No abstract

Klippel-Trenaunay syndrome is a well-known conglomeration of capillary malformations, bony or soft tissue hypertrophy, and abnormal deep or superficial veins. Although it generally presents with grossly enlarged limbs, it can present with more serious features like haematuria, haematochezia, and seizures. This retrospective study included patients admitted with the diagnosis of Klippel-Trenaunay syndrome in this institute from 2001-2010. The patients' demographic data, clinical features, associated findings, and treatments given were tabulated. A total of 19 patients were included in the study. Two patients presented with haematocezia and had to undergo bowel resection. Five presented with bleeding and ulceration. Debulking surgery was done in three of them. Patients also presented with abdominal distension, jaundice, seizures, and haematuria. Although the common presentation of varicose veins was treated with sclerotherapy, the treatment was tailored to each patient. Klippel-Trenaunay syndrome is a multifaceted disorder which can manifest in a number of different ways. These features may be missed by an unwary plastic surgeon treating them only for the limb hypertrophy.

Background Grafting condition is one of the important determinants of skin-graft take. The technique of VacuumClosure has been claimed to improve the same and thereby graft take. However, there are few comparative studies against the conventional dressing technique evaluating its effectiveness in skin grafting. The present study was undertaken to compare Vacuum-closure with conventional dressing over freshly laid split-skin grafts. Methods Consecutive patients undergoing split-skin grafting were randomized into cases and controls. The grafts in controls were covered by a conventional dressing consisting of vaseline gauze and cotton pads. Those in cases were covered by a vacuum-closure assembly and connected to a wall-suction of 80 mm Hg continuously for four days. The percentage of graft take was assessed at nine days and at two weeks and duration of the dressing were compared between the two groups. The difference in cost of the dressing was noted down. Results Sixty four patients underwent split skin grafting of 71 wounds. Forty three of them were males and twenty nine were females. The grafted wounds included fresh surgically created wounds, traumatic wounds, acute and chronic burn wounds, post-inflammatory wounds and diabetic wounds. Thirty five of the grafts were cases and 36 were controls. Final graft take at two weeks in the study group ranged from 70-100 per cent with an average of 95.29 per cent graft take (SD: 5.9) while the control group showed a graft take ranging between 0-100 percent with an average graft take of 85.89 percent (SD: 25.1) Duration of dressing of the grafts was 11.63 days in cases as against 15.11 days in controls. The differences were statistically significant. The additional cost of the vacuum-closure assembly for an average sized ulcer was 6.27 pounds. Conclusion Negative pressure dressing increases the amount of graft take and should be used particularly when the wound bed and grafting conditions seem less-than-ideal for a complete graft take. Negative-pressure dressing can be economically and effectively assembled using locally available materials. Level of Evidence: Level I, therapeutic study.

Background: Clonidine has been used as an adjuvant in Brachial plexus block (BPB) to enhance its quality and duration. However, whether, clonidine in BPB acts perineurally or via systemic absorption is not entirely clear. Methods: Ninety-three patients of either sex, ASA I and II, aged 18-70 years, undergoing lower end humerus fracture fixation were included in the study. Patients were randomized into 3 groups. All the patients received brachial plexus block using nerve stimulator with 28 ml 0.5% Bupivacaine and 2 ml of NS/NS with clonidine. In the first group (Bc) 2 mcg/kg of clonidine was added to the anaesthesia solution and 10 ml of NS was injected intravenously; second group (Bivc) received clonidine 2 mcg/kg diluted up to 10 ml by intravenous route with 28 ml of 0.5% Bupivacaine and 2 ml of NS in the block; third group (B) received 28 ml of 0.5% Bupivacaine with 2 ml of NS in the block and 10 ml of NS intravenously, as placebo. Onset and duration of sensorimotor block, hemodynamic variables, duration of analgesia, level of sedation and adverse effects were noted. Results: Onset of sensory blockade was faster in group Bc (7 ± 0.720 min) compared to group B (11.46 ± 1.138 min) and Bivc (11.46 ± 1.170 min) (p < 0.001). Onset of motor block was faster in group Bc (16.43 ± 1.136 min) compared to group B (22.75 ± 1.456 min) and Bivc (22.25 ± 1.295 min) (p < 0.001). The mean durations of analgesia were recorded as 1160.71 ± 53.259 min in group Bc, 454.64 ± 14.07 min in Group Bivc and 442.50 ± 18.634 min in group B. Conclusion: Addition of clonidine 2mcg/kg to 28 ml of 0.5% bupivacaine in brachial plexus blocks results in a faster onset, increased duration of block and longer postoperative pain relief when compared to bupivacaine alone. These advantages are not observed when the same dose of clonidine is injected intravenously.

Penile amputation is rare and hence the paucity of experience and publication. We present our case of self-inflicted penile amputation, which was successfully managed with microsurgical replantation, with relevant literature review.