Prepancreatic portal vein is an unusual condition. Around 100 cases of prepancreatic preduodenal portal vein have been reported. But only 11 cases of prepancreatic postduodenal portal vein have been reported till now. Here, we report a peculiar case of prepancreatic formation of portal vein associated with prepancreatic superior mesenteric artery. The formation of prepancreatic portal vein by the union of superior mesenteric vein with the splenic vein which came anteriorly by piercing the body of pancreas to form the portal vein in front of the neck of pancreas is an exceptional occurrence which has never been reported in world literature so far. Radiologists and surgeons need to be aware of these unfamiliar prepancreatic vessels to avoid major intraoperative injuries.
The columella is an underrepresented part of rhinoplasty. The objective of this study was to assess the outcome of columella correction following rhinoplasty and to assess any differences in the open and endonasal approach.This is a retrospective study involving 65 rhinoplasty patients, who were divided into 2 groups depending on whether they had an open or endonasal approach. Fifteen patients underwent the open procedure, and 50 patients underwent the endonasal approach. Patients who underwent endonasal rhinoplasty were compared with open rhinoplasty patients in terms of their final outcome, with a focus on the columellar correction. The classification by Rohrich and Liu and Gunter's distance between the nasal axis and columella were used to assess the correction.The overall incidence of columellar correction was 90% in the endonasal group (45 of 50 patients) and 67% in the open approach group (10 of 15 patients); a comparison shows a P value of 0.043 (<0.05). An estimated 49 of 50 patients (98%) from the endonasal group saw a reduction in the nasal axis-columella distance when compared with the open rhinoplasty group, who saw a reduction in 12 of 15 patients (80%); statistical analysis shows a P value of 0.036 (<0.05). The quantitative reduction in this distance in all patients when compared between the 2 groups had a P value of <0.001, suggesting a greater overall reduction using the endonasal approach. This may be related to differences in distribution of the deformities within the 2 groups.There is no standard way to correct the columella, but it is important to identify the deformity and the need to correct it. In our patients, we found comparable outcomes in achieving a satisfactory columella in the open and endonasal groups.
Psoriasis is a chronic debilitating disease which affects the major organs of our body. Different forms of Psoriasis can be seen in which the most common form of presentation is a silvery patch on the skin. Here we describe a case of Psoriasis who had a single lesion on the radial side of the right index finger. The case described over here is a colleague in our department who himself is a medical doctor.
Communication in the healthcare setup is essential for patient safety and for seamless delivery of services to the patient. We have adopted a novel way of communication in the form of a colour-coded visual aid in the form of a traffic light system to guide the patients through the course of their treatment. This shows the treatment plan in the form of Red, Amber, Green and Blue. The Red (Stop) denotes complete immobilisation with Splints, Amber (Proceed with caution) denotes active movements only, Green (Go forward) denotes Passive and Active movements and Blue shows when the patient can undergo guided weight bearing and strengthening exercises without a splint. The implementation of this system has created a streamlining of our protocol and improvement in the quality of the care we deliver. Level of Evidence: Level V (Therapeutic).
Background. Rhinophyma is a chronic and progressive condition, considered a form of severe rosacea, which classically affects the tip of the nose. Some people have rhinophyma without having rosacea. The disease also carries a risk of 3-10% of malignant transformation. Different therapeutic methods have been described over time, with different grades of efficiency, and each of them with its associated risks. At present, the gold standard treatment for the "established" rhinophyma is the ablative laser Aim. To propose a new therapeutic protocol, combining ablative and non-ablative lasers, with an early approach, that results in a better cosmetic outcome and a longer free disease interval. Materials and Methods. The four stages of the new proposed protocol involve early treatment of rosacea with vascular lasers (PDL, NdYAG), then the use of an ablative laser (CO2) and further revision of the post-ablative result (CO2, ErYAG, PDL/NdYAG). Results. The results of the treatment are presented with "before" and "after" photos of the patients. Conclusions. The proposed approach, combining ablative and non-ablative lasers, leads to a better cosmetic result and a longer remission.
Objective: This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage. Background: Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction. Methods: Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines. Conclusions: Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
Pilar cysts are common cysts on the scalp and hair bearing area of the body. We found one such cyst on the dorsum of the thumb. There have been previous reports of them in the finger tips as a very rare occurrence. The site of this lesion supports the theory of a possible origin from the nail matrix. These lesions, even when found at unusual sites should have pilar cyst as a differential diagnosis. They must always be excised and subjected to careful histopathology to rule out proliferating trichilemmal cysts, which carry a rare risk of malignancy.
Abstract Aim The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins. Method A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion. Results 60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance. Conclusions Taking >5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.
The whole world is gripped by the novel coronavirus pandemic, with huge pressures on the health services globally. Within the coming days, this is only going to increase the pressure on the health care services and needs robust planning and preparedness for this unprecedented situation, lest the whole system may cripple and we may see unimaginable mortalities and suffering.1Cucinotta D. Vanelli M. WHO Declares COVID-19 a Pandemic.Acta Biomed. 2020; 91 (Mar 19): 157-160PubMed Google Scholar The whole concept of social distancing2Mahase E. Covid-19: UK starts social distancing after new model points to 260 000 potential deaths.BMJ. 2020; 368 (Mar 17): m1089Crossref PubMed Scopus (61) Google Scholar and keeping people in self isolation has reduced footfall to the hospitals but this is affecting delivery of routine care to patients for other illnesses in the hospital and telehealth is an upcoming way to reduce the risk of cross contamination as well as reduce close contact without affecting the quality of health care delivered.3Smith A.C. Thomas E. Snoswell C.L. Haydon H. Mehrotra A. Clemensen J. Caffery L.J. Telehealth for global emergencies: implications for coronavirus disease 2019(COVID-19).J Telemed Telecare. 2020; (Mar 20:1357633X20916567)Crossref PubMed Scopus (1147) Google Scholar At the Bedford hospital NHS trust, for the past one year we have been running a virtual clinic for our skin cancer suspect patients, where in after a particular biopsy if the clinical suspicion of a malignancy was low, these patients were not given a follow up clinic appointment and instead they were informed of the biopsy result through post, sent both to their GP and themselves. Most patients encouraged this model to not have to come back to an appointment and this took significant pressure off our clinics. In the event we needed to see a patient, they were informed via a telephonic conversation to attend a particular clinic appointment. From an administration standpoint, this resulted in less unnecessary follow up appointments in our skin cancer follow up clinics, which could then be offered to our regular skin cancer follow up patients as per the recommended guidelines, without having to struggle with appointments. Virtual clinics have previously shown to be safe and cost effective alternatives to the Out patient visits in surgical departments like Urology4Browne C. Davis N.F. Mac Craith E.D. Lennon G.M. Galvin D.J. Mulvin D.W. Prospective evaluation of a virtual urology outpatient clinic.Ir J Med Sci. 2018; 187 (Feb): 251-254Crossref PubMed Scopus (11) Google Scholar and Orthopedics.5Holgate J. Kirmani S. Anand B. Virtual fracture clinic delivers British Orthopaedic Association compliance.Ann R Coll Surg Engl. 2017; 99 (Jan): 51-54Crossref PubMed Scopus (36) Google Scholar They improved performance as well as improved economic output.3Smith A.C. Thomas E. Snoswell C.L. Haydon H. Mehrotra A. Clemensen J. Caffery L.J. Telehealth for global emergencies: implications for coronavirus disease 2019(COVID-19).J Telemed Telecare. 2020; (Mar 20:1357633X20916567)Crossref PubMed Scopus (1147) Google Scholar,4Browne C. Davis N.F. Mac Craith E.D. Lennon G.M. Galvin D.J. Mulvin D.W. Prospective evaluation of a virtual urology outpatient clinic.Ir J Med Sci. 2018; 187 (Feb): 251-254Crossref PubMed Scopus (11) Google Scholar We have increased the use of these virtual clinics, with the onset of the novel Coronavirus pandemic, in order to reduce the patient footfall to our clinics. Most patients voluntarily chose not to turn up and with the risk being highest amongst the elderly, it was logical to keep them away from hospitals as far as possible. In order to achieve this, we have started virtual clinics for nearly all patients in order to triage patients that can do without having to come to the hospital for now. The world of telemedicine is the way forward in nearly all aspects of medical practice3Smith A.C. Thomas E. Snoswell C.L. Haydon H. Mehrotra A. Clemensen J. Caffery L.J. Telehealth for global emergencies: implications for coronavirus disease 2019(COVID-19).J Telemed Telecare. 2020; (Mar 20:1357633X20916567)Crossref PubMed Scopus (1147) Google Scholar and this pandemic situation might just be the right time to establish such methods. We propose setting up of more such clinics in as many subspecialties of plastic surgery, which not only will help in the current crises situation, but will also be useful in the future to take pressure of our health care services. None declared Not required None
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