Objectives: Bromelain-based enzymatic debridement has gained significant attention for its potential advantages in treating burn wounds. However, no previous meta-analyses have been conducted to provide concise evidence of bromelain's efficacy. Therefore, this study aims to conduct a systematic review and meta-analysis focusing on the comparison of bromelain use versus standard care in patients undergoing burn debridement.

Methods: Systematic searches were conducted in PubMed, Embase, and the Cochrane Library databases to identify relevant studies. Data synthesis was performed using random-effects models, with findings presented as mean differences (MDs) and weighted odds ratios, accompanied by their corresponding 95% confidence intervals.

Results: The review analyzed 10 studies, including three randomized controlled trials, two clinical trials, and four observational studies, involving 596 burn patients with an average age of 38 years and a mean total body surface area (TBSA) of 16%. Of the participants, 49% received a topical bromelain mixture, while 51% received standard care. Bromelain was linked to faster debridement (MD -3.92; p < 0.00001) and a higher rate of spontaneous healing (MD 71.00; p < 0.00001). Surgical excision and autograft procedures were less common in the bromelain group, with odds ratios of 0.08 (p < 0.0002) and 0.10 (p = 0.0001). No significant differences were observed in wound closure time, infection rates, blood transfusion needs, Modified Vancouver Scar Scale scores, or hospital stays.

Conclusions: The evidence from this study suggests that the administration of bromelain-based enzymatic debridement significantly reduces the time required to complete debridement, increases the chances of spontaneous healing of burn wounds, and decreases the need for further surgical excisions and autograft procedures.

Objectives: Patients with sarcomas involving the femoral vessels have been treated with wide tumor resection and reconstruction using great saphenous vein (GSV) grafts. Several studies have reported on the application of fibrin glue (FG) at microvascular anastomosis sites. This study aimed to evaluate the effectiveness of autologous FG (AFG) in femoral vessel reconstruction using GSV grafts.

Methods: Five male patients with lower extremity sarcomas underwent revascularization using harvested GSV grafts, each 1.5 times longer than the resected femoral artery. Anastomoses were sutured using 8-0 nylon under a microscope. AFG was applied to the anastomosis sites and along the length of the grafts. Approximately 10 mL of AFG (excluding thrombin solution) was available and consequently used. Operative details and postoperative complications requiring re-exploration were assessed.

Results: The mean tumor size was 10.2 cm, the mean vessel defect length was 11.1 cm, and the mean graft-to-defect ratio was 1.56. Among the patients, two underwent revascularization of the artery and vein, while three underwent arterial revascularization. One patient experienced distal-side necrosis due to arterial insufficiency based on severe size discrepancies.

Conclusions: The large volume, high fibrinogen content, and growth factors in AFG suggest its potential to support external vein grafts, prevent graft overdistention, enhance graft thickness, and minimize minor leakage from vein graft branches.

Objectives: Submucous cleft palate (SMCP) is a subtle and occult subtype of cleft palate. Diagnosis is often delayed due to inconspicuous clinical features of the SMCP. This study aims to investigate the demography of SMCP patients, to determine when SMCP patients are operated on, and to analyze the surgical technique applied to correct SMCP in our center.

Methods: Medical records in Hospital Pakar Universiti Sains Malaysia (HPUSM) from 1999 to 2023 were retrospectively reviewed. Patients diagnosed with SMCP who were operated on were identified. The variables extracted from the records include gender, ethnicity, age at diagnosis, age at surgery, antenatal history, genetic study, associated signs and symptoms, other conditions and anomalies, associated syndromes, surgical techniques, and complications.

Results: A total of 21 SMCP patients who underwent repair were identified. However, only 15 complete medical records were obtained. The mean age of surgery is 68.4 months, ranging from 5 to 212 months. The majority of patients at 47.6% underwent Bardach's two-flap palatoplasty. Other techniques identified were Veau-Wardill-Kilner palatoplasty, Von Langenbeck palatoplasty, Furlow double-opposing Z-palatoplasty, and intravelar veloplasty.

Conclusions: This retrospective case series reported that SMCP patients were operated at a later age. The higher average age of surgery is multifactorial and likely includes delayed diagnosis. Various surgical techniques may be used to repair the SMCP. A high level of suspicion of SMCP is paramount when the clinical features of cleft palate are subtle, but patients exhibit other suspicious signs such as recurrent episodes of otitis media, nasal regurgitation, or speech impediments.

Objectives: This study aimed to elucidate the incidence of anterolateral thigh (ALT) flap failures attributable to perforator complications, distinct from issues with microvascular anastomoses or proximal vascular pedicles.

Methods: A retrospective chart review was conducted for 663 free ALT flap transfers for head and neck reconstruction between 1995 and 2024. Data on failed flaps were analyzed.

Results: There were 41 flap failures, generating an overall success rate of 93.8%. Of these, 18 (43.9%) were due to perforator compromise, whereas the remaining 23 (56.1%) stemmed from anastomotic or proximal pedicle complications. The 18 perforator-related failures predominantly occurred after hemiglossectomy (7 cases) and marginal mandibulectomy (5 cases). Flaps in 14 cases were harvested with the vastus lateralis muscle; 13 involved a single skin perforator, and others contained 2 skin perforators. Perforator skeletonization was performed in 12 cases.

Conclusions: Perforator compromise is a major cause of ALT flap failure in addition to problems with microvascular anastomoses or proximal vascular pedicles. Countermeasures such as avoiding perforator skeletonization and including multiple perforators in the skin paddle may be effective in preventing these complications.

Apert syndrome is one of the most challenging congenital hand disorders to treat due to the absence of skin and soft tissues and the complex osseous fusion morphology. In addition, hypoplasia of the digital arteries and abnormal bifurcations are also known, so it is not recommended to create all interdigital spaces in a single operation. Multiple surgeries are usually required. In this report, a two-stage interdigital reconstruction using adipose flaps was performed for syndactyly with Apert syndrome. The osseous fusion of the complex syndactyly was dissected and covered with adipose flaps simultaneously with the interdigital reconstruction of the simple syndactyly at the primary surgery. Six months later, the interdigital reconstruction of the complex syndactyly was performed. This method is considered to be easy to perform and useful for ensuring sufficient soft tissue thickness in the lateral nail fold and secure skin grafting.

Pollicization surgery for thumb reconstruction has a long-standing history. However, advancements in microsurgery and the widespread use of free tissue transplants from the toe for the surgical treatment of traumatic thumb defects have narrowed the indications of pollicization in thumb reconstruction. Despite this, pollicization offers certain advantages over free flap transfer in specific cases. Literature on cases requiring multiple-digit amputations or bilateral thumb reconstruction is sparse, and the indications for pollicization remain controversial. Here, we present a case of a 31-year-old man who lost multiple fingers, including both thumbs, in an industrial accident. He underwent pollicization surgeries on both hands. At 3 years and 9 months post-surgery, his postoperative course and hand function were assessed as good. In an era where microsurgery is prevalent, pollicization remains a viable option for patients with multiple-digit amputations, including index finger and bilateral thumb loss, provided the functional thenar muscles remain intact.

A 15-year-old male patient presented with an enlargement of his right thumb. The thumb had an atypical morphology characterized by a hypertrophic tip and a concave pulp. His parents had noticed this deformity since he was an infant. As the patient grew older, he began to feel tenderness in the hypertrophic region. We thought that this condition could be congenital and attributed the origin of the tenderness to decreased fat tissue in the pulp. We planned surgery to excise the skin on the concave part and augment the bulk there with a flap from the distal hypertrophic part. Intraoperatively, a solid subcutaneous tumor was found in the distal hypertrophic region. Pathological examination confirmed that the tumor was a schwannoma. Postoperatively, the tenderness resolved and the appearance of the thumb improved. This case is very atypical; information on this condition is lacking in the literature.

Lower limb reconstruction, particularly in the distal third, is challenging due to limited local flap options, poor skin laxity, and the direct exposure of critical structures such as bone and tendons due to the thin skin in the region. For larger defects, a microvascular free flap transfer is often required. For small to medium defects, the distally based peroneus brevis muscle flap is a viable option, though it may risk distal flap necrosis over the critical defect area. This study presents the authors' experience using this flap in 9 patients at a Singapore health care center. Key considerations include (1) modifications in situations where a perforator-based propeller flap is considered as an alternative option, (2) the use of intraoperative Indocyanine Green Near-Infrared Video Angiography to reduce necrosis risk, (3) employing negative pressure wound therapy, and (4) determining the optimal immobilization duration.

Bifid scrotum and penoscrotal transposition are rare congenital scrotal anomalies. Cases diagnosed without hypospadias and chordee are uncommon. We present a rare case of bifid scrotum and incomplete penoscrotal transposition without hypospadias and chordee in a 10-year-old patient. Examination revealed an incomplete transposition of the external genitalia, with the scrotum bifid along the scrotal raphe. The hypoplastic penis was buried at the midpoint of the scrotum. Intraoperatively, no hypospadias or chordee was identified. Single-stage scrotal reconstruction was performed with the modified Glenn-Anderson technique. Post-operatively, the patient recuperated well, with minimal edema. Bifid scrotum and penoscrotal transposition may exhibit broad clinical variations. Different surgical techniques with single- or multiple-stage reconstruction may be performed to achieve good functional and cosmetic outcomes. The modified Glenn-Anderson technique is a feasible single-stage scrotal reconstruction procedure that enables the repair of hypospadias and chordee in the same setting. The post-operative swelling and aesthetic results are acceptable.

We report a rare case of a 25-year-old man with paraplegia and hemodialysis dependency due to traumatic spinal cord injury and renal infarction. Ischial and severe sacral pressure ulcers complicated by an urethrocutaneous fistula developed in the patient. A multidisciplinary approach was implemented, including percutaneous cystostomy, negative pressure wound therapy, and musculocutaneous flap surgery. This strategy successfully preserved urethral integrity, a significant achievement in such complex cases. After complete ulcer closure and meticulous follow-up, the patient successfully underwent living donor kidney transplantation with preserved urethral function.

This case highlights the efficacy of a multidisciplinary approach in managing severe pressure ulcers with a urethrocutaneous fistula while maintaining urethral integrity. It also underscores the importance of achieving complete ulcer healing and preventing recurrence before kidney transplantation. Long-term follow-up and development of standardized treatment protocols for such complex cases are warranted, particularly focusing on urethral preservation strategies.

Three patients with severe facial injuries and with history of attack by a single bear were simultaneously admitted to our hospital. With the rapid industrialization and overpopulation of India, there is an increased pressure on the available land, leading to increased human-animal conflicts. Fortunately, all three patients survived. The prolonged hospitalization needed and the tumultuous course in the hospitalization punctuated by multiple complications will tax medical practitioners. This study describes the clinical course of these patients in detail and the treatment particulars to help similarly placed physicians. We would like to stress the importance of early debridement, primary closure of wounds, and early skin grafting for raw areas even in patients with suboptimal physical status, along with appropriate anti-rabies prophylaxis, as key in managing these patients.

Myelomeningocele is the most common congenital abnormality of the central nervous system. We present our experience and review the postoperative outcomes and complications by conducting a retrospective observational study. Medical records of 48 patients who underwent surgical closure of myelomeningocele from September 2013 to December 2023 were reviewed and analyzed. Overall, 28 cases were closed with direct skin repair, while 20 cases required local skin flaps. Five cases of wound dehiscence, 6 cases of cerebrospinal fluid leak, 2 cases of surgical site infection, and 1 case of flap tip necrosis occurred. Management of myelomeningoceles requires a multidisciplinary approach. Most myelomeningocele defects can be closed primarily. However, other methods can be utilized if necessary. Complications are difficult to avoid but outcomes can be optimized if the necessary steps are deployed.