Background:Injury following proximal interphalangeal joint fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement.Materials and Methods:Hemihamate arthroplasty procedure was used in the reconstruction in five cases with comminuted, impacted fractures of the proximal end of middle phalanx of the finger. Three patients were presented within 2 weeks; one patient came by one month and the other by three months following the injury. All patients presented with posterior subluxation of PIP joint.Results:Functional outcome following this procedure in both acute and chronic cases resulted in adequate restoration of joint stability and function.Conclusions:Hemihamate arthroplasty is an adjuvant in the treatment of unstable intra-articular pilon fracture involving PIP joint.

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications.

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Aim:Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries.Methods:The study was conducted in the Department of Plastic Surgery, during the period October 2012–December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group.Results:Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity.Conclusion:Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities.

Aim: Inguinal block dissections for metastasis to inguinal lymph nodes and occasionally trauma are always associated with soft tissue loss over the groin region. A clinical study was undertaken to demonstrate the ability to utilize a superiorly-based perforator fl ap with reliable vascularity and less donor site morbidity to cover defects in the inguinal region. Methods: A prospective study was performed on 7 patients with inguinal soft tissue defects managed in our institution from January 2013 to September 2013. During the study period, a "superiorly-based perforator plus fl ap" was used for soft tissue coverage over the femoral vessels in the inguinal region. Hyperbaric oxygen therapy was administered postoperatively. The postoperative period, hospital course, and follow-up after radiotherapy was documented in patients with inguinal block dissection. Results: Seven patients presented with soft tissue defects in the inguinal region. Five of the defects were secondary to prior surgery, and 2 were secondary to trauma. A superiorly-based perforator plus fl ap was performed in all patients. The defect sizes ranged from 9 cm × 4 cm to 17 cm × 8 cm. The fl ap dimensions ranged from 12 cm × 5 cm to 20 cm × 10 cm. No secondary procedures were necessary following surgery. Postoperatively, there was no evidence of partial or total fl ap loss. No fl ap revisions were required, and no complications were experienced at either the donor or recipient site following radiotherapy. Patients were followed-up for 10-18 months. Conclusion: Inguinal defects require stable soft tissue coverage to withstand radiotherapy following inguinal block dissection surgery, and are susceptible to wound complications. The superiorly-based perforator plus fl ap technique is simple, requires little operative time, and is a reliable fl ap for coverage of the femoral vessels and inguinal region with improved tolerance to postoperative radiotherapy.

Dupuytren's disease of the hand has only been rarely reported in children and is rarer still in infants. Only a few histologically confirmed diagnoses are found in literature. We report a case in a 4-month-old infant with Dupuytren's disease of palm and thumb who required surgery at 6 months of age. Histology confirmed the diagnosis of Dupuytren's disease. The purpose of this report is to show the importance of differential diagnosis of nodules and fibrotic bands in children's hands as paediatric patients may be seen by a variety of treating physicians, not only plastic surgeons or pathologists.

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