Introduction: Surgical site infection (SSI) comes as third most common healthcare related infection which produces morbidity and deaths at large. Still many authors believe that it is better not to use prophylactic antibiotics in simple and uncomplicated cases. Laparoscope, now-a-days is a much used instrument for abdominal surgeries. Even after new aseptic techniques SSI remains to be a major problem. Aims and Objectives: To study the effect of antibiotics on superficial SSI in the cases of open and laparoscopic cholecystectomy. Observation and Results: One hundred patients were enrolled for cholecystectomy. The patients were divided into two groups, A and B. Group A consisted of patients in whom laparoscopic cholecystectomy was done and group B in whom open cholecystectomy was done. The male female ratio was 1: 2.23. The mean age of patients in Group A was 46 years and in Group B was 44; Standard deviation (SD) for age was 14.8% and 13.8% in groups A and B respectively; t-value was 0.654 and P value was 0.515 and they were not significant. The number of males and females was 16 and 26 respectively in Group A and 11 and 31 in Group B. The Chi square X ² = 1.36 and P value was 0.248 and both were insignificant. The rate of superficial surgical site infection was 2.63% in both the groups. Conclusion: Our study concludes that there is no difference in the outcome of patients in cases of open as well as laparoscopic cholecystectomy. There is no significant difference in the surgical site infection rate in cases of open as well as laparoscopic cholecystectomy.

The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. Such defects are typically seen in individuals having an unattached ear lobule. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg-flap technique using a doubled-over skin flap allows a one stage reconstruction of the ear lobule. It is technically simple and may be performed under local anesthesia. The aesthetic results are generally well acceptable and there is a good color match between the neolobule and the surrounding skin.

Removal of jammed titanium screws can be difficult due to the problem of stripping of the hexagonal heads of the screws. We present a technique of extraction of stripped screws with the use of a standard 4.5 mm stainless steel hollow mill in a patient of peri-implant fracture of the radius fixed with a titanium locking plate 2 years back. The technique is quick, safe, and cost effective.

Purpose: Anterior maxilla is a high esthetic demand region. Reconstruction of the soft tissue loss after pathologic resection needs special techniques. Materials and Methods: This article describes the novel use of vascularized interpositional periosteal connective tissue flap of palate (VIP-CT) for reconstruction after resection of long-lasting pyogenic granuloma in anterior maxilla with underlying bone resorption in interdental region. Results: Good esthetic results both in labial gingiva and interdental region were obtained. Conclusion: VIP-CT flap is an ideal option for reconstruction of the pathologic lesions that affect the anterior maxilla and create pathologic space in interdental region.

Paratesticular liposarcomas are rare tumors and are often reported as isolated cases. Patients usually present with a painless scrotal or inguinal mass, mimicking inguinal hernia. They refer to liposarcomas arising from the spermatic cord, testicular tunics, and epididymis. We report a case of bilateral scrotal swelling which was misdiagnosed as inguinal hernia. Intraoperative diagnosis of testicular tumor was made. High inguinal orchiectomy was done. Histopathological examination revealed it to be liposarcoma of the cord. To our knowledge, there is no reported case of bilateral paratesticular liposarcoma in English literature, hence we report this case.

A case of suppurative pericarditis from an esophagopericardial fistula (EPF) following the upper gastrointestinal endoscopy (UGIE). A 38-year-old schizophrenic male patient with gastro-esophageal reflux disease (GORD) and previously dilated esophageal stricture was presented with acute retrosternal chest pain. The patient pulled out the endoscope during UGIE the previous day. A barium swallow (BS) post endoscopy was normal. The patient was initially hemodynamically stable and cardiac evaluation was normal. The patient subsequently developed features of cardiogenic shock. Echocardiography confirmed pericardial effusion and pericardial aspiration yielded pus. Surgical drainage with pericardial tube insertion was done. Pericardial biopsy revealed acute suppurative inflammation with food particles. The patient continued with antibiotics and pericardial drainage for 14 days and repeat BS and chest computerized tomography scan revealed no EPF. The patient was discharged 24 days after the presentation and remained well at follow-up. A rare, serious complication of UGIE which may be easily missed and is associated with a high mortality with delayed treatment.

Desmoid fibromatosis is a benign yet locally aggressive tumor with a tendency to recur. It causes considerable morbidity particularly when it arises in a small area in the head and neck region. This tumor is extremely rare in the submandibular region. We report a case of desmoid tumor in the submandibular region in a 32-year-old male who presented with right submandibular swelling postextraction of right lower wisdom tooth. Excision biopsy was carried out initially following inconclusive fine needle aspiration and discussion at multidisciplinary meeting. The tumor recurred 4 months following initial excisional biopsy necessitating a more radical secondary approach involving segmental mandibulectomy. Intraoperatively we also noted that the tumor was originating from the site of previous wisdom tooth extraction, raising the question of surgical trauma as precursor of desmoid tumor. We achieved a negative resection margin and a complete remission for 24 months.

Isolated pancreatic laceration is a rare injury. The typical mechanism by which it occurs is overstretching of the pancreas across the vertebral column during blunt abdominal trauma. The management depends on the location and extent of the injury. Disruption of the pancreatic duct usually requires operative treatment. Operative options for pancreatic laceration at the neck include distal pancreatectomy or suturing of the cephalic remnant and Roux-en-Y pancreatico-jejunostomy on the left remnant. We are reporting two cases of isolated pancreatic injury with disruption of the pancreatic duct but preserved posterior surface of the pancreas. These patients were managed by performing anterior Roux-en-Y pancreatico-jejunostomy at the lacerated area. Both the patients had successful outcome with removal of drains by 6 ^th postoperative day. Anterior Roux-en-Y pancreatico-jejunostomy in this particular scenario is easy, less time consuming, and has the advantage of preserving the pancreas and the spleen.

Keloid is cutaneous lesion characterized by fibrous growth produced as a result of aberration in the healing process. Pressure therapy, in combination with other forms of therapy, is used for the management of keloids. Clips or stents are generally used for the therapy and prophylaxis. This report presents use of presurgical compression and prophylactic passive pressure therapy with acrylic appliances for auricular keloids in a patient  . Spring and magnets were used in the design of custom-made appliances for compression and retention.

Neurofibromatosis type 1 (NF-1) is a heterogeneous autosomal dominant disease with an incidence ranging from 1 in 2500 to 1 in 3000. Rare intrathoracic vascular disorders resulting in massive spontaneous hemothorax with fatal consequences may occur in these patients, so also are various types of skeletal dysplasia which may result in dramatic presentations, posing management challenges to the attending physicians. We report the case of a 43-year-old woman with NF-1 who developed spontaneous massive hemothorax and was discovered to have a concurrent giant intrathoracic meningocele and thoracic kyphoscoliosis with severe vertebral dysplastic changes. Surgical treatment via a right thoracotomy with primary repair of the meningocele and spinal fusion with fibula graft resulted in good outcome. This case represents an extreme manifestation of this otherwise indolent disease in clinical practice.

Total gastrectomy for cancer results in many digestive troubles leading to an impairement of the quality of life. Different types of reconstruction have been proposed to improve the postoperative digestive functions. According to several prospective randomized trials and a recent meta-analysis, the Roux-en-Y jejunal pouch construction appears to be the best technique for reconstruction concerning the postoperative quality of life. However, this safe reconstructive surgery is not still recognized as a gold standard.

Objective: Treatment of mild and moderate hallux valgus deformities. Discussion: Minimally invasive technique enables surgeons to treat mild and moderate hallux valgus deformities with excellent and good results in the majority of patients. Nonunion of first metatarsal, moreover, has only rarely been reported. Summary: We describe the essential steps of a surgical technique for the treatment of nonunions after miniinvasive subcapital first metatarsal osteotomy reconstructed using a tricortical iliac crest bone graft.