Split Skin Graft Research Articles

The Effectiveness of a Medical Cocktail Therapy for Nonhealing Refractory Ischemic Diabetic Foot Ulcers

Abstract Diabetic foot ulcers are a serious complication of diabetes mellitus. Healing of ischemic or neuroischemic foot ulcers is most challenging as conventional therapies often fail to achieve adequate vascularity. Heel ulcers can be very severe and strenuous to treat and can eventually lead to amputation of the limb due to poor vascularity. Optimizing therapies to improve vascularity should, therefore, be a major goal in treating such cases. Here, we report two cases of chronic nonhealing ischemic ulcers of the heel. Patients approached us after conventional medical treatments failed to achieve healing. We treated them with a cocktail (Diabcare protocol) that we formulated using existing medications along with appropriate wound care and antibiotics. Diabcare protocol comprises rosuvastatin, aspirin, rivaroxaban, cilostazol, tadalafil, and zinc sulfate. Serial measurements of ulcers revealed progressive healing and wound contraction. Vascularity improved significantly, and fresh granulation appeared within days to weeks of initiation of therapy. Ulcers healed completely, with spontaneous epithelialization in the first case and after a split skin graft (SSG) in the second case, within a mean period of 3 months.

An Unusual External Genital Lesion and its Treatment- A Case Report

Lesions around the external genitalia are embarrassing, physically, socially, and emotionally depressing. Patients generally present late for treatment. Here, the authors describe a case of 32 years old female patient, who presented with multiple giant warts-like lesions involving the external genitalia since past 6 months. Any presence of pain, bleeding from the lesion, or alteration in bowel, bladder, or menstrual habits were denied. Lesion posed diagnostic and therapeutic challenges. She underwent resection of the lesion with reconstruction using a bilateral gluteal fasciocutaneous flap and split skin graft with diversion sigmoid colostomy. She further developed anal stricture and subcutaneous fistula, requiring anal dilatation and seton placement. After a brief period of Keigels’s exercises and anal dilatation, she underwent a reversal of sigmoid colostomy. The patient had to undergo staged surgeries to restore near normal external genitalia. This case is an unusual presentation of a genital lesion which was treated with a multidisciplinary team approach to restore her anatomy.

A Comparison of Skin Graft Techniques with and without Plaster Back Slab Dressing in Reducing Donor Site Morbidity in Radial Forearm Free Flap Surgery - A Retrospective Study.

The radial forearm free flap (RFFF) is a commonly used free flap for the reconstruction of orofacial defects because of its versatility and reliability. The donor site is closed with either split or full-thickness skin graft, and one of the common donor site morbidities is skin graft failure. Various techniques to minimise skin graft failure were reported, and we compared the skin graft techniques with and without plaster back slab dressing in the radial forearm donor site. This is a retrospective study of 75 patients who had RFFF for reconstruction of oral cavity cancer at two different tertiary teaching hospitals in the United Kingdom between April 2015 and March 2020. Thirty-nine patients from Hospital one had volar back slap, bolster dressing and crepe bandage. In contrast, 36 patients from Hospital two had only pressure dressing without a back slab. The mean age of the study population was 60.65 (P = 0.274). In both groups, two patients had donor site complications. However, there was no significant difference in the donor site skin graft complications with a P = 0.662. There was no evidence in the literature to support an ideal bandage for skin graft at the RFFF donor site. Our comparison of two techniques of skin graft dressings with and without back slap did not show any difference in the skin graft take, and the volar back slab did not add any additional benefits. The simple use of foam as a bolster dressing without a back slab is ideal for the radial forearm free flap donor site.

Agricultural Rotavator Induced Polytrauma in a 11-years-old Child – A Case Report

Agricultural polytrauma injuries in children are rare. Rotating blades of a rotavator can cause devastating injuries. An 11-year-old male child presented with severe facial avulsion injuries, degloving injury of left lower limb, grade IIIB compound left tibia shaft fracture with a large butterfly fragment, and closed right tibia shaft fracture. General anesthesia through tracheostomy intubation was given. Simultaneous surgical intervention for the face and limbs was performed by a team of experts. The facial injury was debrided and repaired. After thorough debridement, compound left tibia fracture fixation was performed with two interfragmentary screws and neutralizing ankle-spanning external fixator. The closed right tibia shaft fracture was treated with closed elastic intramedullary nailing. Simultaneous debridement of degloving injuries over both thighs was performed and wound closure was done. Subsequently, the patient underwent debridement of wounds and vacuum-assisted closure 3 times with split skin grafting for the left leg. All fractures healed well at 6 months and the child was able to do all activities without any functional limitations. Agricultural injuries in Children can be devastating and should be managed using a multidisciplinary approach at a tertiary care center. A tracheostomy is a viable option for securing the airway in severe facial avulsion injuries. In a hemodynamically stable child, definitive fixation can be performed in a polytrauma situation and an external fixator can be used as a definitive implant in an open long bone fracture.

Reawakened Sexual Interest: The Result of Surgical Correction of Concealed Penis

Concealed penis (CP) is a developmental anomaly in which the penis is hidden in the skin of the abdomen, thigh or scrotum. As a result of this, the penis appears shortened in length. It was first described by Keyes Jr. E.L. in 1919. It can be associated with voiding problem and in adults, sexual issues, among others. Objective: To show that surgery can reverse celibacy induced by CP and highlight the need for an interdisciplinary approach to correction of this anomaly. Patient and Method: A thirty-one-year male patient who had a surgical release of his buried penis by two surgeons in 2019 in a private hospital. The case note was reviewed, the data obtained analyzed and the results including photographs, were presented. The patient was followed up. Result: A 10 cm length of penis and a hundred percent (100%) take of sheet of split skin graft used to resurface the denuded penis were achieved using combined spinal and epidural anesthesia. The patient, his mother and the surgeons were satisfied with the outcome. Consequently, he resolved to marry a wife after all. Conclusion: Concealed penis can now be regarded as a known cause of celibacy and surgical correction can reverse the celibate state.

Pedicled anterolateral thigh flap: A versatile flap for complex regional defect reconstruction.

Soft-tissue defects of the lower abdomen, perineum, groin, and trochanteric area often involve the loss of composite tissue components and are technically challenging to reconstruct. The goals of reconstruction should include the replacement of the defect with a suitable soft-tissue flap that provides stable coverage while protecting important exposed structures. However, there are limited locations in this region for the creation of pedicled flaps for complex defect reconstruction. The pedicled anterolateral thigh (ALT) flap is considered superior to other comparable flaps due to its varying soft-tissue components and long pedicle with consistent anatomy that allow the reconstruction of locations that are difficult to reach without significant flap donor site morbidity. Herein, we present a case series of our experience of using a pedicled ALT flap to reconstruct regional defects over a range of locations. The present study comprised ten patients who underwent surgical reconstruction of soft-tissue defects of the lower abdomen, groin, trochanteric, scrotal, and penoscrotal defects using a pedicled ALT flap over a two-year period. The flap was customized according to the defect when required. In our case series, flap loss was not observed with only a few minor complications. All patients accepted the aesthetic appearance of the flap recipient site area without requesting revision surgery. The donor site was closed primarily in half of all cases, with split skin grafting applied in the remaining patients. Graft take at the flap donor site was satisfactory in all cases. A pedicled ALT flap is a reliable and suitable option for complex soft-tissue reconstruction for regional soft-tissue defects of the lower abdomen and perineum.

Comparison of Fixation and Uptake of Split Skin Graft Using Autologous Platelet Rich Plasma with Conventional Method for Ulcer

Platelet Rich Plasma contains a major Growth factor and has adhesive and healing properties. PRP promotes angiogenesis, collagen synthesis, and wound healing. The main aim of this study is to compare the efficacy of SSG fixation using autologous platelet-rich plasma with the conventional method like suturing. In this study, patients who were admitted with a diagnosis of ”ulcer” in the General Surgery department in SRM medical college hospital and research centre were included and would be taken as subjects for this study. It is a randomized, controlled study with a sample size of 60. Thirty people were put in the autologous PRP group, and another 30 people were put in the suture group. Instant graft uptake of SSG to the ulcer was statistically significant in the PRP group. The seroma formation, the number of dressings and the period of hospital stay were comparatively increased in the suture group than in the PRP. The usage of PRP is secure and efficient in healing ulcer. It has been discovered to be very advantageous in many ways for both the patient and the surgeon. Based on what we found, we recommend using autologous PRP on wounds before resurfacing to help them heal better and faster than suturing.

Aggressive management of extensive de gloving injury of the left lower limb with debridement and split skin grafting and application of vacuum-assisted closure system over recipient grafting site in a tertiary health care setup

Aggressive management of extensive de gloving injury of the left lower limb with debridement and split skin grafting and application of vacuum-assisted closure system over recipient grafting site in a tertiary health care setup

The Role of Platelet-Rich Plasma in Reducing Pain, Pruritis, and Improving Wound Healing of Skin Graft Donor Site.

Background Wound healing is a dynamic and complex process. Therefore, no single agent can efficiently mediate all aspects of the wound healing process. Split-thickness graft has become a workhorse of plastic surgery for wound or raw area cover. In this study, we evaluate the effectiveness of autologous platelet-rich plasma (PRP) on the donor site and its effect in pain, purities, and epithelization. Materials and Methods This is a prospective study. A total of 15 patients were included who underwent split skin grafting for burns, trauma, or post-tumor excision raw area. PRP was prepared using standard described procedure. The donor site raw area after harvesting split-thickness graft was measured and the surface area was divided into two equal halves. One half was dressed using PRP and the other half was dressed using paraffin gauze piece only. The dressings were changed weekly for 3 weeks. Observation We found significant reduction in severity of pain and pruritis in the PRP group as compared with control group. Epithelization was faster in the PRP group on day 7 and 14, but the overall healing time was nearly the same by day 21. The side-by-side dressing thus show a definite improvement in the post-split-thickness skin graft wound care and PRP as a good dressing alternative. Conclusion Autologous PRP is very effective adjuvant in management of skin graft donor site. Its role in relieving pain and pruritis over donor site significantly improves patient's discomfort postoperatively. It helps in early and painless wound healing. However, we recommend for larger clinical study for better understanding of the efficacy of this blood product.

Outstanding surgeon of the twentieth century, professor Natalya Ivanovna Butikova

The purpose of the study is to highlight the scientific, clinical, pedagogical and social activities of the outstanding maxillofacial and plastic surgeon, Doctor of Medical Sciences, Professor N.I. Butikova.
 Material and methods. Based on the analysis of domestic literature, as well as the life, professional activities and scientific works of Doctor of Medical Sciences, Professor N.I. Butikova to present her role in the formation and development of domestic maxillofacial and plastic surgery.
 Results. Information from the life of a well-known surgeon in our country, one of the patriarchs of Russian pediatric traumatology and maxillofacial surgery, Doctor of Medical Sciences, Professor Natalia Ivanovna Butikova, who turned 110 years old in 2020, is presented. The formation of N.I. Butikova as a doctor, researcher and teacher, her activities during the Great Patriotic War are noted. The main directions of her scientific activity in the development and improvement of methods for the treatment of gunshot injuries of organs and tissues of the maxillofacial region and neck, the rehabilitation of the wounded with defects in the jaws and tissues of the oral region using the methods of bone autoplasty and Filatov's stalk are highlighted. Natalya Ivanovna paid much attention to improving the treatment of face and neck burns and their consequences, as well as to surgical methods for eliminating mimic muscle paralysis. Its role in the development of oncostomatology, combustiology, pediatric traumatology and orthopedics is revealed. N.I. Butikova developed surgical methods for the treatment of syndactyly in children under the age of one year and the first years of life using zigzag incisions, improved the methods of free tissue grafting and plasty with split skin grafts, and proposed an apparatus for preventing secondary contraction of skin grafts during transplantation.
 Conclusions. It is emphasized that she was one of the pioneers of domestic maxillofacial surgery. N.I. Butikova, being one of the founders of domestic surgery, the creators of the school of pediatric traumatologists and orthopedists, as well as maxillofacial surgeons, is rightfully recognized as one of the patriarchs of national healthcare.

Protocol for an open randomised controlled trial investigating Fibrin Glue in Skin grafts for Skin cancer (FiGSS)

IntroductionSkin cancer is a common disease in the tropics, and oncological resection typically requires reconstruction with skin grafts. Fibrin glue, initially established as a haemostatic agent, has been studied extensively...

Recurrent Dermatofibrosarcoma Protuberans of the Head and Neck: a Case Series.

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma that develops from dermal fibroblasts and spreads within the dermis and subcutaneous fat. It is locally aggressive, with a high local recurrence rate after excision but has extremely low metastatic potential. In the case of recurrent tumors, surgical excision with adequate margins is the gold standard treatment and may require adjuvant radiotherapy or chemotherapy in some cases. We conducted a retrospective analysis of individuals with dermatofibrosarcoma protuberance of the head and neck region that had treatment at our facility between 2016 and 2021. We gathered the data on the surgical techniques, reconstructive techniques used, histopathological features, adjuvant therapy, and outcomes. We treated three patients with head and neck dermatofibrosarcoma protuberance: one scalp lesion and two on the cheek. All three patients had recurrent tumors, two of whom were treated elsewhere for the primary lesion. One patient underwent surgery for a benign spindle cell tumor of the right cheek, but a final histopathological examination revealed dermatofibrosarcoma protuberance, and the tumor recurred within 3months. The duration of recurrence is between 3 and 24months. The size of the tumor ranges from 7.2 to 10.5cm. The wide local excision margins range from 2 to 4cm. Reconstruction ranges from split skin graft to regional flap. Inadequate margins raise the possibility of local recurrence in dermatofibrosarcoma protuberance.

Correlation between Bacterial Wound Colonization and Skin-Graft Loss in Burn Patients.

Loss of skin grafts can be a dangerous complication during the early postoperative course of patients with extensive burns. A major risk factor for impaired healing of grafts is local wound infection due to bacterial colonization. Burn wounds are particularly prone to bacterial colonization. In this retrospective cohort study, we analyzed correlations between bacteria isolates from burn wounds and loss of skin grafts after surgical treatment. A cohort of patients with burn wounds who received split-skin grafts for wound coverage was divided into groups with and without loss of skin grafts. Demographics, comorbidities, trauma characteristics and bacterial isolates from wound cultures were reviewed and compared. Bacterial colonization isolated from burn wounds upon hospital admission was found to be a significant predictor of skin-graft loss. Additionally, an Abbreviated Burn Severity Index greater 6 predicted graft loss. When comparing bacterial swab results from admission with isolates from revision surgery after graft loss, causative pathogens were found to have changed.

Stem cell therapy for type1 diabetes with transplantation of stem cells into the Omental pouch, peritoneum, and blood, experimental study

IntroductionType 1 diabetes is a dreadful autoimmune disease of childhood with incidence of 0.26/1000 children in India. To develop a new, cheap, and effective treatment for this disease, we invented an autologous Stem cell therapy for type 1 diabetes in which stem cells are transplanted into the Omental pouch, peritoneum, and blood. The Omental pouch stem cell operation in the therapy is reported for the first time in the medical literature. Materials and methodsLast 5 years I treated 21 patients of Type 1 diabetes with autologous stem cell therapy and in the same period, a group of 26 patients of Type 1 diabetes with conventional treatment of Insulin injections was put as a control group. Blood sugar fasting and post prandial, Anti Gad antibody titer, Glycosylated Hb and C peptide levels and weight of patient and total Insulin requirement in 24 h were the variables to be measured before the therapy and after the therapy. Stem cells were harvested from patients own bone marrow and separated by density gradient method. An infusion of 20 mg/kg methylprednisolone in 100 ML normal saline given intravenously over 1 h prior to the therapy. The total average numbers of cells harvested were 7.86 × 107. One third quantity of isolated stem cells were put into the Omental pouch through no. 7 IFT, another one third into peritoneal cavity through no. 10 IFT and remaining third is given IV in 100 ml normal saline. ResultsThe minimum follow up was 6 months and maximum of 4 years. In the therapy group, the average weight gain after one year of therapy, daily requirement of Insulin and its drop after therapy, drop in HbA1c levels, drop in fasting and post prandial blood sugar, rise of C peptide levels and drop in Anti-GAD antibody titer were measured and was found to be statistically highly significant. The same parameters were measured in control group and was not statistically significant. There were a few side effects noted after stem cell therapy such as mild skin rash, nausea, and pain in abdomen. DiscussionIn autologous bone marrow derived stem cell therapy, cells are transplanted into the Omental pouch, peritoneum, and blood. Cells transplanted in the Omental pouch get vascularized like a split skin graft. Omental surface has far less cellular immunity than blood, hence, if some of these cells get converted into Islets like cells producing Insulin, then they are less vulnerable to damage by the immune system. It means that the Omental pouch may act as a new biological pancreas producing Insulin. Stem cells injected intravenously reach the pancreases and may get differentiate into Islet like cells due to specific growth factors released by pancreas. Stem cells can reverse autoimmunity by their immunomodulatory function. Stem cells transplanted in peritoneum grow longer due to large surface area and little cellular immunity and secrete growth factors and cytokines for a long time which can rejuvenate existing Islets of Langerhans. The therapy group had substantially good results compared to the control group and the difference was statistically highly significant. ConclusionsAutologous stem cell therapy was safe, and effective for the long term for the treatment of Type 1 diabetes. We need a greater number of cases and a longer follow up to make it better. The therapy creates a lot of hope for Type 1 diabetes patients as it can be easily repeated any number of times.

Phyllodes tumour presenting in a rare location: a case report and literature review

Phyllodes tumors are rare fibro-epithelial tumors that are known to grow very rapidly in a short period. The tumor is known for its propensity to recur locally despite adequate wide excisions and even mastectomies. This case report is of a woman who had a recurrent Phyllodes tumor in a peculiar location. Phyllodes tumours are generally confined to arising from the breast; however, in this case, we found it arising from the anterior abdominal wall. The tumour was removed with a 2 cm margin of excision. The large defect that remained after excision was reconstructed using a latissimus dorsi flap, along with a split skin graft. The immediate post-operative period was uneventful. Ultrasonography did not detect a recurrence after 12 months. We presented relevant literature highlighting tumor infiltration into the anterior abdominal wall, our surgical management and reconstructive planning for closure of a large post-excision defect. In order to prevent a recurrence of phyllodes tumour, it is important to excise the tumour with wide margins of 2 cm. A multi-disciplinary team approach is essential for the reconstruction of the remaining defect.

A CASE REPORT AND LITERATURE REVIEW: PRIMARY CARCINOMA OF LACRIMAL GLAND TREATED WITH ADJUVANT CHEMO- RADIATION.

Primary Sebaceous Carcinoma of Lacrimal Gland, possibly arising from heterotopic sebaceous tissue, is extremely rare and must be differentiated from secondary invasion of the Orbit by a primary Eyelid tumor/metastatic spread from other areas of the body. It is known to be aggressive So, delay in diagnosis can increase the chance of local recurrence and metastasis. In this article we report a case of Primary Sebaceous Carcinoma of the lacrimal gland, who underwent surgery with positive margin received Adjuvant radiotherapy in our Institute. A 55-year-OldCASE REPORT: Lady presented with Left eyelid swelling. MRI ORBITS & PNS reveals malignant mass of approx. 4.3 X 3.8 cm size in superior & temporal aspect of the left Orbit arising from the left upper eyelid compressing left globe and inseparable from the left lacrimal gland with approx. 2.3X 1.5 cm sized enlarged left Pre- auricular Node. No optic nerve encasement, Orbital wall Destruction & Extension to adjacent paranasal sinuses is seen. CECT Thorax & Whole abdomen – Normal. FNAC from eyelid swelling & Pre- Auricular Node S/o Sebaceous Carcinoma with metastasis. Patient underwent left Orbital Exenteration + left supercial parotid split skin graft. HPE show the tumor mass of size 4.5 X 4X 3 cm, completely replacing tarsal plate of eyelid & tumor mass show a highly inltrative malignant tumor with morphology consistent with sebaceous carcinoma with positive margin and tissue from left parotid show inltration by the sebaceous carcinoma (Possibly metastasis to the Intra-parotid node with extra nodal extension). Patient received Adjuvant/post op Chemoradiation 60 Gy/30#/ 6weeks/Rapid Arc technique with weekly 6 cycles chemotherapy Inj. Cisplatin. Patient requires close monitoring for any sign of recurrence / Distant metastasis. A Rare case report of sebaceousCONCLUSION: carcinoma of the Lacrimal Gland which requires appropriate evaluation & management for better prognosis.

Relation Between Gender and Concomitant Medications With Erythropoietin-Treatment on Wound Healing in Burn Patients. Post Hoc Subgroup-Analysis of the Randomized, Placebo-Controlled Clinical Trial "EPO in Burns".

Burns are leading causes of mortality and morbidity, including prolonged hospitalization, disfigurement, and disability. Erythropoietin (EPO) is a well-known hormone causing erythropoiesis. However, EPO may play a role in healing acute and chronic wounds due to its anti-inflammatory and pro-regenerative effects. Therefore, the large, prospective, placebo-controlled, randomized, double-blind, multi-center clinical trial “EPO in Burns” was initiated to investigate the effects of EPO versus placebo treatment in severely burned patients. The primary endpoint of “EPO in Burns” was defined as the time elapsed until complete re-epithelialization of a defined split skin graft donor site. Additional analyses of post hoc defined subgroups were performed in view of the primary endpoint. The verum (n 45) and control (n 39) groups were compared with regard to the time it took for study wounds (a predefined split skin graft donor site) to reach the three stages of wound healing (re-epithelialization levels). In addition, the effects of gender (females n 18) and concomitant medications insulin (n 36), non-steroidal anti-inflammatory drugs (NSAIDs) (n 41), and vasopressor agents (n 43) were tested. Life tables were used to compare study groups (EPO vs. placebo) within subgroups. The Cox regression model was applied to evaluate interactions between the study drug (EPO) and concomitant medications for each re-epithelialization level. Using our post hoc defined subgroups, we observed a lower chance of wound healing for women compared to men (in terms of hazard ratio: hr100%: 5.984 [95%-CI: (0.805–44.490), p = 0.080]) in our study population, regardless of the study medication. In addition, results indicated an earlier onset of re-epithelialization in the first days of EPO treatment (EPO: 10% vs. Placebo: 3%). Moreover, the interpretation of the hazard ratio suggested EPO might have a positive, synergistic effect on early stages of re-epithelialization when combined with insulin [hr50%: 1.307 (p = 0.568); hr75%: 1,199 (p = 0.715)], as well as a stabilizing effect on critically ill patients [reduced need for vasopressors in the EPO group (EPO: 44% vs. Placebo 59%)]. However, additional high-quality data from clinical trials designed to address these endpoints are required to gain further insight into these effects.

Pseudoepitheliomatous keratotic and micaceous balanitis: a series of eight cases.

Pseudoepitheliomatous keratotic and micaceous balanitis (PEKMB) is a clinicopathological entity characterized clinically by micaceous scale on the glans, and histologically by acanthosis, hyperkeratosis and pseudoepitheliomatous hyperplasia. We present a series of eight cases of this rare condition, the first series of more than two cases to be reported. To determine the clinical and histological characteristics of cases of PEKMB, and evaluate treatments used and clinical course. This monocentric case series was conducted at the University College London Hospitals tertiary male genital dermatology clinic between April 2018 and August 2020. Eight patients with PEKMB were evaluated. Data were collected on demographics, clinical presentation, histological features, presence of human papilloma virus (HPV), history of lichen sclerosus, treatment of PEKMB and subsequent response, and presence or development of squamous cell carcinoma (SCC) or penile intraepithelial neoplasia (PeIN) during follow-up. Eight Caucasian males presented with clinical and histological evidence of PEKMB. Seven had a background of lichen sclerosus; two had failed treatment with superpotent topical steroids and four had symptoms for three or more years prior to circumcision. There was no clinical or histological relationship with HPV infection, and p16 staining was negative. HPV PCR, performed in two cases, was negative. Basal atypia, insufficient to amount to PeIN, was present in six patients. One patient progressed to PeIN during follow-up, and no patient progressed to invasive malignancy. Five patients were treated successfully with glans resurfacing and split skin graft reconstruction. Our observations demonstrate that PEKMB represents a form of chronic, undiagnosed or misdiagnosed, inadequately treated or treatment refractory, unstable lichen sclerosus. The significant potential for squamous carcinogenesis (differentiated PeIN and verrucous carcinoma) can be mitigated by timely diagnosis and treatment. Glans resurfacing and split skin graft reconstruction appears to be a successful treatment modality in patients with refractory disease.

Choice of the method for eliminating postburn shoulder joint contractures

BACKGROUND: In the Russian Federation, over 400,000 patients with thermal injuries are registered yearly, with approximately 30% of them requiring hospitalization. Physicians pay special attention to the rehabilitation of patients with complications of deep burns. According to several authors, deep burns occur in 47% of cases. The most common complications of deep burns are contractures and limb deformities. Shoulder contractures occur in over 50% of patients. The outcomes and terms of a patients return to active social and working life depend on the timeliness and selection of an optimal surgical intervention from a wide range of reconstructive and plastic techniques.
 AIM: This study aimed to improve the functional and esthetic results of surgical treatment in patients with postburn shoulder joint contractures.
 MATERIALS AND METHODS: From 2011 to 2020, 198 patients underwent surgery, including 59% women and 41% men. Right shoulder, left shoulder, and right and left shoulder simultaneous joint contractures occurred in 54.5%, 38.5%, and 7% of cases, respectively. The patients age ranged from 18 to 72 years, and 99% of them were of working age. The scope of preoperative examination included clinical data, photographic documentation, duplex vascular scanning, and determination of the degree of contracture using a mechanical goniometer. Patients with grade I, II, and III shoulder joint lesions accounted for 29%, 60%, and 11% of the total number of cases, respectively. Early surgical rehabilitation prevents the development of secondary myogenic and arthrogenic contractures and accelerates the patients social reintegration. Local tissue plasty using the armpit adipodermal tongue-shaped flap, a nonperforated full-layer or split skin graft, a rotated flap based on perforating vessels, and the expander stretching method were used to eliminate contractures.
 RESULTS: Bacterial infection, total and marginal necrosis, hematomas, and seromas were not observed in the immediate postoperative period. Complete elimination of the shoulder joint contracture was achieved in 63% of cases, whereas joint mobility increased by over 60 in 30% of patients.
 CONCLUSIONS: The algorithm presented for choosing a method of surgical rehabilitation for patients with shoulder joint contractures leads to an increase in the efficiency of reconstructive surgery after burn injuries.

Lymphatic Malformation of Inguinal region in an adult: A Case Report.

Lymphatic malformation are most commonly located in regions of confluence of major lymphatic channels, including the neck ( 75%), axilla ( 20%), mediastinum, retroperitoneum, pelvis and groin. We are reporting here a rare case in which a 35year old female presented with swelling over right groin and thigh. A provisional diagnosis was made on radiological investigations. Wide Local Excision with Tensor Fascia Lata Flap Reconstruction with Split Skin Graft was done and the diagnosis was confirmed on histopathology and immunohistochemistry. Keywords: Lymphatic malformation, Acquired Progressive Lymphangioma, Benign lymphangioendothelioma