Bi-pedicled Visor Flap for Coverage of Two Skull Defects: A Practical Flap Option for Metastatic Scalp Lesions With a Favorable Cosmetic Outcome

Reconstruction of the scalp after acquired defects poses a great challenge to reconstructive surgeons. In oncologic resections, the defect must be covered with well-vascularized tissue to withstand radiotherapy post-surgery. However, due to the limited scalp tissue mobility, primary closure or loco-regional flaps are challenging and limited in choice. Fortunately, with the current understanding of the robust blood supply system to the scalp tissue, they can survive with the closure under tension. In this paper, we present a case of scalp reconstruction using a bi-pedicled visor flap to cover the two skull defects after ablative surgery. In addition, this article highlights the reason for the option, the surgical procedure, and the cosmetic outcome of the surgery.

Carcinosarcoma: A Rare and Aggressive Breast Tumor in a Young Lady

Carcinosarcoma of the breast is a subtype of metaplastic breast carcinoma characterized by differentiation of the neoplastic epithelium toward mesenchymal-looking elements. It is a highly aggressive rare subtype of invasive breast neoplasm that exhibits a distinct histologic entity. Only a limited number of reports related to this type of disease have been reported. Here, we present a case of breast carcinosarcoma in a lady in her early 20s, which is relatively young among all cases published. It was challenging to achieve diagnosis preoperatively with histopathological evaluation of the ultrasound-guided tru-cut biopsy sample. With no evidence of distant metastasis clinically and radiologically, a surgical option was opted for. Left mastectomy and left chest wall reconstruction with deep inferior epigastric artery free flap were performed. Post-excision specimen was confirmed to be carcinosarcoma.

Atypical Chest Pain in a Patient With Breast Implant

Breast implant surgery typically improves patient breast satisfaction and health-related quality of life. However, breast implants are also linked to long-term local problems like capsular contracture and breast discomfort. Chest pain is one of the reasons that patients with breast implants seek consultations, which is not typically attributable to cardiovascular reasons. The potential reasons for atypical chest pain are diverse. The absence of a precise diagnosis may also result in incorrect examinations and management, leading to further worry and wasted work time. A 55-year-old woman with a breast implant 10 years prior to the incident, presented with atypical chest pain on and off for a year and was treated as a case of unstable angina, costochondritis, and vasospastic spasm. Despite multiple visits, her symptoms did not resolve. Later, the patient presented with a lump over the left breast, associated with constitutional symptoms. Examination revealed a left breast implant with capsular contracture grade III, and ultrasonography showed signs of a ruptured implant. Symptoms eventually resolved after the removal of the breast implant.

"Ultraviolet C phototherapy as an adjunct wound therapy in full-thickness wound of a rat model"

Ultraviolet C (UVC) phototherapy is a potential modality to improve wound healing due to its well-known antimicrobial properties, and it promotes the expression of certain growth factors. However, limited data exist to show the clinical effect of UVC in wound healing compared with other advanced modern dressings. This animal preclinical study involved 56 Sprague-Dawley female rats aged 3 months old, weighing between 250 and 300 g, which were acclimatized for one week. Following the creation of a 2 × 2-cm-square full-thickness wound over the dorsum of each rat, they were divided into four treatment groups, namely, the control, UVC, hydrofiber silver, and UVC/hydrofiber silver groups. On Days 2, 4, 7, 10, 14, 21, and 28 postwounding, two rats from each group underwent wound assessment via wound measurement (mm²), calculation of the percentage of wound contracture and percentage of epithelization. Wound specimens were obtained for histological examination of inflammatory cells (neutrophils, lymphocytes and macrophages) and fibroblast cell counts. There was a relationship between wound size reduction and time to heal (P<0.05, R2=0.70) among the four treatment groups. The UVC/hydrofiber silver group had a significantly smaller wound size given the time to heal compared with the control group (P = 0.01) and UVC group (P = 0.02). There were no significant differences in terms of wound contracture and epithelization percentage among the four treatment groups. Histopathological examination revealed a significantly lower mean fibroblast count in the UVC/hydrofiber silver group than in the other groups (P = 0.025). These data suggested that UVC phototherapy did not increase the rate of healing but maintained the integrity of the wound by providing antimicrobial properties and preventing overproduction of fibroblasts. UVC was also safe, as no overt inflammatory response was discovered.

Successful Composite Grafting of Glans Penis in Pediatric Traumatic Penile Amputation

Traumatic penile amputation is a rare urologic emergency, more so in the pediatric population. It can result in significant consequences concerning function, appearance, psychological effects, and the overall quality of life. Immediate management should be initiated to salvage the amputated penis. We report a case of a four-year-old boy with a traumatic glans penis amputation caused by a sliding door accident. Successful composite grafting of the glans penis was done with an excellent functional and aesthetic outcome. This case highlights composite grafting as a viable option if microvascular replantation of penile amputation is deemed not feasible. Composite grafting is favorable if the grafted tissue is less than 2cm in size and the tissue is not crushed or contused.

Case Series of Neonatal Extravasation Injury: Importance of Early Identification and Management

Extravasation injury is a common iatrogenic injury, especially in neonates. Intravenous access is essential in neonatal care, but neonatal extravasation injury is associated with severe morbidity. We present three cases of neonatal extravasation injuries with varying presentations, etiological agents, and timing of management. It shows that extravasation injuries treated with the saline flush-out technique and timely intervention have a superior outcome with almost immediate resolution and subsequent healing with no scars. This is in stark contrast with the lesions treated conservatively with dressings that took more time to heal. We are reminded to be vigilant with infusion therapies and the importance of early detection and prompt treatment in neonatal extravasation injuries.

Heel Pad Reconstruction With Medial Plantar Flap

The heel of the foot is covered by highly specialized thick, glabrous skin containing fibroadipose tissue with numerous fibrous septae traversing the subcutaneous tissue, which acts as a shock-absorbent and prevents shearing of the skin. The loss of heel pad would cause interruption of the propelling function of the foot during walking. Therefore, heel pad reconstruction is an important procedure for wound closure in the acute phase and also functional reconstruction in delayed cases. We report a case of heel pad deformity in a patient who presented to us with left heel pain and inability to fully bear weight, which has caused her walking difficulty, following a road traffic accident. She sustained a degloving injury of the left foot and an open fracture of left calcaneum with ruptured Tendon Achilles in which the wound was initially addressed with failed reverse sural flap and the wound was allowed to heal by secondary intention. Delayed heel reconstruction was carried out with a propeller medial plantar flap and split skin graft. Postoperatively, the patient had improved functional and esthetic outcome.

The Practice of First Aid for Burn Injuries Among the Population of East Coast of Peninsular Malaysia for 2012-2016

Burns are a devastating public health problem that result in 10 million disability-adjusted life-years lost in low- and middle-income countries. Adequate first aid for burn injuries reduces morbidity and mortality. The rate of proper first aid practices in other countries is 12% to 22%.1,2 A 5-year retrospective audit was performed on the database of the Burn Unit in Hospital Universiti Sains Malaysia for 2012-2016; this involved 485 patients from the east coast of Malaysia. The mean age of the patients is 17.3 years old. The audit on first aid practices for burn injury showed poor practice. Out of 485 burned patients, 261 patients (53.8%) claimed that they practiced first aid. However, only 24 out of 485 patients (5%) practiced the correct first aid technique where they run their burn wound under cool water for more than 20 minutes. Two hundred and twenty-two patients had not received any first aid. Two patients did not respond to the question on the first aid usage after burn injury. The mean age of patients who practiced first aid was 15.6 years old. Out of the 261 patients who practiced first aid, 167 (64%) run their wound under tap water for different durations. Others practiced traditional remedies such as the application of "Minyak Gamat" (6.5%), soy sauce (5.5%), other ointments (3.6%), milk (1.8%), and eggs (0.7%), as well as honey, butter, and cooking oil (0.4% each). First aid practices for burn injuries in the population of east coast Malaysia are still inadequate. The knowledge and awareness of school children and the general Malaysian population must be enhanced.