European Journal of Molecular & Clinical Medicine

Anaesthesia for geriatric patients who are morbidly obese is quite challenging. Understanding anaesthetic care for such patients can be related to the description of fundamental alterations in physiology and changes in the pharmacokinetics and pharmacodynamics of anaesthetic medications. With advances in cardiology and cardiothoracic surgery, several newer implantable cardiac devices have become common in the surgical population. Cardiac pacemakers are generally required in patients with symptomatic bradycardia or severe conduction block. Many of the newer implantable cardiac electronic devices are targeted at managing heart failure. While managing such patients for non-cardiac surgeries, specific issues related to equipment characteristics and troubleshooting should be a priority for anaesthesiologists. There is a possibility of malfunction of the devices resulting in catastrophic outcomes. Intraoperative care of the pacemaker and understanding its anaesthetic implication is crucial in managing these high-risk patients. We present the anaesthetic management of a case of an elderly morbidly obese male patient, posted for inter-scapular non-healing ulcer debridement having a permanent pacemaker in situ in DDDR (dual-chamber rate-modulated) mode. The pacemaker was changed and inserted previously for complete atrioventricular (AV) block on electrocardiogram (ECG) and degenerative AV conduction disease with complete symptomatic AV (atrioventricular) block, on electrophysiology study. The pacemaker mode changed to asynchronous ventricular pacing mode preoperatively. Erector spinae block with field block was given. The patient tolerated the surgical procedure well, and vital parameters were maintained throughout the operation. After the operation, the patient was shifted to the intensive care unit (ICU), the pacemaker was reprogrammed to DDDR mode, and vigilant monitoring was done. Postoperatively patient developed iatrogenic pneumothorax which was managed successfully by the pulmonology team. The patient was then transferred to the ward on postoperative day 3 in stable condition. This case highlights that a good erector spinae plane block + field block along with vigilant monitoring and team effort is a reasonable choice for elderly obese patients with permanent pacemakers coming for elective surgeries

Background: Fournier's gangrene is aec necrotizing fasciitis of the genitalia and perineum that can lead to polymicrobial infection and organ failure or death. The goal of this study was to identify the pre presence systemic and local predisposing factors, management challenges, and outcome in Telangana. Fournier gangrene is a urologic emergency that has a high mortality rate. It is a polymicrobial necrotizing fasciitis of the perineal, perianal, and genital regions with a mortality rate ranging from 15% to 50%.
Aims & Objectives: This study was undertaken to find out the age and sex incidence, etiological and risk factors, clinical features and outcome of patients, and evaluate the treatment options for Fournier’s gangrene.
Methods: It is a prospective observational study conducted in hospitals attached to Govt Medical College &Hospital, Siddipet in Department of General Surgery from June 2020 to May 2022. A total of 40 cases fulfilling the inclusion criteria were included in the study. Factors like age, gender, etiology, risk factors, clinical features, site of involvement, type of bacterial flora, reconstructive procedure used, duration of hospital stay and mortality were studied.
Results: A total of 40 patients were studied. 26 male and 4 female patients were in the study. Males are most afflicted (82.5%). M:F-4.7:1 In females, vulval induration, necrosis, perineal and perianal abscess were found. Scrotum (most common site) was afflicted in 26, perineum in 8, penis in 5, groyne in 3, and vulva in 2 patients. Six in research group suffered total scrotum loss. Only 2 patients came within 24 hours following RTA with degloving injuries to scrotum, penis and perineum. Most were approximately 1 week with a mean presentation of 6.8 days following disease onset. Those who came after 1 week experienced severe morbidity, late recovery, numerous debridements and prolonged hospital stays.
Conclusions: This study suggests that earlier presentation, early diagnosis and treatment with prompt debridement and appropriate antibiotics are the main stay of treatment. The resulting soft tissue defects following debridement required surgicall reconstruction, thus decreasing morbidity, hospital stay and early return of patients to regular life

Background: Lateral premalleolar flap that is a reliable, study, and very useful to cover soft tissue defects of the distal leg, ankle, and foot but still remains underutilized and under-reported in the literature. 
Aims: To study the dimensions of the Lateral Premalleolar Flap that can be harvested with safety and its uses for the defects around the ankle.
Materials and methods: This retrospective study is conducted for 3 years included 12 patients irrespective of sex and age between 5-70 years with soft tissue defects around the ankle joint. Various dimensions were assessed and studied.
Results: A lateral premalleolar flap was performed in 12 patients in our study, all of whom were male (100 percent). The participants ranged in age from 15 to 70 years old, with a median age of 40.5 years. The defect was caused by trauma in 11 cases (91%), and electrical burns in one patient (9 percent ). The defect was seen in the anterior lower leg in seven patients (58%) and the medial malleolus in two patients (17%), the dorsum of the foot in one patient (8%), and the Achilles tendon in two patients (17 percent ). Eight flaps (66%) survived entirely, while four patients (34%) had partial necrosis, requiring revision and reinset in two patients (17%) and debridement and skin grafting in the other two (17%). 
Conclusions: Because of its reliable blood supply, short operating time, minimal equipment, and ease of execution under regional anesthesia with minimal blood loss and without sacrificing any major vessels, the lateral Premalleolar flap is a good option for lower third leg, dorsum of foot, and posterior ankle defects.

Introduction-Chronic osteomyelitis is a therapeutic challenge and even with proper management it is seldom cured. The usual surgical management involves extensive surgery and prolonged hospitalisation. In cases where only intramedullary variety of infection is present, we can proceed with a less debilitating procedure. In this study our aim is to prove the efficacy of limited intramedullary reaming and medulloscopy with post operative suction-irrigation for managing this kind of osteomyelitis.
Methods and Materials - This study was conducted since June 2018 to May 2020 in which we operated nine patients of medullary chronic osteomyelitis with our technique. The inclusion criteria is Patients with Radiographic / MRI proven Chronic osteomyelitis of medullary variety of Femur or Tibia. Entry points were made at proximal and distal ends of lesion in the bone. The medullary cavity was reamed from proximal and distal points using hand reamers. An arthroscope was used to visualise the medullary cavity for remaining infectious nidus. Post operatively a continuous suction-irrigation system was placed.
Results- Eight patients were followed up for a mean duration of 13 months. At final follow up all the patients were free of symptoms without any pain and discharging sinus.The mean ESR and CRP levels at the time of presentation was 28 and 5.67 respectively and at the final followup was 12 and 0.60 respectively.
Conclusion- Intramedullary debridement using a reamer and arthroscope gives good results as a single staged procedure. With addition of suction-irrigation system it clears off any remaining nidus of infection.

Background: The annual incidence of diabetic foot ulcer (DFU) in population-based studies is 1.0 to 4.1% and prevalence of 4.5 to 10%, with an overall lifetime incidence of up to 25%. Surgical management (such as dressing, offloading, debridement, and the necessary surgeries) play an important role in controlling/healing DFU.Present study was aimed to study surgical management of diabetic foot at our tertiary hospital.