A 5-year-old girl presented with an inability to abduct her left shoulder and flex her left elbow following a fall 1.5 months earlier. Electrodiagnostic studies were suggestive of a partial upper trunk brachial plexus injury. The child was advised to attend monthly follow-up visits with regular physiotherapy and nerve stimulation. At 3 months after injury, elbow flexion had recovered completely, and shoulder abduction had improved to 30°. After an additional month of observation without further clinical improvement in shoulder abduction, a nerve-to-triceps transfer to the axillary nerve was planned in the fifth month. Intraoperatively, the posterior division of the axillary nerve was found to be excitable. To preserve nerve continuity, an end-to-side supercharging procedure was performed using the nerve to the medial head of the triceps to augment the axillary nerve. The postoperative period was uneventful, and physiotherapy was resumed 3 weeks after surgery. Within 7 months of surgery, the patient demonstrated full shoulder abduction. Restoration of shoulder function is a primary goal in the management of brachial plexus injuries. Nerve transfers offer substantial potential for improved functional recovery. In this case, lateral neurorrhaphy of the nerve to the medial head of the triceps to the axillary nerve provided additional motor input, facilitating earlier deltoid recovery. Early surgical intervention in selected cases may contribute to faster and more effective recovery, particularly in the pediatric population.

Introduction: Anthropometry, derived from Greek origins, loosely translates to measuring the man. The quest for an ‘optimal nose’ that is not just functional but also aesthetically pleasing to the eye is as old as civilisation itself. Nasal analysis is the first and foremost step in performing a rhinoplasty. Indirect methods of nasal analysis include clinical photography, 2D cephalogram, 3D stereophotograph, 3D laser scanning and computerised tomography. Rhinoplasty for a surgeon is where science meets art. Methods and Materials: A prospective single-centre descriptive case series of 15 patients ( N = 15) who underwent rhinoplasty for nasal deformity resulting from varying pathologies. Demographic and clinical characteristics and photographs of all patients were recorded, followed by non-contrast computed tomography-guided anthropometric measurement at our institution over a period of 1 year from June 2023 to June 2024. All patients were assessed using the Rhinoplasty Outcome Evaluation (ROE) and Nasal Obstruction Symptom Evaluation (NOSE) questionnaires pre- and postoperatively. Results: In the context of aesthetic analysis, ROE results showed statistically significant results with high patient satisfaction postoperatively. The preoperative ROE score was 36.2 ± 8.9, which increased to 89.6 ± 11 postoperatively ( P < .001). The preoperative NOSE score was found to be 83.7 ± 11.4 and postoperatively decreased to 33.7 ± 9.3, representing a statistically significant difference ( P < .001). Conclusion: Nasal anthropometry offers objective data essential for planning surgery. This in turn achieves better surgical results leading to higher rates of patient satisfaction.

Context: Electrical burn injuries produce deep and progressive tissue damage that often exceeds the apparent cutaneous defect. Exposure of tendons, joints, vessels, and bone frequently necessitates flap reconstruction for durable coverage and preservation of function. Aims: To assess the efficacy of various flaps for reconstruction in patients with electrical burn injuries and to establish the role of flaps in reconstruction for patients with electrical burn injuries and its sequelae. Settings and Design: Retrospective descriptive study was conducted at a tertiary care center. Subjects and Methods: Records of patients with electrical burns who underwent flap reconstruction between January 2020 and December 2025 were reviewed. Patients managed with dressings or skin grafting alone were excluded. Demographic data, anatomical site, timing of reconstruction, type of flap, and intraoperative findings were analyzed. Flap survival and postoperative complications were documented. Statistical Analysis Used: Descriptive statistical analysis. Results: Seventy-two patients underwent 89 flap procedures. The majority were males in the third decade of life. The upper limb was the most commonly involved region. Pedicled and loco-regional flaps were used most frequently, while free tissue transfer was required in selected cases. Flap survival was achieved in 84 of 89 procedures, with an overall success rate of approximately 94%. Complications were limited and managed without major re-intervention. Conclusions: Flap reconstruction remains central to the management of electrical burn defects. A broad, individualized reconstructive approach allows reliable coverage and functional restoration in this challenging group of patients.

Synovial sarcoma is a rare soft tissue sarcoma that infrequently involves the head and neck region and very rarely arises from the scalp, accounting for fewer than 0.1

Background: Brachial artery injuries are common in upper limb trauma and require timely repair to prevent ischemia and limb loss. In developing countries like India, delayed presentation is frequent due to limited access to specialised care, inadequate infrastructure and delays in multidisciplinary coordination, complicating timely revascularisation. This study aimed to evaluate limb salvage outcomes and factors influencing prognosis in patients undergoing delayed repair of traumatic brachial artery injuries. Methods: This prospective study included 30 male patients (ages 18-58 years) with traumatic brachial artery injuries treated over 2 years. All patients presented more than 6 hours after injury. Emergency surgical repair was performed using either primary anastomosis or reversed vein grafts, with the great saphenous vein used in 14 patients and upper limb veins in others. Associated nerve and tendon injuries were repaired simultaneously. Fasciotomy was performed in 20 patients. Patients were followed up at regular intervals (2 weeks to 6 months), and outcomes were assessed in terms of limb salvage, complications and secondary procedures. Results: Out of 30 patients, 26 limbs (86.6%) were salvaged, and 4 (13.4%) required above-elbow amputation due to gangrene. Most patients (20/30) presented between 12 and 24 hours, with one case successfully revascularised at 92 hours post-injury. Ten patients underwent primary repair; 20 required vein grafting. Concomitant nerve injury was found in 26 patients, primarily affecting the median nerve (16 patients). Fasciotomy helped prevent irreversible ischemic damage. Two patients developed acute kidney injury, and 10 required negative pressure wound therapy followed by skin grafting. Conclusions: Delayed surgical repair of brachial artery injuries, even beyond conventionally accepted ischemic time thresholds, can achieve high limb salvage rates. However, systemic limitations in developing countries continue to pose major challenges to achieving timely intervention and optimal outcomes. Level of Evidence: Level IV (Therapeutic).

Objectives: This retrospective observational study was conducted to emphasize on epidemiological demographics and management of patients presenting with acute hand injuries to the Plastic Surgery and Emergency department and study the functional outcome of such injuries post-intervention. Materials and Methods: The present observational study was conducted on 118 patients who had presented with hand injuries from July 2020 to December 2021 with the objectives to determine their demographic characteristics, their severity using hand injury severity scoring system. Functional outcome assessment was done using two-point discrimination for the sensory, while Purdue Pegboard Test and Jebsen-Taylor hand function test were used for the motor assessment of these patients. Results: In the present study, males were more affected than females (M: F = 5.5:1), with the majority of the patients sustained multiple injuries involving different components of the hand in 38.1% patients, and with the most common mode of injury being machine cut injuries in 40.7% patients (P < 0.049). Conclusion: Since it was a prospective study, there was a major correlation between the gender and mode of injury, especially males getting more affected than females. The severity of hand injury showed a significant association with the functional outcome of the hand.

Following proximal ulnar nerve repair, there will be a delay in innervating the distally placed intrinsic muscles of the hand, which can lead to irreversible damage to the intrinsic motor end plates. Supercharging with end-to-side anterior interosseous nerve (AIN) transfer can augment the results of nerve repair by babysitting the motor end plates and thus preventing its denervation. Recently, there have been discussions regarding whether AIN, which contains only 500 axons, can augment the ulnar motor branch, which contains approximately 1,500 axons. In one of our cases, electromyogram following surgery showed activity in the first dorsal interossei and abductor digiti minimi without any signs of reinnervation in the flexor carpi ulnaris. This may support the contribution of AIN in supplying the intrinsic muscles. Considering the low morbidity of the procedure and potential improvements in muscle strength, all patients undergoing ulnar nerve repair in high ulnar nerve palsies can be counseled to undergo an end-to-side AIN transfer.

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 x 10 cm and the smallest was 4 x 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.

Ectodermal dysplasia-syndactyly syndrome 1 (EDSS1) is an exceedingly rare condition associated with mutations in the PVL4 gene. It is characterised by sparse, brittle hair, eyebrows and eyelashes, abnormal dentition and nails, along with bilateral cutaneous syndactyly involving the fingers and toes. We report a 2-year-old girl who presented to us with bilateral complete simple syndactyly of the third and fourth web spaces of the hands, along with bilateral syndactyly of both feet involving the second to fourth toes. Upon examination, sparse hair and eyebrows, along with abnormal dentition, were noted. Thorough clinical examination and genetic analysis were conducted on the affected child and her father, who exhibited similar clinical features. Genetic analysis revealed a homozygous nonsense mutation in the PVL4 gene in both individuals. According to the literature, EDSS1 has been reported in only 10 families worldwide, and there are no reported cases from India. Level of Evidence: Level V (Therapeutic).

Introduction: Fibrolipomatous hamartomas are rare congenital benign tumors that can affect the nerves. The symptoms arise due to compression and may require surgical excision. Case Report: A man in his mid-20s suffered swelling over the volar aspect of the left forearm and hand for 4 months. He was symptomatic. A soft, non-tender swelling of size 6 × 4 cm was present over the flexor aspect of the left forearm and palm, with features suggestive of median nerve compression. Magnetic resonance imaging and electromyography were performed. Decompression of the carpal tunnel was performed with debulking of fibrofatty elements and fine dissection of the neural elements. Conclusion: This case report demonstrates a rare fibrolipomatous hamartoma encompassing the median nerve, which required surgical excision. Keywords: Fibrolipomatous hamartoma, median nerve, surgical excision.

Extraskeletal Ewing sarcoma (EES) is a rare entity, accounting for only 3% of lesions encountered in upper extremity. We present two paediatric patients, who were initially diagnosed with a vascular malformation based on clinical assessment and imaging. Final histopathology revealed Ewing sarcoma of soft tissue origin, confirmed by immunohistochemical analysis. Hand surgeons, who are routinely approached for a myriad of hand pathologies, should be wary and consider EES as a differential when treating such lesions. A multidisciplinary approach with an appropriate treatment algorithm can help in a speedy diagnosis, improving the long-term prognosis of the disease. Level of Evidence: Level V (Therapeutic)

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

Background The medial sural artery perforator (MSAP) flap is reliable in resurfacing defects of the popliteal fossa. There is possibility of resurfacing the popliteal fossa defects after postburn contracture release with scarred MSAP flaps with good overall long-term outcomes. Materials and Methods A study was conducted from June 2017 to July 2023 to evaluate the functional and surgical scar aesthetic outcome in patients with soft-tissue defects in the popliteal fossa after postburn contracture release that were reconstructed using scarred and unscarred MSAP flap with 10 patients in each group. Results The clinical outcome was assessed in terms of the perioperative and late postoperative complications, range of motion of the knee joint along with surgical scar outcome using the Patient and Observer Scar Assessment Scale (POSAS). The functional results in the scar tissue flap group were comparable with those in the normal tissue flap group, but the aesthetic outcome of surgical scar was found to be better in the normal tissue flap group. Conclusion The MSAP flap provides ideal tissue for soft-tissue reconstruction with minimal donor site morbidity for popliteal fossa defects after postburn contracture release in both the scarred and unscarred flap groups.

Background: The use of regional flaps based on perforator arteries is generating more interest in limb reconstruction surgery. The surgical approach allows for the restoration of soft tissue lesions using neighboring homologous tissues without the need for microvascular anastomosis. The aim of the study was to evaluate the clinical results of local perforator flaps in the treatment of complex lower limb and upper limb defects. Materials and Methods:Fourteen patients (six upper limb and eight lower limb defects) underwent reconstruction using perforator-based flaps which were studied retrospectively during a three-year period. Donor sites were examined thoroughly and flaps selection was done using a handheld manual Doppler mapping preoperatively, to locate the perforator vessels and their flow. Thereby, perforator-based propeller flaps were raised and used for defect coverage based on their maximum arc of rotation. Results:Postoperatively, all the flaps included in the study survived. Partial flap necrosis and venous congestion in the flap were reported in two patients following intervention. Donor site morbidity was minimal without any loss of function. Most of the patients were satisfied with the aesthetic outcome. Conclusion:Perforator flaps using hand held Doppler are the most yielding, simple and safe flaps for the Reconstructive Surgeons. The need for the complicated microsurgical procedures can be avoided with the use of such locoregional propeller flaps which providedbetter aesthetic results with minimal donor site morbidity.

Purpose: This studyinvestigated the presence of SARS-CoV-2 RNA virus in the chronic wounds of confirmed COVID-19 positive patients. Methods: This is a single-centre retrospective observational study conducted at a dedicated COVID-19 tertiary centre. COVID-19 positive patients with chronic wounds (traumatic/infective) were included in this study. The specimens from wounds were collected while doing the dressing and analyzed with real-time reverse tran­scriptase polymerase chain reaction (rRT-PCR) to know the presence of the virus. Results: A total of eleven patients were included in this study. Eleven samples were collected safely from wound swabs and analyzed. None of the samples from the wound tested positive for the virus while they were tested positive from nasopharyngeal swab which was taken simultaneously or within 3 days prior. Conclusions: The wounds of COVID-19 patients were considered negative with least risk of transmission of the disease. Thus, these patients were managed safely using proper wound precautions and strict COVID 19 protocols and guidelines.

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.