Objective: A very few flaps would be described as versatile as the Keystone Flap. There is an increasing demand for coverage of defects in lower limb due to traumatic defects as well as other parts of the body. Keystone flap is one of its kind, which is simple and easy to perform. It is a safe option for conditions where microsurgery may not be a viable option. The relative simplicity of this flap makes it a to go option at many places. Methods: A prospective study was developed from October 2017 to December 2019 at SMS Hospital, Jaipur. We assessed the size of the flap, operation time, average hospital stay and the complications. Perforators over the leg were Doppler marked preoperatively over which the flap was raised. Results: 50 patients were taken into the study. 30 key stone flaps were done to cover lower limb defects, 10 flaps were done for upper limb defects and the remaining 10 were for trunk defects. The average intraoperative time from skin incision to final suture was 50 min (range 20e90 min). The largest defect covered by keystone flap in our series measured 50 Â 20 cm and the smallest defect covered was 8 Â 4 cm. The average hospital stay was 3 days. We observed partial flap necrosis in 2 cases which required skin grafting. 3 other cases had wound infection leading to wound dehiscence, which required secondary suturing. The overall success rate was 95%. Conclusion:The Keystone flap being a versatile flap with its qualities of replacing "like with like", easy to perform, use of local tissue, good vascularity and a low complication rate makes it an excellent flap for a variety of defects. The KeyStone flap allows reconstruction in a single stage and is a relatively easy and fast technique for the beginner as well as the experienced surgeon. We believe it should be incorporated more into a surgeons practice.
Background The declaration of COVID pandemic by the WHO can certainly be seen as a watershed era the world has witnessed in modern times. All non-essential industries and services have taken a back seat including aesthetic medicine. Over the last decade, India has witnessed a steady growth in medical tourism owing to global standards of care and services at a relatively modest cost. The following study was conducted to ascertain the sea change that this pandemic has brought into aesthetic surgeons' practice, patient management, planning and consultation. This paper throws light on the journey of Indian aesthetic surgery from its infancy to its current presence in the global market as a context of the study. We have also discussed the impact of social media on aesthetic surgeons' practice, lifestyle and its role as an emerging new method of medical education. Methods A questionnaire consisting of 62 questions divided in 3 sections was rolled out to 150 Indian aesthetic surgeons who have been practising either independently in their clinics or are associated with hospitals. A: Pre-COVID practice management and lifestyle; B: life during the lockdown; C: anticipated changes in post-COVID era. Results In the pre-COVID era, an average aesthetic surgeon was finely balancing his profession, personal lifestyle, learning, and recreation. The lockdown clamped their practices which lead into a financial drought; despite which, they were able to maintain their productivity by engaging in webinars, reading, and research. The post-COVID times demand an implementation of safety protocols along with changes in setup , regulating patient traffic, engaging in distant learning through virtual conferences, and maintaining a healthy lifestyle acquired during the lockdown. Conclusions India was rightly witnessing a surge in popularity of aesthetic surgery and medical tourism over the last decade. The corona pandemic has definitely hit this escalating growth curve hard, and it will take some time for the demand to recover. Our study revealed the following conclusions: The effect of COVID 19 demands a major change in aesthetic surgeons' professional practice like limiting consultations, changing hospital floor plan, following COVID testing, and having new safety protocols. Social media is rightly poised to be a major tool for education and marketing as also for recreation and leisure. The role of teleconsultation needs to be reprised and legalised. Webinars and virtual conferences will find more takers in future. Level of evidence: not ratable.
Background Excessive use of corticosteroids therapy along with gross immunocompromised conditions in the novel coronavirus disease 2019 (COVID-19) pandemic has raised the risks of contracting opportunistic fungal infections. Here, we describe our experience with the implementation of a surgical protocol to treat and reconstruct rhino-orbital-cerebral mucormycosis. Methods A retrospective review of our prospectively maintained database was conducted on consecutive patients diagnosed with mucormycosis undergoing immediate reconstruction utilizing our “Mucormycosis Management Protocol.” All patients included in this study underwent reconstruction after recovering from COVID-19. Wide local excision was performed in all cases removing all suspected and edematous tissue. Reconstruction was done primarily after clear margins were achieved on clinical assessment under a cover of injectable liposomal amphotericin B. Results Fourteen patients were included. The average age was 43.6 years and follow-up was 24.3 days. Thirteen patients had been admitted for inpatient care of COVID-19. Steroid therapy was implemented for 2 weeks in 11 patients and for 3 weeks in 3 patients. Eight patients (57.1%) had a maxillectomy and mucosal lining resection with/without skin excision, and six patients (42.8%) underwent maxillectomy and wide tissue excision (maxillectomy and partial zygomatic resection, orbital exenteration, orbital floor resection, nose debridement, or skull base debridement). Anterolateral thigh (ALT) flaps were used to cover defects in all patients. All flaps survived. No major or minor complications occurred. No recurrence of mucormycosis was noted. Conclusion The approach presented in this study indicates that immediate reconstruction is safe and reliable in cases when appropriate tissue resection is accomplished. Further studies are required to verify the external validity of these findings.
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