Perforator propeller flaps for sacral and ischial soft tissue reconstruction

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.     

Lipid Profile In Transplant Patients: A Clinical Study

15 renal transplant recipients were studied for their lipid profile. The patients were on regular post transplant follow up and had non clinical or laboratory evidence of graft dysfunction, intercurrent infection or post transplant diabetes mellitus for at least 3 months prior to the study. The mean duration of transplant was 15 ± 9.5 months (range 3-32 months). Majority (86%) were on triple immunosuppression therapy and received a mean prednisolone dose of 10.5 mg. An equal number of healthy subjects were randomly selected and studied for their lipid profile and served as control for the study group. There was no significant change in the HDL-cholesterol level as compared with controls. However, these patients showed a significantly higher LDL-cholesterol and total cholesterol levels. Further, a significant inverse correlation was observed between triglycerides and total cholesterol levels and transplant duration.Key Words: Lipid profile, Renal transplant     

Movement of pulmonary artery catheters

Summary Intraluminal movements of pulmonary artery catheters are seldom considered, although they may have a significant impact on flow measurement and safety. The purpose of this study was to document the movements of these catheters within the heart cycle, and to establish whether any patterns existed. We analyzed two-dimensional real time echocardiography cross-sectional images of the human pulmonary artery in 20 patients, plotting the position of the intra-arterial catheter frame-by-frame onto a standardized template. We found that movement of the catheter within the pulmonary artery occurred in a seemingly random pattern. There was no movement pattern to the inferior right of the vessel, an area known to have complex velocity profiles and erroneous velocity measurements. The catheter moved substantially throughout the heart cycle, occasionally quite close to the vessel wall. We observed significant movement of the pulmonary artery catheter throughout the heart cycle, without any predictable pattern. Although we did not specifically investigate the effect of these movements on cardiac output, they imply that intra-arterial Doppler flow measurements from the pulmonary artery may be inaccurate, since a stable catheter position, and, hence, a sample volume, cannot be ensured. Further speculation can be made on the implications of these movements in regard to thermodilution cardiac output and safety.     

Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals

North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64 % among all admissions. Of these individuals, 13.65 % (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.