A Quadrangular Flap Technique for Vermilion Repair in Unilateral Cleft Lip

Summary: In unilateral cleft lip repair, the vermilion triangular flap technique reported by Noordhoff1 and its modification are widely accepted for the augmentation of the vermilion height on the medial side of the cleft; however, these techniques do not focus on the deformity of the labial tubercle. In this article, we herein report a modified technique for vermilion repair that is focused on the labial tubercle. The muco-vermilion quadrangular flap was elevated from the lateral lip to augment the labial tubercle. As a result, the amount of labial tubercle is appropriate. Fifty-three consecutive unilateral cleft lip repairs were performed. In most cases, the amount of the labial tubercle was appropriate, and the curvature of free margin was preferable. The technique could reduce the number of scars on the vermilion by placing some of the suture lines on the oral surface and enabled the augmentation of the labial tubercle. In conclusion, the quadrangular flap can be considered an ideal flap for the construction of the vermilion.

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Incarcerated congenital transmesenteric hernia in an adult: a case report

Abstract

Transmesenteric hernia is a rare cause of bowel obstruction and strangulation. It can be due to iatrogenic injury, trauma, inflammatory and less likely congenital. We present a case of true congenital transmesenteric hernia in a 26-year-old male with no previous surgical history or trauma. The patient presented acutely with no prior symptoms. Investigations provided limited information towards the diagnosis of the hernia, but suggestive of mid-gut volvulus. Emergency laparotomy was performed to find >75% of small bowel herniating through a proximal jejunal mesenteric defect leading to incarceration and early strangulation. No resection was required and patient recovered well. This case presents yet another rare pathology and highlights the importance of keeping a low threshold for operative intervention in uncertain cases.

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Traumatic diaphragmatic rupture with underlying lung laceration and tension pneumoperitoneum

Abstract

Tension pneumoperitoneum is commonly caused by gastrointestinal perforation and pulmonary causes are extremely rare. We present a case of a 47-year-old male post motor vehicle accident with a suspected left-sided haemopneumothorax on initial chest x-ray. CT of the chest post chest tube insertion showed a left-sided diaphragmatic rupture and an extensive diaphragmatic hernia. While en-route to the operating theatre, the intubated patient developed tension pneumoperitoneum with positive pressure ventilation and required immediate surgical intervention and repair. A review of the literature around tension pneumoperitoneum and diaphragmatic hernia in trauma is discussed.

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Hybrid approach to the management of infective endocarditis complicated by coronary artery embolism: a case report

Abstract

Septic coronary embolization in a patient with endocarditis is a rare and can be a devastating complication. The management of this clinical problem in the current era may be best served with a multi-modality approach. We present an interesting case of a patient with septic coronary embolization managed with the combined use of aspiration thrombectomy followed by surgical management of the infected valve.

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Acne keloidalis nuchae: risk factors and associated disorders – a retrospective study

Abstract

Background

Acne keloidalis nuchae (AKN) is a chronic scarring folliculitis which usually occurs in young adult males of African descent. Studies have suggested that AKN may be associated with other dermatologic conditions and even general medical disorders. The aim of this study was to identify cutaneous and extracutaneous associated disorders and to examine risk factors in our population for developing AKN.

Methods

The study was a retrospective, descriptive, and analytical study conducted at the Dermatology Outpatient department of the University Hospital of the West Indies. Data were obtained from the medical records of patients diagnosed over a 15-year period (2000–2014).

Results

There were 1031 new patients during the study period. Of these, 43 (4.2%) had AKN. The male to female ratio for AKN was approximately 7:1. Pseudofolliculitis barbae was associated with keloidal plaques on the scalp (OR = 6.22, P = 0.036). Also, when the duration of AKN was divided into two groups (0–5 years and greater than 5 years), there was an association between keloidal plaques and duration of greater than 5 years (OR = 7.5, P = 0.032). However, when the odds ratio was adjusted, only the duration of AKN remained significantly associated with keloidal plaques (OR = 7.08, P = 0.047). Chronic scalp folliculitis (P = 0.001) and the presence of any component disease of the metabolic syndrome (OR = 14, P = 0.008) and specifically hypertension (OR = 6.75, P = 0.036) were significantly associated with the extension of the lesions beyond the nape and occipital scalp.

Conclusions

Pseudofolliculitis barbae, chronic scalp folliculitis, and aspects of the metabolic syndrome may be associated with acne keloidalis nuchae.

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Severe colloid milium presenting as papillomatosis cutis associated with vitiligo

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Intrinsic and Extrinsic Causes of Malignancies in Primary Immunodeficiency Disorders

Malignancies occur with a higher incidence rate and manifest earlier in life in patients with primary immunodeficiency disorders (PID) than in the general population. However, no universal mechanism of malignancy predisposition in PID can been determined. Despite the strong support for the physiological role of tumor immunosurveillance and increasing success of strategies in immunological tumor therapy, which include checkpoint inhibition, monoclonal antibodies, and engineered T cell antigen receptors, the incidence and pattern of malignancies in PID do not reflect an increased tumor immune escape per se.

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