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Background The keystone design perforator island flap (KDPIF) is unique among local flaps because of its high potential for adaptation. We describe our experience with the use of the keystone flap for the reconstruction of a variety of defects in different regions of the body concerning its versatility, surgical outcomes, complications, postoperative pain, operative time, and esthetic outcomes. Methods A prospective observational study was conducted at our institute from June 2021 to June 2023 where the use of KDPIFs in resurfacing soft tissue defects of different etiopathogenesis was evaluated and the data were analyzed. Results Forty-four patients were included in the study with soft tissue defects of various etiologies and at different locations. The largest flap raised was 18 × 10 cm and the smallest was 4 × 2 cm. The average intraoperative time for completion of the procedure was 74.86 minutes (range: 45-120 minutes). The success rate of flap survivability was 95.45% with two patients having total flap loss necessitating another reconstructive option. Partial flap dehiscence which healed secondarily was observed in two patients. Postoperative pain showed a significant fall of 83.7% from baseline and 82.9% of cases were extremely satisfied with the esthetic outcome. Conclusion The keystone flap is a valuable reconstructive tool in the armamentarium of a plastic surgeon. It is technically reproducible, suitable to be done in resource-limited settings, and provides contiguous tissue with good vascularity and fewer complications.
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Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi commonly affecting nasal mucosa, conjunctiva, and urethra. Subcutaneous tumor nodule presentation is rare and often mimics as sarcoma. Such tumoral rhinosporidiosis has been reported rarely. This report describes a 60-year male who presented with a solitary, firm, nontender swelling in posterior aspect of right leg with an ulcer and mimicking clinically as soft tissue sarcoma. Histopathology was diagnostic. Surgical excision was found to be useful.
Asunto(s)
Rinosporidiosis , Sarcoma , Enfermedades Cutáneas Parasitarias , Neoplasias de los Tejidos Blandos , Humanos , Masculino , Animales , Rinosporidiosis/diagnóstico , Rinosporidiosis/cirugía , Enfermedades Cutáneas Parasitarias/patología , Conjuntiva/patología , Sarcoma/patología , Rhinosporidium , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
ABSTRACT: Soft tissue defects with exposed tendon, bones, and joints around the knee are difficult and challenging to treat because of its location over a joint, requires a stable cover that is supple and stretchable. For any knee defects, the gastrocnemius muscle flap is the first choice for the reconstruction, although it causes less functional deficit; however, because of its less reach, it is difficult to cover the defect in the superolateral aspect of knee joint and anterior to the tibial tuberosity with the other disadvantage being the bulkiness. The medial sural artery perforator flap (MSAPF) provides thin fasciocutaneous tissue similar to the adjacent normal soft tissue in the knee and so, its use leads to an improved reconstruction of contour and eliminating the need of a skin graft over the primary defect. Here, we will be discussing a case series using MSAPF to cover the defects around the knee.
Asunto(s)
Colgajo Perforante , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , Arterias/cirugía , Humanos , Articulación de la Rodilla/cirugía , Colgajo Perforante/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tejidos Blandos/cirugía , Resultado del TratamientoRESUMEN
A man in his early 30s, presented with multiple soft tissue swellings over the buttocks, around the knees, ankles and dorsum of both the hands since childhood. His father and paternal uncle had similar lesions, and his father had coronary artery disease. One of his sisters had a history of sudden death due to an unknown cause at 14 years. The patient and his parents had very high serum levels of total cholesterol and low-density lipoprotein. Based on the above findings, a clinical diagnosis of familial hyperlipidaemia type II was made. Larger lesions were excised in stages, and histopathological evaluation revealed the lesions to be eruptive xanthoma. A cardiac assessment revealed no significant abnormality. Lipid-lowering agents and low-dose aspirin were started, and the patient was advised for regular cardiology and endocrine evaluation. This case emphasises its rare presentation and the importance of early diagnosis and management to prevent any untoward future incidence.