Introduction Macrocephaly is a head circumference >2 SD above the age-matched mean. When due to untreated hydrocephalus, the head can become too large and heavy for postural control, impairing gross motor development and quality of life. While VP shunting or endoscopic third ventriculostomy (ETV) are the guideline-supported mainstays of infant hydrocephalus, late presenters may need

Introduction Radial polydactyly, a congenital anomaly characterized by duplication of the thumb, represents one of the most common preaxial limb anomalies, with an incidence of 0.08 to 1.4 per 1,000 live births [1]. The classification and surgical management of radial polydactyly remain challenging due to the heterogeneity of its presentations, particularly in cases that extend

Introduction  Craniosynostosis is a congenital condition characterized by the premature fusion of cranial sutures, leading to abnormal skull growth and elevated intracranial pressure. Early surgical correction is essential to prevent neurodevelopmental delays [1]. However, craniosynostosis surgery is often associated with significant intraoperative blood loss, posing increased risks in young children due to their lower circulating blood

Introduction Fractures involving the thumb IP joint are uncommon, particularly when complicated by soft tissue injury such as extensor tendon laceration. Traditional fixation methods including percutaneous K-wires or external skeletal distractors—carry risks such as pin tract infection, soft tissue irritation, or interference with tendon healing.  While traction methods such as dynamic external fixation have been

Introduction Triple-negative breast cancer (TNBC), defined by the absence of estrogen, progesterone, and HER2 receptors, accounts for 15–20% of all breast cancers and is characterized by rapid progression, high recurrence rates, and limited treatment options (Dent et al., 2008). TNBC exhibits distinct metastatic behavior, with a predisposition for visceral and central nervous system sites over

Introduction Free tissue transfer is a cornerstone of modern reconstructive surgery, providing durable coverage for extensive scalp and cranial defects. The success of such procedures depends on stable systemic perfusion and uncompromised microcirculatory flow. Sepsis and hypotension, however, complicate intraoperative management and may jeopardize flap survival. Historically, the intraoperative use of vasopressors was discouraged due

Introduction Polythelia refers to the presence of supernumerary nipples along the embryonic mammary ridge and is often an incidental, asymptomatic finding. While these structures are frequently dismissed as cosmetic variants, they may harbor glandular tissue capable of benign or malignant transformation, and require clinical evaluation when symptomatic (Fama’ et al., 2007). Histologically, they can mirror

Introduction Tuberous breast deformity is a rare congenital deformity characterized by abnormal breast development, often presented in the pubertal age. The hallmark feature of this deformity is changes in the breast morphology. It can present as both unilateral or bilateral and symmetric or asymmetric, which can lead to psychological distress in the patient, particularly due

Background HIV infection in severe burn patients provides a unique set of challenges in low to middle-income countries (LMIC). Burn trauma compromises cutaneous and mucosal barriers, inducing systemic inflammation and triggering cascades that promote viral reactivation. Sri Lanka has a very low prevalence of HIV, which is below 0.1% (NSACP, 2025). Guidelines from the STD/AIDS