indirectly related to surgery with any complication seen in the due course of follow up of 5 years was also taken care of.Results:In our experience with treatment of congenital pseudarthrosis over a span of 10 years with free fibula transfer, the results have been gratifying with no flap loss. All our patients had UNEVENTFUL post-op recovery. Only 2 patients out of 26 had non-union, for which cancellous bone grafting was done (7.6%). Most of the patients were ambulatory with support by 3-6 months and continued to walk without support after a span of 18-24 months. The incidence of stress fracture in our study over the follow-up period was 4 out of 26 pts (15.3%). None of them had any deformity in the donor leg.Conclusion:When compared to other surgical modalities of treatment of the problem in question, vascularised free fibula transfer has emerged as a real saviour with good patient compliance and less complication rate in our study. It achieves the desired target with no residual deformities and near normal to normal gait with no stigma of bone removal from other leg.

Background:The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA) and hemifacial microsomia (HFM) can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency.Materials and Methods:Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring.Results:All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up.Conclusion:Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.

Introduction:Successful free tissue transfer depends on a multitude of factors, and adequate drainage of venous blood is one of the most critical part of successful free tissue transfers.Material and Methods:We report 6 cases of microvascular free flaps used for covering various defects, which developed venous congestion, that were salvaged with heparinised saline irrigation through the distal end of the congested vein by the help of an intravenous cannula. The irrigation was continued for 5 days.Results:All the flaps were successfully salvaged.Conclusion:This method has potential applications in situations for successful salvage of free tissue transfer particularly due to venous thrombosis.

Background/Purpose:Anal incontinence is one of the most psychologically and socially debilitating conditions in an otherwise healthy individual. It can lead to social isolation, loss of self-esteem, self-confidence and depression. This study is devoted to the problem of anal incontinence in the adult patients. The aim of our study is to analyse the results of gracilis muscle transposition for anal incontinence and improvement in quality of life (QOL) of patients.Materials and Methods:This was a retrospective study. A total of 18 patients with complaint of anal incontinence were enrolled in this study. All patients were treated with gracilis muscle transposition.Results:All patients are continent, and there is an improvement in their QOL.Conclusion:Gracilis muscle transposition is a good option for patients of anal incontinence who are not treated by non-surgical means.

Any mass arising from the breast region need not to be breast carcinoma! A rapidly growing mass from the chest wall need not to be highly malignant! The present case report defines the thin line between the two extremes and high lightens the importance of a good clinical examination followed by a judicial management. The lady in question had a huge Giant cell tumor in the Anterior arc of ribs which is quite rare, making it the second largest tumor been reported so far and the largest in Asia. The patient was referred to us by the Department of Thoracic Surgery in view of the aggressive nature of the lesion and the requirement of a major reconstructive surgery for the chest wall. The reconstructive procedure chosen was time tested and not new yet not so popular in the present time. It could cover such a huge chest wall defect with minimum morbidity and good results.Keywords Breast . Giant cell tumor . Anterior ribs Twenty-three year old lady presented with left chest wall mass from past 1 year, rapidly enlarging since 5 months. She had complains of heaviness in chest associated with pain radiating to left shoulder and arm with no features suggestive of systemic disease. On local examination, solitary chest wall mass was present on left side 14×12 cm extending 1 cm from clavicle inferiorly in vertical direction and from left border of sternum in horizontal direction displacing the breast tissue inferolaterally. There was no visible pulsations and no impulse on cough. On palpation, it was non tender, uniformly hard in consistency with mild local rise in temperature. The overlying skin was pinchable and dilated veins were present over the mass. The mass was fixed with the chest wall. On pectoral contraction, the mass appeared less prominent. On systemic examination, breath sounds were decreased on left side with cardia displaced to right (Fig. 1).Diagnosis was made of Chondrosarcoma, Malignant Fibrous Histiocytoma and Pulmonary tumor with Rib metastasis. CT thorax showed 10×8×8.5 cm large mass lesion from chest wall which showed heterogenous enhancement extending into the intrathoracic region with erosion of left second rib. The lesion was compressing the mediastinum with clear fat planes. No significant hilar or mediastinal lymphandenopathy was seen (Fig. 1). FNAC of the mass was suggestive of chondrosarcoma. After investigations, patient was planned for wide local excision with concurrent reconstruction of the chest wall.Under anaesthesia, left inframammary incision was given which was deepened to sub pectoral space. The whole breast tissue was reflected up with the pectorals to inspect the tumor. It was seen invading the chest wall, so approach was made in infero-lateral direction. Ribs were cut to explore its extent and its involvement with mediastinal structures. There was a clear plane which was further accentuated between the mass and lung. More than 2/3rd of the left pleural cavity was found to be occupied by the tumor. Cardia was pushed to right and left lung was found to be collapsed but uninvolve...