Indian Journal of Plastic Surgery
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   Table of Contents - Current issue
January-April 2016
Volume 49 | Issue 1
Page Nos. 1-134

Online since Wednesday, May 11, 2016

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Privileges p. 1
Mukund Jagannathan
DOI:10.4103/0970-0358.182256  PMID:27274115
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Reed O. Dingman p. 3
Mukund Jagannathan
DOI:10.4103/0970-0358.182255  PMID:27274116
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Novel expansion techniques for skin grafts p. 5
Dinesh Kadam
DOI:10.4103/0970-0358.182253  PMID:27274117
The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal–epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials.
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Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer p. 16
Hari Venkatramani, Praveen Bhardwaj, Adam Sierakowski, S Raja Sabapathy
DOI:10.4103/0970-0358.182232  PMID:27274118
Introduction: We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. Materials and Methods: In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes–Weinstein monofilament testing. Observation and Results: The average Tamai score was 69 (range 60–83.5). Six patients achieved 'good' outcomes and one patient, with a double toe transfer, an 'excellent' outcome. The average follow-up time was 43 months (range 10–148 months). Conclusion: This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.
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Management of fourth degree obstetric perineal tear without colostomy using non - stimulated gracilis - our experience over eleven years p. 26
Jiten Kulkarni, Anuradha J Patil, Bhaskar Musande, Abhishek B Bhamare
DOI:10.4103/0970-0358.182236  PMID:27274119
Background: Although gracilis muscle transposition for faecal incontinence has been well-described method, its literature for use in obstetric perineal tear without colostomy is sparse. In this study, we have tried to analyse its use in fourth-degree obstetric perineal tears. Patients and Methods: A total of 30 patients with recto-vaginal fistula with faecal incontinence secondary to obstetric perineal tear were retrospectively studied between February 2003 and May 2014. The recto-vaginal fistula was explored, dissected and identification of sphincters was done using muscle stimulator. Fistula closure was done followed by sphincter repair, vaginal tightening procedure and single gracilis transposition. None of the patients had covering colostomy. Faecal incontinence was assessed pre- and post-operatively by digital rectal examination (single examiner), Park's score and Corman's score in all cases and using barium hold and transperineal ultrasonography, manometric studies in a few cases. The outcome was measured at an average follow-up of 8.8 months (7–24 months). Results: As per Park's score 26 patients had Grade I continence, two had Grade II and two patients had Grade III continence. Corman's score improved from fair to excellent in 26 patients. The patients in whom manometry was performed showed a remarkable rise in both resting and squeeze pressures. Two patients developed post-operative infections in upper 1/3 thigh incision site and three patients at gluteal region scar site. Conclusion: Satisfactory continence following gracilis muscle could be achieved.
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A case series of flow-through free anterolateral thigh flap to augment the vascularity of ischaemic limbs with soft tissue defect p. 35
Aditya Aggarwal, Hardeep Singh, Sanjay Mahendru, Vimalendu Brajesh, Sukhdeep Singh, Srinivasan Krishnan, Rakesh Kumar Khazanchi
DOI:10.4103/0970-0358.182229  PMID:27274120
Introduction: In a world of fast moving vehicles, heavy machinery and industries crush injury to limbs with vascular compromise and soft tissue defect is common. The traditional treatment is a 2 step one dealing with vascular repair and soft tissue cover separately, in the same operation. We report a series of single step vascular repair and soft tissue cover with flow through anterolateral thigh flap (ALT) flap for limb salvage. Materials and Methods: Ten patients with soft tissue defect and vascular injury were included in this study. A two team approach was used to minimise operative time, team one prepared the vessels and team 2 harvested the flap. Observations and Results: Of the ten patients operated (8 males), eight flaps were done for upper limb and two for lower limb salvage. Six anastomosis were done with ulnar vessels, two with radial and two with posterior tibial vessels. Nine extremities could be salvaged while one patient developed progressive thrombosis leading to amputation. Conclusion: The ALT flow-through flap is a versatile single step procedure that can be used to salvage an ischemic limb with soft tissue loss avoiding the need for interpositional vein graft.
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Presurgical nasoalveolar moulding in unilateral cleft lip and palate p. 42
Mohammed Zuhaib, Krishnamurthy Bonanthaya, Renu Parmar, Pritham N Shetty, Pradeep Sharma
DOI:10.4103/0970-0358.182235  PMID:27274121
Context: Presurgical nasoalveolar moulding (PNAM) is a non-surgical method of reshaping the cleft lip, alveolus, palate and the nose to minimize the severity of the cleft deformity, before primary cheiloplastyand palatoplasty. In this context, PNAM proves to be an invaluable asset in the management of unilateral cleft lip and palate. Aims: The study was conducted to evaluate the effi cacy of PNAM in the management of unilateral cleft lip and palate with the following objectives: (1) To assess and compare the degree of reduction in the size of cleft palate and alveolus (pre-PNAM and post-PNAM). (2) To evaluate and compare the improvement in columellar length and correction of columellar deviation (pre-PNAM and post-PNAM). (3) To assess the changes in the position of the alar base and the alar cartilages. Settings and Design: Prospective study. Subjects and Methods: A prospective study consisting of, which included 20 patients with complete unilateral cleft lip and palate was conducted. The age at the start of PNAM treatment of the infants ranged from 2 to 44 days of age reporting to our institute between December 2011 and August 2013. All the patients underwent PNAM therapy before primary cheiloplasty at 6 months of age; clinical parameters were assessed pre- and post-therapy using photographs and dental study models of the maxilla. Statistical Analysis Used: Student's t-test for paired comparisons. Results: Results of the study showed a promising reduction in the cleft size before the surgery, signifi cant improvement in nasal symmetry, including the columellar length on the cleft side. Conclusions: PNAM is a valuable adjunct to our surgical armamentarium in dealing with the challenges of primary closure of unilateral cleft lip and palate thereby enhancing the overall surgical outcome. The advantages of this method include the simplicity of the procedure and improving the quality of surgical repair, particularly in obtaining tension free muscle closure in unilateral clefts.
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Cadaveric study using radio-opaque contrast to determine arterial communication between the two bellies of gastrocnemius muscles p. 53
Pawan Agarwal, KL Gupta, P Yadav, Dhananjaya Sharma
DOI:10.4103/0970-0358.182240  PMID:27274122
Introduction: Gastrocnemius muscle is a workhorse flap to cover upper third tibial defects but has a limitation in covering middle one-third tibial defects. The inferiorly based hemi gastrocnemius muscle flap can be useful for reconstruction of the middle third of the leg. The arterial communication between the gastrocnemius muscle heads has been demonstrated, the consistent location, however, was not studied in large specimens. Materials and Methods: This study was conducted on sixty specimens of gastrocnemius muscles harvested from thirty fresh cadavers to determine arterial communication between two heads of gastrocnemius muscle using radio-opaque contrast with future application of taking one head of muscle distally based for coverage of middle third defect of tibia. A total of 60 specimens were obtained from thirty fresh cadavers. In thirty specimens, medial sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. In remaining thirty specimens lateral sural artery ligated and divided and 20 ml iohexol (350) given through popliteal artery. Digital X-rays of gastrocnemius muscle specimens were taken, and collaterals between two bellies in lower half were noted and the distance of collaterals from the muscles top edge was also noted. Results: We found the communications between both bellies of the gastrocnemius muscle in all specimens in both legs. The mean distance of communications from the upper edge of the medial belly was 15.88 cm and from upper edge of the lateral belly was 14.72 cm in the right leg, respectively. The mean distance of communications from upper edge of the medial belly was 16.01 cm and from upper edge of the lateral belly was 13.78 cm in the left leg. The distal communications between gastrocnemius bellies were not constant in their location, but all the connections were present in distal 3.79 cm of raphe. Conclusion: This study supports the future application of inferior-based hemigastrocnemius muscles flap to cover defects of middle third leg. When distally based hemigastrocnemius flap is planned roughly 1/3rd of distal attachment or distal 3.79 cm of connection between raphe should be maintained to preserve the vascular communications between the two bellies.
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Preauricular transmasseteric anteroparotid approach for extracorporeal fixation of mandibular condyle fractures p. 59
Rajasekhar Gali, Sathya Kumar Devireddy, Kishore Kumar Rayadurgam Venkata, Sridhar Reddy Kanubaddy, Chaithanyaa Nemaly, Mallikarjuna Dasari
DOI:10.4103/0970-0358.182254  PMID:27274123
Introduction: Free grafting or extracorporeal fixation of traumatically displaced mandibular condyles is sometimes required in patients with severe anteromedial displacement of condylar head. Majority of the published studies report the use of a submandibular, retromandibular or preauricular incisions for the access which have demerits of limited visibility, access and potential to cause damage to facial nerve and other parotid gland related complications. Purpose: This retrospective clinical case record study was done to evaluate the preauricular transmasseteric anteroparotid (P-TMAP) approach for open reduction and extracorporeal fixation of displaced and dislocated high condylar fractures of the mandible. Patients and Methods: This retrospective study involved search of clinical case records of seven patients with displaced and dislocated high condylar fractures treated by open reduction and extracorporeal fixation over a 3-year period. The parameters assessed were as follows: a) the ease of access for retrieval, reimplantation and fixation of the proximal segment; b) the postoperative approach related complications; c) the adequacy of anatomical reduction and stability of fixation; d) the occlusal changes; and the e) TMJ function and radiological changes. Results: Accessibility and visibility were good. Accurate anatomical reduction and fixation were achieved in all the patients. The recorded complications were minimal and transient. Facial nerve (buccal branch) palsy was noted in one patient with spontaneous resolution within 3 months. No cases of sialocele or Frey's syndrome were seen. Conclusion: The P-TMAP approach provides good access for open reduction and extracorporeal fixation of severely displaced condylar fractures. It facilitates retrieval, transplantation, repositioning, fixing the condyle and also reduces the chances of requirement of a vertical ramus osteotomy. It gives straight-line access to condylar head and ramus thereby permitting perpendicular placement of screws with minimal risk of damage to the facial nerve.
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Direct brow lifting: Specific indications for a simplified approach to eyebrow ptosis p. 66
Michele Pascali, Ilaria Bocchini, Anna Avantaggiato, Francesco Carinci, Valerio Cervelli, Fabrizio Orlandi, Davide Quarato
DOI:10.4103/0970-0358.182243  PMID:27274124
Context: Brow lifting is an essential element in the rejuvenation of the ageing face. Various surgical techniques have been described. Among these, the direct brow lifting is an easy and effective technique that is often neglected because the scar can remain visible. Thus, this approach is usually reserved for elderly patients and males, with thick bushy brows. Aims: The authors present their result from a series of fifty consecutive patients treated over 2 years with direct brow lift. The aim is to demonstrate when the hairline is high or temporal alopecia is present and whether this technique is the best in bald patients, when some surgical steps are carefully adhered to. In these cases, the scar is less visible, hidden in the brow and is a good solution in women too. Subjects and Methods: Between January 2011 and January 2013, fifty patients underwent direct brow lift surgery. All were men. In all the cases, brow lifting was undertaken together with an upper blepharoplasty. The amount of brow elevation produced was assessed by comparing the vertical distances between the superior eyebrow hairline and the inter-pupillary line, pre- and post-operatively. The result and the scar quality were assessed both by the patient and the surgeon. Statistical Analysis Used: The paired t-test. Results: The authors obtained statistically significant results in brow elevation in 98% of the patients after a 12-month follow-up. The main complication associated with this procedure was visibility of the scar in two patients. Conclusions: The direct brow lift technique in bald men and with a high anterior hairline provides excellent and long-lasting results.
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An audit cycle of consent form completion: A useful tool to improve junior doctor training p. 72
Catherine Leng, Kavita Sharma
DOI:10.4103/0970-0358.182246  PMID:27274125
Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.
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Indigenous technique of fabricating vaginal mould for vaginal reconstruction and uterine drainage in McIndoe vaginoplasty using 10 ml syringe p. 76
Brijesh Mishra, Gaurav Janavar, Yashodhara Pradeep, Arun K Singh, Vijay Kumar, Divya N Upadhyay
DOI:10.4103/0970-0358.182230  PMID:27274126
Absence of vagina poses multitude of physical and psychosocial problems in woman's life. 10% of Mayer- Rokitansky-üster-Hauser (MRKH) syndrome patients with high vaginal septum and vaginal atreisa has additional issue of draining uterine cavity. MC Indoe vaginoplasty is universally acceptable and widely practiced procedure for neocolposis reconstruction. Simultaneous reconstruction of vagina with simultaneous continued uterine drainage presents surgical challenge. We offer a simple solution of creating a vaginal mould using a 10 ml disposable syringe, which enables graft application of neovaginal cavity with simultaneous protected uterine drainage per vaginum. Total 10 patients were included in this study of which 4 needed uterine drainage procedure in addition to neovaginal creation. All the patients fared well, there were no problems regarding graft loss or vaginal mould extrusion etc. Fabrication of mould for graft enables easy dressing changes with out disturbing the skin graft. This innovation offers a simple easily reproducible and cheap way of fabricating vaginal mould for McIndoe vaginoplasty. It is especially useful for neovaginal graft application and simultaneous uterine drainage.
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Considerations for double-hand replantation in a resource-constrained healthcare facility p. 81
Bibhuti Bhusan Nayak, Nilamani Mohanty, Annada Prasad Patnaik, Prasanta Kumar Bal
DOI:10.4103/0970-0358.182233  PMID:27274127
Bilateral-hand amputation is extremely rare and double-hand replantation is even rarer. Only one case of successful double replantation at arm level has been reported from India. We present a case of double-hand replantation at proximal palmar level in a young adult executed in a small nursing home. The patient presented 5 h after injury with limbs preserved well in ice. There were difficulties in executing such an unusual case in a small nursing home set-up. The patient is performing his activities of daily living and basic functions independently. We share our experience of this double-hand replantation with special emphasis on problems encountered.
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Nerve sparing clitoroplasty in a rare case of idiopathic clitoromegaly p. 86
Abha Rani Kujur, Vijay Joseph, Praveen Chandra
DOI:10.4103/0970-0358.182241  PMID:27274128
Clitoromegaly is an embarrassing condition causing psychological stress, requiring intervention. The goals of clitoroplasty are to achieve normal genital anatomy and to preserve tactile sensation with a satisfactory sexual response. We present a rare case of idiopathic clitoromegaly managed by reduction clitoroplasty, preserving the dorsal neurovascular bundle and extensive network of nerves around the corpora to the glans and the creation of labia minora.
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Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis p. 91
Toshihiko Satake, Reiko Nakasone, Shinji Kobayashi, Jiro Maegawa
DOI:10.4103/0970-0358.182248  PMID:27274129
The lumbar artery perforator (LAP) flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast.
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Double free-flap for a bimalleolar defect of lower leg and ankle p. 95
Naren Shetty, Narendra S Mashalkar, Sunder Raj Ellur, Karishma Kagodu
DOI:10.4103/0970-0358.182250  PMID:27274130
Double free-flaps are necessary when tissue cover cannot be sufficed with a single flap. The other factors to be considered when using two free flaps for resurfacing of distal limb defects are the availability of more than one recipient vessel, the risk of distal limb ischaemia and the donor site morbidity of double flap harvest. If these factors are adequately addressed, double free-flaps can be safely executed for resurfacing distal limb defects with minimal morbidity. We report the simultaneous harvest and transfer of the anterolateral and anteromedial thigh flaps inset and vascularised as double free-flaps to resurface a large bimalleolar defect in a 14-year-old boy with no additional morbidity as compared to that of a single free tissue transfer.
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Successful microsurgical replantation of an amputated penis p. 99
Sanchit Garg, Shivprasad V Date, Arunesh Gupta, Amresh S Baliarsing
DOI:10.4103/0970-0358.182257  PMID:27274131
Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.
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Palatoglossal fusion with cleft palate and hypoplasia of cerebellar vermis p. 106
Shailesh Solanki, M Narendra Babu, Gowrishankar , S Ramesh
DOI:10.4103/0970-0358.182238  PMID:27274132
A new-born male presented within 12 h of birth with respiratory distress. On examination and workup, he had palatoglossal fusion, cleft palate and hypoplasia of the cerebellar vermis. A 2.5 Fr endotracheal tube was inserted into the pharynx through nostril as a nasopharyngeal stent, following which his respiratory distress improved. Once child was optimised, then feeding was started by nasogastric tube and feeds were tolerated well. Elective tracheostomy and gastrostomy were done, followed by release of adhesions between the tongue and palate at a later stage. Review of literature suggests that palatoglossal fusion is uncommon and presents as an emergency. Mostly, these oral synechiae are associated with digital and/or cardiac anomaly. Other disorders associated with intra-oral synechiae include congenital alveolar synechiae, van der Woude syndrome, popliteal pterygium syndrome and oromandibular limb hypogenesis syndrome. The authors report a hitherto undescribed association of palatoglossal fusion with cleft palate and hypoplasia of the cerebellar vermis.
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Hand replantation: First experience in a sub-Saharan African country (Togo) p. 109
Komla Sena Amouzou, Komla Amakoutou, Batarabadja Bakriga, Anani Abalo, Assang Dossim
DOI:10.4103/0970-0358.182228  PMID:27274133
Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chen's criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.
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Glial heterotopia of the lip: A rare presentation p. 112
Mehmet Dadaci, Fazli Cengiz Bayram, Bilsev Ince, Fatma Bilgen
DOI:10.4103/0970-0358.182244  PMID:27274134
Glial heterotopia represents collections of normal glial tissue in an abnormal location distant to the central nervous system or spinal canal with no intracranial connectivity. Nasal gliomas are non-neoplastic midline tumours, with limited growth potential and no similarity to the central nervous system gliomas. The nose and the nasopharynx are the most common sites of location. Existence of glial heterotopia in the lip region is a rare developmental disorder. We report a case of large glial heterotopia in the upper lip region in a full-term female newborn which had intracranial extension with a fibrotic band. After the surgery, there was no recurrence in the follow-up period of 3 years. When glial heterotopia, which is a rare midline anomaly, is suspected, possible intracranial connection and properties of the mass should be evaluated by magnetic resonance imaging. By this way, lower complication rate and better aesthetic results can be achieved with early diagnosis and proper surgery.
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Hot-press hand injury caused by roller type ironing machine p. 116
Abdul Kerim Yapici, Umit Kaldirim, Ibrahim Arziman, Sukru Ardic, Murat Eroglu
DOI:10.4103/0970-0358.182245  PMID:27274135
Thermal crush burn injury due to roller type ironing press machine is relatively rare and can cause destructive effects with significant morbidity. These injuries can be avoided by taking some basic precautions. Early debridement after admission and definitive treatment after the extent of injury are delineated and these are the preferred approaches in the management. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine.
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Reinforcement of peritoneal repair in donor site post-concurrent laparotomy and rectus abdominis myocutaneous flap breast reconstruction using autologous dermal graft repair from zone 4 of deep inferior epigastric perforator flap: A case series in Asian patients p. 119
Priya Tiwari, Bien Keem Tan
DOI:10.4103/0970-0358.182237  PMID:27274136
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A cost-effective cadaveric model for plastic surgery simulation p. 121
Nigel Yong Boon Ng, Charles Yuen Yung Loh, Thanassi Athanassopoulos
DOI:10.4103/0970-0358.182234  PMID:27274137
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Smart apps for the smart plastic surgeon—An update p. 123
Aniketh Venkataram, Mayur Shetty, Sunderraj Ellur, Narender Manikavachakan
DOI:10.4103/0970-0358.182242  PMID:27274138
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Modified way of applying a tie-over dressing p. 124
Rahul Krishnarao Patil, Ashok Raj Koul
DOI:10.4103/0970-0358.182251  PMID:27274139
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An alternative receptacle for fat harvest: The infant mucous sucker p. 126
Satyaswarup Tripathy, Saurabh Rawat, Jerry R John, Ramesh Kumar Sharma
DOI:10.4103/0970-0358.182227  PMID:27274140
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'Glove technique' to secure skin grafts: A novel technique p. 127
Sumer Singh, Yogesh C Bhatt, Piyush Doshi, Sanjay G Vaghani
DOI:10.4103/0970-0358.182247  PMID:27274141
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Achieving optimal leg position for fibula flap harvest p. 128
Dushyant Jaiswal, Vinay Kant Shankhdhar, Prabha Yadav, Prashant Puranik, Rajendra Gujjulannavar, Ramani C Venkat
DOI:10.4103/0970-0358.182231  PMID:27274142
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Concern with the use of electrodes in perforator marking p. 130
Tarak Agrebi Moumni Chouari, Michalis Koullouros
DOI:10.4103/0970-0358.182249  PMID:27274143
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Author's reply to comments on 'A simple technique of marking the perforator of a free flap for post-operative monitoring' p. 131
Hari Venkatramani, Gururaj Hosahalli, S Raja Sabapathy
DOI:10.4103/0970-0358.182252  PMID:27274144
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Index case of kite string causing neurovascular and tendon injury to ankle is being reported p. 132
J Sasidhar Reddy, Anurag Pandey, Lalit Chaudhary, Vivek Kumar, Shiv Shankar Saha
DOI:10.4103/0970-0358.182239  PMID:27274145
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Dr. Narendra J. Pandya p. 134
Mukund Jagannathan
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