Thorsen Mitchell (taxipaul7)

Reconstruction of nasal defect is difficult and challenging. A full-thickness defect of nose requires reconstruction of thin inner lining, middle skeletal (bony/cartilaginous) support, and outer skin layer cover. Large full-thickness defects of nose require complex multistage reconstruction to achieve good functional and aesthetic result. We present here a case of 12-year-old boy, a known case of xeroderma pigmentosa, who underwent wide local excision for squamous cell carcinoma of the nose, leaving a near total defect of the external nose. The reconstruction was done with a suprafascial, thin radial artery forearm free-flap for the external cover as well as the inner lining along with the septal cartilage graft for skeletal support in a single stage.Large upper central chest wall defects are a reconstructive challenge. The commonly described flaps for this area do not provide very large skin paddle, and free tissue transfer remains the only option for large skin defects. Supraclavicular flap as a local flap is widely used for head and neck reconstruction and has been described for upper chest wall defects earlier. We have used nonislanded supraclavicular flap for reconstruction of two cases of large chest wall defects, which would otherwise need free tissue transfer, single flap in one case and bilateral flaps in the other. It is easy to do and has minimal morbidity. Supraclavicular flap offers a simple solution for large skin defects of the upper central chest wall and is especially useful in patients with high-operative risk and guarded prognosis.The development of a tracheocutaneous fistula (TCF) is a well-documented complication after tracheostomy, especially in chronic morbid patients, in whom tubes or cannulas are left in place over time, or in irradiated patients. Surgical treatments are therefore needed which range from simple curettage and dressings to local skin flaps, muscle flaps and, in the more complex cases, microsurgical free tissue transfers. We present a novel combined technique used to successfully treat recurrent TCFs in irradiated patients, involving a superiorly based turnover fistula flap and a sternocleidomastoid transposition flap.Sternal cleft (SC) is a rare congenital malformation which can be partial or complete. We report a case of complete SC in a 9-month-old child. Our technique involves a combination of reinforcement with the deep cervical fascial extension, followed by the anterior perichondrial flaps, bridged with the rib graft, incorporating surplus resected cartilaginous xiphoid process, and covered with the bilateral pectoralis major muscle flap for the chest wall reconstruction with 3D printing assisting preoperative planning. The size of the defect in relation to the age of presentation was a deciding factor in the adoption of this alternative surgical technique.In this article, I reflect on my experience of being awarded the International Resident Travel Scholarship for "Plastic Surgery the Meeting 2019." I was the first Indian to be awarded the scholarship, and it offered me not only monetary assistance but also mentorship for future leadership positions. The award further opened doors for several future opportunities in the form of memberships in the American Society of Plastic Surgery (ASPS) committees and Resident Advisory Board of the prestigious "Plastic and Reconstructive Surgery Journal." I believe this article will make more residents aware and utilize such opportunities for their career development.Tendon transfer for ulnar palsy has been an area of interest for many a stalwart in hand surgery, especially in southeast Asian countries, mainly because of the prevalence of Hansen's disease in these countries. Although the procedures look standardized, there are still many lacunae. Here in this article, we discuss about a surgical technique by which all the motor disabilities evolving due to ulnar nerve paralysis are addressed with three sets of tendon transfers performed in a s