Chronic wounds continue to be a major challenge for the medical profession, and plastic surgeons are frequently called in to help in the management of such wounds. Apart from the obvious morbidity to the patient, these problem wounds can be a major drain on the already scarce hospital resources. Sometimes, these chronic wounds can be more taxing than the underlying disease itself. Although many newer methods are available to handle such situations, the role of stem cells in the management of such wounds is an exciting area that needs to be explored further. A review of literature has been done regarding the role of stem cells in the management of chronic wounds. The abnormal pathology in such wounds is discussed and the possible role of stem cells for optimal healing in such cases would be detailed.

Introduction: An unsightly scar following cleft repair can undo the good work of even an experienced surgeon. A functioning orbicularis oris muscle beneath the lip scar maintains a zone of dynamic tension resulting in a stretched scar. Botulinum toxin type A (BTA) can be used to create a temporary paralysis of the orbicularis muscle during the healing phase. This may lead to better scar formation after a cleft lip repair. Method: The present prospective randomized control trial enrolled 28 infants with unilateral cleft lip undergoing primary lip repair. They were randomized to receive injection of either BTA (botox group) or normal saline (control group) intraoperatively into adjacent orbicularis oris muscle immediately after completion of cleft lip repair. Blinded experts reassessed the scar after 6 months. Objective assessment was undertaken employing Visual Analogue Scale (VAS), Vancouver Scar Scale (VSS), and photographic scar width measurements. Results: Twenty-two subjects were able to complete a follow-up duration of 6 months. Children in the BTA (Botox Group) had a statistically significantly better VAS score and lesser scar width compared to the control group. However, the difference in the VSS score between both groups was not statistically significant. On comparing patients with cleft lip alone with cleft lip and palate, no statistically significant difference was found in VAS, VSS, and scar width. There were no complications associated with the use of botulinum toxin A. Conclusions: Botulinum toxin type A injection is a safe and effective addition to improve scar appearance following cleft lip repair. There was improvement in appearance of the scar in terms of width, but no improvement was seen in the scar pigmentation. The scar outcome is independent of cleft lip classification.

Angioleiomyoma of the hand is a rare differential diagnosis of painful soft tissue nodule in the extremity. It arises from smooth muscle of the blood vessels and the most common symptom is pain. Imaging with magnetic resonance imaging shows characteristic features like a hypodense peripheral capsule with linear or branching internal hyperdensities on T2-weighted images, and post-contrast diffuse homogenous enhancement with a vessel leading up to the lesion. Histopathological examination shows well circumscribed fascicles of mature smooth muscle cells surrounding vascular lumina, lined by normal appearing endothelium without elastic lamina present. These cells stain positive for smooth muscle actin, desmin, vimentin, type IV collagen and S100, but stain negative for HMB-45 and ER. Angioleiomyoma is amenable for surgical resection. We report a case of painful subcutaneous nodule of hand, with radiological and histopathological findings suggestive of angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for painful nodule of extremity.

The peroneal artery perforator-based flap is reliable and reproducible in an acute post-traumatic setting. It should be considered as a suitable alternative for reconstruction for limited defects with exposed fractured tibia over the middle and lower third of the leg.