Background: Skin grafting is a procedure designed to restore the integrity of the skin. The primary reasons for skin graft failure include seroma, hematoma, and infection. These complications hinder the graft's adherence and revascularization, raising the risk of graft rejection, especially during the early postoperative period and aesthetic outcome later.
Objective: The purpose of this study is to analyse graft acceptance and rejection due to seroma or infection, as well as the timing of the first check dressing on the third day compared to the fifth day and assessing the aesthetic outcome.
Methods: A comparative and prospective study was conducted at our institution from June 2023 to July 2025 involving 200 patients who underwent split-thickness skin grafting (STSG) and were divided into two groups. In Group A, the initial postoperative dressing was applied on day 3, while in Group B, it was done on day 5. The second postoperative dressing occurred two days after the first. The skin grafted area was evaluated for incidence of seroma ,infection, the percentage of graft uptake and rejection, using both culture sensitivity testing and clinical observation.
Results: The findings indicated that the average graft uptake in Group A was 88.5%, compared to 81.93% in Group B during the first dressing with better aesthetic outcome in group A. During the second dressing, Group A showed 88.24% and Group B showed 78.03%
Conclusion: Performing the initial postoperative dressing on the third day after skin grafting significantly enhances final graft acceptance and aesthetic outcome.

Background: Nurses play a crucial role in ensuring patient safety during intravenous therapy. Awareness of vascular extravasation is essential for preventing tissue injury and promoting evidence-based care. Considering the clinical importance of intravenous injections, their potential complications, and the limited awareness among emergency nurses, this study aimed to assess the level of knowledge regarding vascular extravasation among nurses working in the emergency departments of Khatam-al-Anbia and Ali Ibn Abi Talib hospitals in Zahedan.
Methods: This cross-sectional descriptive study was conducted on 77 emergency department nurses from Khatam-al-Anbia and Ali Ibn Abi Talib hospitals in Zahedan during 2024–2025. Data were collected using a validated, researcher-developed questionnaire assessing six domains of extravasation knowledge. Statistical analysis was performed using SPSS version 24, and relationships between awareness scores and demographic variables were analyzed using the independent t-test, with the significance level set at p < 0.05.
Results: The mean age of participants was 34.4 ± 6.8 years, and 62.3% were female. The overall mean knowledge score was 34.2 ± 5.6 (range: 19–46) out of a maximum of 72, indicating a generally low level of awareness. In total, 61% of nurses demonstrated low awareness and 39% demonstrated moderate awareness, while none achieved a high level. The results showed a significant association between awareness scores and both educational level and participation in training courses (p < 0.05), whereas no significant relationship was found with age, gender, or work experience.
Conclusions: The findings indicate that a considerable proportion of emergency nurses possess inadequate knowledge regarding vascular extravasation. Structured and continuous training programs are strongly recommended to enhance awareness, improve prevention and management skills, and ensure safer intravenous practices in emergency settings.

Introduction: Frontal sinus ostium stenosis is a common postoperative challenge in endoscopic sinus surgery, potentially leading to disease recurrence. Imiquimod is an immunomodulatory agent with anti-inflammatory and antifibrotic properties, recently gaining attention in experimental studies.
Objective: To evaluate the safety of low-dose topical imiquimod cream in reducing the rate of frontal sinus ostium stenosis following endoscopic sinus surgery.
Methods: This pilot randomized intra-patient controlled clinical trial was conducted on 20 patients with CRSwNP. Each patient underwent bilateral Draf 2a surgery. One frontal sinus was randomly assigned to receive Gelfoam impregnated with 5% imiquimod cream, with applications repeated in the second and fourth postoperative weeks. The contralateral side served as the control. Patients were assessed at week 4 and month 3 postoperatively via endoscopic and CT imaging. Endoscopic scores were based on the DIP system, and the STDR ratio was evaluated using 3D CT reconstruction. Data analysis was performed using paired t-tests and Wilcoxon tests at a significance level of 0.05.
Results: At three months post-surgery, STDR was significantly lower on the intervention side (p < 0.05), indicating reduced soft tissue density and opacification. Endoscopic evaluation also showed a marked improvement in polyp and inflammation scores on the treated side. No significant differences were observed at one month. No major local or systemic adverse effects were reported.
Conclusion: Topical application of low-dose imiquimod cream after endoscopic sinus surgery may effectively reduce inflammation, discharge, polyp formation, and opacification in the frontal sinus, and may be considered a safe preventive option for ostium stenosis. Larger trials are recommended to confirm these findings

Pleomorphic leiomyosarcoma (PLMS) is a rare malignant tumor of smooth muscle origin. Primary hepatic localization is extremely uncommon, with only a few cases reported in the literature. We present a case of primary hepatic PLMS diagnosed and surgically treated in our institution.
An 83-year-old female presented with abdominal pain and vomiting. Her medical history included previous surgery for hepatic hydatid cyst. Laboratory analysis revealed elevated cholestatic enzymes and bilirubin levels. Dynamic liver CT showed a 200×136 mm hypodense lesion with septal enhancement in the right lobe extending partially to the left (Figure 1). Thoracic CT demonstrated right pleural effusion. After preoperative optimization, surgery was performed. Intraoperatively, a 30×20 cm semisolid mass was identified, and frozen section analysis suggested a borderline tumor. Extended right hepatectomy (trisectionectomy) involving the right and middle hepatic veins was performed. The postoperative course was uneventful, and the patient was discharged. Final histopathological examination confirmed the diagnosis of pleomorphic leiomyosarcoma.
Primary hepatic PLMS is exceedingly rare. Curative surgical resection remains the mainstay of treatment and offers the best chance for long-term survival. This case highlights the importance of aggressive surgical management in rare hepatic sarcomas.

Warfarin remains a cornerstone anticoagulant therapy for patients with mechanical heart valves but carries significant bleeding risks. Ovarian hemorrhagic cysts represent a rare but potentially life-threatening complication in women of reproductive age receiving anticoagulation therapy. The combination of warfarin overdose and ovarian bleeding can result in severe hemoperitoneum requiring emergency intervention. I present the case of a 48-year-old woman with a history of mitral valve replacement who was admitted to the emergency department with acute pelvic pain. The patient had been receiving warfarin therapy for mechanical valve anticoagulation and developed signs of warfarin overdose with an International Normalized Ratio of 8.9. Computed tomography revealed a large hemorrhagic ovarian cyst with associated hemoperitoneum. Conservative management was initially attempted with warfarin reversal using prothrombin complex concentrate. However, due to hemodynamic instability, the patient required emergency laparotomy. Right salpingo-oophorectomy was performed. The patient recovered fully and was discharged on postoperative day 9. Emergency physicians and surgeons should maintain high clinical suspicion for ovarian hemorrhagic complications in women of reproductive age receiving anticoagulation therapy, particularly when presenting with acute pelvic pain, oliguria, and elevated coagulation parameters. Early recognition, appropriate reversal of anticoagulation, and timely surgical intervention when indicated can prevent life-threatening complications and preserve reproductive function.

Letter to the Editor:
Vascular access is a foundational clinical skill in surgical practice with wide applicability in trauma, vascular surgery, critical care, and interventional procedures. While traditional landmark-based techniques have long been taught, robust evidence supports the superiority of ultrasound-guided vascular access for increasing first-pass success, reducing complications, and improving overall patient safety. Similarly, fluoroscopy-guided access remains essential for complex vascular procedures and should be taught systematically early in surgical training.
Ultrasound-guided access training has been shown to significantly improve procedural success and reduce safety risks compared to traditional techniques. Simulation-based curricula provide residents with repeated practice and objective feedback in a low-risk environment, leading to measurable performance gains. Moreover, simulation curricula specifically designed for femoral arterial access have demonstrated marked improvement in resident technical ability and confidence. In addition, novel educational interventions such as web-based and mastery learning systems show promise in facilitating skill acquisition even outside traditional clinical settings.
Comparative studies have also highlighted procedural advantages of ultrasound guidance over fluoroscopy for common femoral artery access, including higher cannulation success and reduced inadvertent punctures—critical insights that ought to guide surgical education priorities. As surgical practice increasingly integrates imaging modalities into both elective and emergency workflows, formal training in ultrasound and fluoroscopic techniques must be incorporated into residency curricula to ensure graduating surgeons are competent, safe, and prepared for modern clinical demands.
We therefore advocate for structured training modules in ultrasound- and fluoroscopy-guided vascular access, including dedicated simulation sessions, supervised clinical application, and objective competency assessments. Incorporating these skills into surgical residency education aligns training with contemporary practice, enhances patient safety, and equips future surgeons for the evolving scope of vascular and interventional care.