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A urethrocutaneous fistula is a common complication after hypospadias repair, but congenital fistula is a rare anomaly. We present a 16-year-old boy with this unusual anomaly. Its etiology, embryology, and management are discussed in brief. [ABSTRACT FROM AUTHOR]

Background: Resection of eyelid malignancies leads to complex reconstructive problems due to the functional and aesthetic importance of an eyelid. Hence, a large number of such cases are referred to plastic surgery facilities. Eyelid malignancies are of varied histological types and the western and Asian data have considerable variations in case distribution and presentation. This study is an attempt to characterise these tumours in the Indian population. Materials and Methods: The present study is a retrospective analysis of 85 consecutive cases of eyelid malignancies that reported to a tertiary health care facility in central India over a 15-year period starting from January 1996 up to December 2009. The cases were analysed for their age of presentation, sex distribution, tumour location, delay in seeking treatment, recurrence rate and variations with respect to the pathological subtype. Observations: Mean age of presentation for all the malignancies was 59 years. The median age of presentation was 65 years for basal call carcinoma (BCC), 58 years for sebaceous gland carcinoma (SGC), 55 years for squamous cell carcinoma (SCC) and 45 years for malignant melanoma. There was slight female preponderance as 56.28% of the patients were females. The most common location of the tumour was lower lid (58.2%) for all the malignancies. BCC was the most common malignancy (48.2%) followed by SGC (31.2%) and SCC (13.7%). Mean duration of symptoms was 9 months (range 3-21 months). The most common presenting complaint was mass with ulceration across all histological subtypes. Other associated complaints included itching, discharge from eye, pain and ptosis. The mean size of tumour at diagnosis was 2.34 ± 0.4 cm for BCC, 2.19 ± 0.6 cm for SGC and 1.99 ± 0.7 cm for SCC. The mean rate of growth of BCC was 1.39 cm/year. The corresponding values for SGC and SCC were 3.63 and 4.89 cm/year, respectively. The rate of follow‑up was 89% at 3 months, 71% at 6 months, 62% at 1 year and 31% at 5 years. Recurrence rate was 1.9% for BCC and 12.7% for SGC. Surgical methods used included wedge excision and primary closure, excision and skin grafting, and tarso-conjunctival flap. Conclusions: We recommend that the surgeons treating eyelid malignancies in India should have a high index of suspicion for SGC. A wider margin of 10 mm is recommended for SGC excision as opposed to 5 mm for BCC. [ABSTRACT FROM AUTHOR]

We present a series of 91 cases caused by both wild and domestic animals over a period of 5 years from 2005-2009. The objective of the study was to compare the results of primary reconstruction with the traditional method of debridement and secondary healing. A total of 91 patients were studied from January 2005-December 2009. In 54 patients, the injuries were carefully documented, and immediate reconstruction was performed. Thirty-seven patients with contraindications to surgery or who refused to undergo surgery were allowed to heal by secondary intention and were studied as a control group. The patients and their relatives were asked to rate their result and outcome. Among the 54 patients who underwent primary reconstruction, 37 patients were males and 17 were females. Age ranged from 2 to 70 years. Amongst the wild animals, bear was the most common offending animal while dog was the most common street animal. Overall bear bites were the most common presentation to our facility. Four out of 54 cases (7.4%) with primary reconstruction developed infection of the operative site. Of the patients with immediate reconstruction, 57.4% thought that the result was excellent, 35.2% patients were satisfied with the result but wanted further refinement while 7.4% were unhappy and wanted immediate revision. Of the 37 patients who did not undergo primary reconstruction, 16.2% thought that the result was excellent, 45.9% were satisfied and 37.8% wanted immediate revision. We recommend that animal bite wounds should be considered for reconstruction at the earliest to achieve maximal functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 × 1.5 × 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20 years old female presented with a midline skin lesion in the anterior part of neck since birth. It indicates that the indications for surgery in congenital mid-line cervical cleft (CMCC) are aesthetic, prevention of cervical contractures, and associated clefts of lip and mandible. It reveals that simple excision or transection of the fibrous band leads to recurrence of scarring and fibrosis.

A letter to the editor is presented which describes a new method of piercing the ear lobule, in which an 18 guage intracath is inserted into the lobule and the stilette is removed gradually, leaving the plastic cannula in the lobe.

Although blast injuries are common with war; cooking gas; firecracker, mobile phone blast cases are increasing in number in last couple of years. We present 3 cases of mobile blast in 3 children causing injury to dominant hand in them. [ABSTRACT FROM AUTHOR]

Introduction: Bear attacks though relatively rare are frequent enough to be of concern for those who are in bear habitats. Our centre at Nagpur, being surrounded by dense forests from all the sides, treats a large number of victims. Aim: The aim was to document the injuries, management and the potential complications of bear attacks. Materials and Methods: We reviewed the records of 48 consecutive patients who were treated in our department from January 2006 to December 2013 for bear attacks. Outcome: The majority of patients were referred 24-48 h post-attack. All but two patients had involvement of either the face or scalp. Involvement of eyes, mandible, facial nerve, was common. Reconstruction included simple suture of lacerations to management of complex compound injuries with three-dimensional defects. Thirteen patients developed infection. Conclusion: Bear attack victims need a multidisciplinary approach. Early broad spectrum antibiotics, anti-rabies prophylaxis and irrigation and debridement of the wound are needed. We advise early referral to tertiary treatment centres. [ABSTRACT FROM AUTHOR]

Background: Eyelid malignancies are completely treatable if detected early. The treatment depends on the invasiveness of the cancer which in turn depends on the type of malignancy.Aim: The aim of the study was to characterize the distribution of the types of eyelid malignancies in central India.Settings and Design: The study was conducted in the Department of Plastic and Maxillofacial Surgery at a tertiary care hospital.Materials and Methods: We report a series of 27 cases of eyelid malignancies. In the same case series, we also include a case of malignant hemangiopericytoma which is an extremely rare form of eyelid malignancy worldwide.Statistical Analysis: Depending on the underlying statistical distribution, either analysis of variance (ANOVA) or the Kruskal-Wallis (K-W) test was used to assess the differential distribution of these variables across the types of eyelid malignancies observed in this study.Results: We observed that sebaceous cell carcinoma (approximately 37%) was almost as prevalent as basal cell carcinoma (approximately 44%) in the study subjects and had an earlier age of occurrence and a more rapid clinical course.Conclusions: Sebaceous cell carcinoma of the eyelid is almost as common as basal cell carcinoma in a large tertiary care centre in central India. [ABSTRACT FROM AUTHOR]

We report three rare cases of tumor-like conditions arising from Hoffa's fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa's disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Utility of combined abduction angle for hip surveillance in children with cerebral palsy" by Divecha A and Bhaskar A. in the November 2011 issue.