Journal of Plastic Surgery and Transplantation

Pressure injuries are areas of necrosis where soft tissues are compressed between bony prominences and external hard surfaces. They are caused by unrelieved mechanical pressure in combination with friction, shearing forces, and moisture. Pressure necrosis is an unwarranted, preventable complication and can be influenced by various internal and external factors. Low level laser therapy (LLLT) has gained its importance in medical field since it was found to have wound healing and scar modifying properties. We present an unusual case of fingertip pressure necrosis that occurred during the management of a hand burn injury for which use of Low level laser therapy (LLLT) was incorporated into the management.

Pediatric burns account for around 25% of burn cases. Pediatric thermal burns affecting >10% TBSA are usually advised hospitalization. With burns of above 60% TBSA holds a high risk of mortality. Extensive thermal burns especially in toddlers is extremely challenging, due to their low body reserve, risk of hypothermia, metabolic and nutritional disturbances and reduced donor sites, low compliance towards physiotherapy, resulting in significantly high mortality and morbidity. Even extensive pediatric burns could be salvaged with immediate medical attention, coordinated involvement of multidisciplinary team, Aggressive surgical intervention and physiotherapy. This multidisciplinary approach not only prevents death but also allows the patient to return to a near normal life after the incident

Herein we report a rare case of young male who developed volar compartment syndrome of forearm and arm with no or minimal external injury following trauma at worksite while trying to hold steelbars from falling on to him. On complete workup and exploration there was internal rupture of flexors of forearm and extensors of arm with hematoma without much external contusion of left upper limb (Fig . 1) while only minimal hematoma without rupture of muscles in the right upper limb (Fig. 6). Development of compartment syndrome was further delayed in the right upperlimb (Fig. 5). Even though the clinical picture was bizarre enough to perform prophylactic fasciotomy at the first contact of patient, it could have prevented necrosis of torn muscles and closure of wound at an earlier period. Emergency fasciotomy did save the left upperlimb while prophylactic fasciotomy in right upperlimb could prevent further necrosis of muscles and wound closure at an earlier period.

Venous ulcer is a common manifestations of untreated chronic venous insufficiency affecting only about 5% of those with the condition.1 Many at times venous ulcers are easy to identify, and to start the appropriate treatment. However, in post skin graft patients where the depth of primary injury is unknown and the assessment of superficial veins is not always possible clinically, the diagnosis of venous ulcer may be delayed. We present one such case in our institute where the venous ulcer was initially treated as an unstable scar with ulceration.

In India traumatic eye injuries remain the most common cause for monocular blindness in pediatric age group. Cradle hook ocular injuries itself remains rare but usually presents with simple eyelid laceration or skin avulsion. Injury involves a puncture wound when the hook pierces at a high velocity through the bulbar conjunctiva, either leaving a laceration over cornea or causing severe global injuries or even sparing the globe and involving the eyelids only. Other common modes of ocular injuries in paediatric age group are injury with wooden stick, metallic hook, fire crackers and sports related tools, but this can be associated with serious complications like corneal laceration, scleral perforation, traumatic cataract, vitreous hemorrhage and even retinal detachment. Even though we encounter total avulsion of eyelid with or without canalicular injury occasionally, we seldom visualize large segmental loss of tarsal plate or loss of full thickness upper eyelid in paediatric age group. Right eye and upper eyelid are affected more than left eye or lower eyelid respectively and majority involves full thickness injury. The eyelid and ocular adnexa often protects the globe and minimises the injury to globe. Eyelid injuries should be treated at the appropriate time as they can further result in anatomical as well as functional problems. Propitious repair through effective primary closure can prevent complications like entropion, ectropion, trichiasis, and epiphora. Here we encountered a very unusual presentation of ocular injury with loss of majority of upper eyelid skin and soft tissue following an accidental metallic cradle hook injury.

Background: Ring avulsion injuries occur when a sudden force pulls a ring from a finger, causing trauma that ranges from soft tissue laceration to complete amputation.1 Aim: To describe the management of a ring avulsion injury using a groin flap technique. Objectives: To prevent amputation, maintain finger function, and minimize morbidity. Material: A 17-year-old male presented with a ring avulsion injury to the right little finger, resulting in complete amputation at the distal interphalangeal joint and exposed tendon up to the proximal mid-phalanx. Result: The groin flap healed well, preserving finger function. Conclusion: Regional flaps play a critical role in managing ring avulsion injuries, especially in cases where microvascular replantation is unfeasible.2

The use of “negative pressure” has become a cornerstone in the treatment of acute and chronic injuries in almost all specialties. Continuous alternating, cyclic are three types of negative pressure wound therapy (NPWT). Cyclic NPWT is similar to intermittent in that it uses the same maximum air pressure, but the pressure never reaches zero in the cyclic mode. Cyclic application of “negative pressure” leads to excellent local skin microcirculation in terms of blood flow and subsequent tissue oxygenation. This article compared cyclic NPWT with other NPWTs.