Gastrointestinal perforations remain the most common cause of surgical pneumoperitoneum since time immemorial. The aim of this study was to find out the effectiveness of plain radiography in diagnosing hollow viscous perforation. A prospective analysis of a total of 1,723 patients of perforation peritonitis between January 2009 and June 2011, confirmed by exploratory laparotomy, was worked out in the study. All these patients had undergone either an upright chest or erect abdominal or both radiographs before undergoing operative procedure. Pneumoperitoneum was evaluated, and the findings were compared with that of exploratory laparotomy. Out of the 1,723 patients of documented perforation on intraoperative finding, 1,537 patients showed pneumoperitoneum on preoperative plain radiography. The overall positivity rate of plain radiography in detecting pneumoperitoneum was 89.20%. The positivity rate was highest for stomach and duodenal perforation (94.19%) and the least for appendicular perforation (7.69%) with highly significant difference (p value, <0.001). In developing world, where there is limited availability of resources and overburden of patients, imposing a limitation in adapting advanced radiological technique as a first line of investigation, plain radiography may be considered as a valuable screening tool in detecting pneumoperitoneum with high positivity rate.

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. The treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. The aim of this work is to assess the role of Z-plasty in promoting primary healing in pilonidal disease and to evaluate morbidity and recurrence. This study included 40 patients (36 males and 4 females) who underwent excision of sinus and Z-plasty closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 6 to 12 months. There were 36 males and 4 females with a median age of 25 years. The mean hospital stay was 2 days. The mean time to return to work after discharge from the hospital was 14 days. There were no recurrences, and all patients were satisfied with the cosmesis. Two patients (5 %) had numbness over the flap. Necrosis of flaps did not occur in any patient. Only three patients were noticed to have wound infection (7.5 %). Five patients (12.5 %) developed wound seroma. Although requiring some technical expertise, excision of sinus and Z-plasty offer superior results with respect to recurrence in the hospital stay and cosmesis of patients with pilonidal sinus.

Basal cell carcinoma (BCC) is the most common skin cancer worldwide. The WHO has defined it as “a locally invasive, slowly spreading tumor which rarely metastasizes, arising in the epidermis or hair follicles and in which the peripheral cells usually simulate the basal cells of the epidermis.” Here we discuss the management of BCCs of central face with surgical excision and reconstruction with forehead flap as single modality treatment. Material and Methods. This is a retrospective review of 50 patients who underwent surgical excision of BCC involving the facial region followed by primary reconstruction using forehead flaps at a single institution. There were 20 males and 30 females, mean age of 59 years. Results. No recurrence at primary site was observed during the follow-up of 1–4 yrs. There was no ectropion or exposure sequela. However, epiphora was evident. Size of lesions ranged from 2 to 6 cm. Keloid formation was seen in 2 (4%) patients. Functional and cosmetic outcomes were satisfactory. Conclusion. For the face, the best reconstructive effort eventually fails in the face of tumor recurrence. The forehead flap represents one of the best methods for repair of extensive facial defects. Complete tumor extirpation, the primary event, is the key.

BACKGROUNDLarge soft tissue leg defect involving upper and middle third remains a therapeutic challenge. The objective of this study was to evaluate the effectiveness and versatility gastrocnemius myocutaneous flap cover for post traumatic large defect of upper and middle third of leg.METHODSThis prospective study was conducted from January 2015 to January 2017 on 25 consecutive cases of post-traumatic upper and middle third leg defect who were treated with gastrocnemius myocutaneous flap and the functional and aesthetic outcome were evaluated.RESULTSThere was no case of complete flap failure. Partial skin necrosis occurred in 2 patients (8%). There was no postoperative hematoma while mild discharge was seen in only 4(16%) patients. With regard to the donor site morbidity, no functional deformity was seen in follow up period. The procedure was found to be reliable, technically easy and aesthetically acceptable.CONCLUSIONPost-traumatic large defects of leg extending in upper and middle third were easily covered with the help of regional gastrocnemius myocutaneous flap with excellent outcome and aesthetically acceptable coverage of skin without any major complications or long term morbidity.