Indian Journal of Plastic Surgery
An open access publication of Association of Plastic Surgeons of India
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Post-burn scars and scar contractures
Arun Goel, Prabhat Shrivastava
September 2010, 43(3):63-71
DOI:10.4103/0970-0358.70724  PMID:21321660
The mortality and morbidity from burns have diminished tremendously over the last six to seven decades. However, these do not truly reflect whether the victim could go back to society as a useful person or not and lead a normal life because of the inevitable post-burn scars, contractures and other deformities which collectively have aesthetic and functional considerations. This article gives an overview of the post-burn scars and scar contractures, especially their prevention, minimisation and principles of management.
  60,706 660 6
Phalloplasty: The dream and the reality
Mamoon Rashid, Muhammad Sarmad Tamimy
May-August 2013, 46(2):283-293
DOI:10.4103/0970-0358.118606  PMID:24501465
Phalloplasty has come a long way as Plastic Surgery has evolved over the years. The complication ridden multistage tube pedicles popularized by Gillis were, with the advent of microsurgery, replaced by radial forearm flaps. The composite osteo-cutaneous version of this flap promised 'All for one and one for all' assuring both a reliable urinary conduit and a phallus stiffener. Prelamination and prefabrication to make the neo-urethra came with the promise of reducing both fistula and strictures but that did not happen and flap failure rates increased. Penile stiffeners of various types have been introduced; the artificial ones were associated with high infection and failure rates and are best inserted after the neo-penis regains some sensitivity. With the introduction of perforator flaps the Anterolateral thigh flap in its sensate pedicled form has started replacing the Radial forearm free flap as the first choice flap because of a hidden donor area and lack of microsurgical expertise requirement. Being sensate it tolerates a stiffener better. It is now possible to reconstruct an aesthetically pleasing glans as well, thus meeting both the aesthetic and functional desires of the patient. Complications encountered in this reconstructive effort include flap failure, urethral fistula, urethral stricture and stiffener related problems.
  58,525 221 1
Unfavourable outcomes of liposuction and their management
Varun V Dixit, Milind S Wagh
May-August 2013, 46(2):377-392
DOI:10.4103/0970-0358.118617  PMID:24501474
Liposuction is one of the most popular cosmetic surgery procedures currently performed by plastic surgeons around the world. It must be clear at the outset that liposuction is not primarily a modality for weight loss, it is meant to be a body contouring procedure and therefore the inherent limitations and safety issues related to this must always be respected if complications and unfavourable results are to be avoided as far as possible.
  48,317 168 -
Keloids and hypertrophic scars: a review
J Meenakshi, V Jayaraman, KM Ramakrishnan, M Babu
July-December 2005, 38(2):175-179
  45,036 972 17
The management of perineal wounds
Ramesh k Sharma, Atul Parashar
May-August 2012, 45(2):352-363
DOI:10.4103/0970-0358.101318  PMID:23162235
Management of perineal wounds can be very frustrating as these invariably get contaminated from the ano-genital tracts. Moreover, the apparent skin defect may be associated with a significant three dimensional dead space in the pelvic region. Such wounds are likely to become chronic and recalcitrant if appropriate wound management is not instituted in a timely manner. These wounds usually result after tumor excision, following trauma or as a result of infective pathologies like hideradenitis suppurativa or following thermal burns. Many options are available for management of perineal wounds and these have been discussed with illustrative case examples. A review of literature has been done for listing commonly instituted options for management of the wounds in perineum.
  44,852 204 1
Osteoradionecrosis of the mandible: Etiology, prevention, diagnosis and treatment
Sukh S Rayatt, Marc A.M Mureau, Stefan O.P Hofer
December 2007, 40(12):65-71
The treatment of head and neck cancer remains a challenge. Despite advances in surgical reconstructive techniques, most patients will require adjuvant therapy in the form of radiotherapy or chemo-radiotherapy to improve locoregional control. The short- and long term side effects of radiotherapy can be difficult to treat. In this review the causative effects and pathogenesis of osteoradionecrosis of the mandible will be highlighted. In addition, preventive measures and clinical features of radiotherapy induced damage will be presented. Finally, medical and surgical management of osteoradionecrosis, as well as, reconstructive surgery of the mandible will be discussed. At the end of this paper the reader should have up to date knowledge concerning the etiology, prevention, diagnosis and treatment of patients with osteoradionecrosis of the mandible.
  41,048 1,002 5
Macromastia of pregnancy: A unique presentation of this rare clinicohistopathological entity
Anil K Sarda, Vishal N Kulshreshta, Shweta A Bhalla, Lakhwinder Singh, Uma K Chaturvedi
January-June 2004, 37(1):74-76
The present case is a unique presentation of a patient who developed a small lump in her breast during her first pregnancy but it was only during her third pregnancy that it increased in size and became a huge fungating mass. Although, gigantic sizes of this pathologic entity have been reported, the present case had the involved breast hanging till below the inguinal ligament and required sling to support the breast. Since the pre-operative diagnosis was suggestive of cystosarcoma phylloides, no attempt at reconstructive surgery was contemplated.
  38,687 455 -
Susruta and our heritage
PS Chari
January-June 2003, 36(1):4-13
  36,823 583 -
A novel and accurate technique of photographic wound measurement
Rahul Shetty, H Sreekar, Shashank Lamba, Ashish Kumar Gupta
May-August 2012, 45(2):425-429
DOI:10.4103/0970-0358.101333  PMID:23162244
Context: Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive. Aims: To introduce a simple and accurate technique by which wounds can be accurately measured. Settings and Design: This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique. Materials and Methods: The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA. Results: The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method. Conclusions: This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.
  34,412 2,281 1
A challenging case of total phalloplasty
R Sridhar, V Jayaraman
January-April 2012, 45(1):148-150
DOI:10.4103/0970-0358.96618  PMID:22754174
Plastic surgery continues to maintain a prominent presence in the evolution of male genital reconstruction. In this case report, we are presenting a case of post-electric burn with a total loss of penis. Sustaining other major injuries following an electric burn with loss of right upper limb and extensive tissue damage to left upper limb, abdomen and both thighs, this young male patient was initially managed from life-threatening problems. With many options closed following a major electric burn and its acute management, penile and urethral reconstruction was a unique and a great challenge in this patient. Heeding to the patient's wish of male pattern micturition, we had performed a successful reconstruction of urethra and entire phallus with groin flap.
  33,995 130 1
Degloving injuries of the hand
R Krishnamoorthy, G Karthikeyan
May-August 2011, 44(2):227-236
DOI:10.4103/0970-0358.85344  PMID:22022033
Avulsion of skin from the hand or fingers is an injury that has a dramatic presentation. The entire musculo-skeletal unit of the finger is intact, and the patient can often move the parts of his naked hand quite normally. The challenge for the reconstructive surgeon lies in resurfacing the hand or finger with a good quality pliable sensate skin cover while preserving the movements and function of the hand. Traditionally, skin grafting has been the standard method of reconstruction in such injuries. However, skin grafting does have many disadvantages, too. This article deals with the features of such injuries, management protocols and other reconstructive options available in the armamentarium of the hand surgeon.
  31,992 357 8
Closed rupture of the flexor digitorum profundus tendon of little finger: A case report
Pawan Agarwal
January-June 2004, 37(1):71-73
Closed rupture of the FDP tendon is rare. However, whenever they occur the most common site of rupture is the tendon-bone insertion, less frequent site is at the musculo-tendinous junction. Midsubstance ruptures are even more unique and are usually due to underlying pathology such as fracture, cystic degeneration, rheumatoid arthritis, or sequel following local steroid injection. This report describes a closed rupture of FDP tendon of little finger. Mechanism of injury, diagnosis and management are discussed.
  30,993 287 -
Microsurgical tubal recanalization: A hope for the hopeless
M Jain, P Jain, R Garg, FM Triapthi
July-December 2003, 36(2):66-70
Objective: To analyse the various factors affecting pregnancy rate after microsurgical tubal recanalisation. Design: Prospective study, follow-up of 5 years in patients treated with tubal microsurgery. Setting: Referral Tertiary Care Hospital. Patients: Fifty women underwent microsurgical tubal recanalisation procedure. Principles of microsurgery were followed throughout the procedure meticulously. Interventions: Microsurgical tubal recanalisation. Main outcome measure: Pregnancy rate. Results: With microsurgery, an overall 60% pregnancy rate was achieved. In these patients, pregnancy outcome was in form of intrauterine pregnancy (96.66%), ectopic pregnancy (3.33%), term viable pregnancy (96.55%) and spontaneous abortion (3.45%). Conclusions: The important factors for determining the success of operation were age of the patient, time interval between sterilization and reversal, site of ligation, method used for previous ligation & the remaining length of the tube after recanalisation. The microsurgical technique should be available at specialized centres to improve the success of family planning services.
  29,782 343 -
Puncture, drainage and irrigation: Is that enough for treating an abscess?
Kalpesh J Gajiwala
July-December 2006, 39(2):189-195
An abscess is a common occurrence. The gold standard for treatment is incision and drainage. Here a simple technique of a small puncture followed by drainage and irrigation done under local anesthesia is described. Sixty-four patients were treated between 1990 and 2006. Barring two, which were taken off the study, all healed completely without recurrence. The advantages of this procedure are that it is simple, can be done as an office procedure enabling a quick return to work and results in faster, scar free healing. It also allows better pain management.
  28,952 394 2
The efficacy of moisture retentive ointment in the mangement of cutaneous wounds and ulcers: A multicenter clinical trial
BS Atiyeh, J Ioannovich, G Magliacani, M Masellis, M Costagliola, R Dham
July-December 2003, 36(2):89-98
Local management of chronic wounds and ulcers remains one of the most costly unsolved problems in health care today. With proper clinical management, most chronic wound healing problems can be resolved and healing expected, though recurrence may be common. The recent logarithmic growth in our knowledge about wound healing and the appreciation of the importance of a moist environment in optimal wound healing has led to the introduction of new and exciting therapeutic modalities. In view of the many practical disadvantages as well as the serious complications of currently available moisture retentive dressings when applied to chronic contaminated wounds, a prospective multicenter clinical trial was conducted from December 1999 to November 2000 to evaluate the safety and efficacy of a newly introduced moisture retentive ointment (MEBO: Moist Exposed Burn Ointment) (Julphar – Gulf Pharmaceutical Industries, UAE) in the local wound care of problematic non-healing wounds. The active component of the ointment is ß-sitosterol in a base of beeswax, sesame oil and other components. Though it was not a comparative study, the ointment was found to induce rapid reduction in ulcer size even after a prolonged stagnant state with other therapeutic modalities without complications such as skin maceration, unmanageable excessive exudation, and wound infection. As expected with such chronic wounds, the healing potential of local ointment application is limited by the mere size of the original defect and the underlying pathologies and associated diseases. however, the safety and practicality of simple ointment application was found to be a valid alternative treatment for local management of chronic wounds.
  28,689 447 -
Efficacy of injections of phosphatidylcholine into fat deposits-a non-surgical alternative to liposuction in body-contouring
Heinrich Karl-G
July-December 2005, 38(2):119-122
Injecting phosphatidylcholine has been used in South America as a non-surgical treatment in body contouring. The objective of this study was to demonstrate the efficacy of injecting phosphatidylcholine in the reduction of localised fat deposits. 86 patients were included in the study. Patients received 1-3 treatments in localised fat deposits in various areas of the body using phosphatidylcholine. After treatment with phosphatidylcholine (250 mg / 5 ml), fat deposits show an average circumferential reduction per application of 2.70 cm. No patient showed irregularities, dimples or any serious side effect after treatment. Results remained stable during the time of follow up. All patients showed remarkable reductions of the fat deposits treated with phosphatidylcholine. Using the correct technique, injecting phosphatidylcholine may be a safe and efficacious alternative to liposuction in patients objecting to surgery.
  28,117 324 9
Homodigital reconstruction of the digits: The perspective of one unit
D Elliot
July-December 2003, 36(2):106-119
Over a period of twelve years, a strategy of reconstruction of digital injuries has been evolved in our unit which now allows us to reconstruct most defects of the digits with more predictable and, hopefully, better results than in the 1980s. This policy includes much of the philosophy and techniques of earlier and contemporary surgeons, with local modifications which we believe are improvements of the earlier techniques and a few new procedures. Wherever possible, the extraordinary capacity of the digital skin to regenerate has been exploited and homodigital techniques of reconstruction are used to limit the total injury of the trauma and reconstruction to the damaged digit. The techniques which we currently use are summarised in this article.
  26,246 491 -
Developmental field reassignment in unilateral cleft lip: Reconstruction of the premaxilla
Michael H Carstens
January-June 2007, 40(1):75-101
  25,670 829 5
C-V flap nipple reconstruction combined with areola grafting
F Yuksel, B Celikoz
July-December 2003, 36(2):71-75
Creation of a nipple-areola complex often represents the final step in a long and troubling reconstructive process for women with breast cancer. After this hard time, the procedure of choice needs to be convenient, painless and reliable. C-V flap technique for nipple reconstruction, designed especially for later areola tattooing, is a quick and effective form of nipple reconstruction using local tissue and reported that it could serve this aim. Nipples of 12 patients whose mastectomy sites were reconstructed with TRAM flaps were reconstructed with C-V flaps, but their areolas were skin grafted from distant areas instead of tattooing. At the follow-up evaluations, patients’ satisfaction was high in projection, pigmentation, sensation and overall parameters. We concluded and agreed that C-V flap technique was a very reliable method of nipple reconstruction, even when combined with areola grafting.
  25,815 414 -
The use of Sanskrit, an ancient language, as a tool to evaluate cleft palate speech problems
Kalpesh Gajiwala
July-December 2007, 40(2):112-120
Speech is a complex process. The evaluation of speech in an individual with cleft palate is difficult, and the existing classification of phonemes is complicated. Sanskrit, an ancient language, has an arrangement of alphabets that is orderly and scientific and therefore provides a simple means to understand the production of phonemes and memorize them. This article demonstrates the inherent advantage of this arrangement of Sanskrit alphabets to effectively analyze defective cleft palate speech and provides a tool for surgeons to decide a course of action in their routine clinical practice. Improved insight into the speech defect by the surgeon also facilitates better coordination with the speech language pathologist in assessment and treatment of a child with cleft palate.
  24,867 537 -
The history of the plastic surgery department, K.E.M. Hospital, Mumbai, India
Kuldip Singh Goleria, Roshani E Rana
July-December 2004, 37(2):136-142
The history of the Department of Plastic Surgery, K.E.M. hospital, Mumbai, is presented from its inception in 1961, to date. The initial struggle, hard work and complete dedication have been mentioned. Fond, cherished memories of personalities, faculty and students along with their contributions are revived.
  24,338 324 -
Pressure ulcers: Back to the basics
Karoon Agrawal, Neha Chauhan
May-August 2012, 45(2):244-254
DOI:10.4103/0970-0358.101287  PMID:23162223
Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as the medical personnel. A lot has been done to understand the disease process. So much so that USA and European countries have established advisory panels in their respective continents. Since the establishment of these organizations, the understanding of the pressure ulcer has improved significantly. The authors feel that the well documented and well publicized definition of pressure ulcer is somewhat lacking in the correct description of the disease process. Hence, a modified definition has been presented. This disease is here to stay. In the process of managing these ulcers the basic pathology needs to be understood well. Pressure ischemia is the main reason behind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described in detail with review of literature. There are a large number of risk factors causing ulceration. The risk assessment scales have eluded the surgical literature and mostly remained in nursing books and websites. These scales have been reproduced for completion of the basics on decubitus ulcer. The classification of the pressure sores has been given in a comparative form to elucidate that most of the classifications are the same except for minor variations. The management of these ulcers is ever evolving but the age old saying of "prevention is better than cure" suits this condition the most.
  23,748 361 3
Median facial dysplasia: A review
P Agarwal
July-December 2003, 36(2):126-130
Three cases of Median facial dysplasia are presented with their classification, embryological basis and management strategy.
  22,582 246 -
Preparation of two component Fibrin Glue and its clinical evaluation in skin grafts and flaps
S Saxena, P Jain, J Shukla
January-June 2003, 36(1):14-17
Tissue adhesive is one of the alternative to conventional suturing and has some added advantages. Fibrin glue has been used in obtaining haemostasis following trauma to spleen and liver. It has also been used in repair of dural tear and bronchial fistula. Fibrin glue is a biological tissue adhesive based on the final stage of coagulation wherein. Thrombin acting on fibrinogen converts it into fibrin. Thus, it has two components, one is fibrinogen and another is thrombin. We have prepared both components of fibrin glue. Fibrinogen was obtained from patient’s own blood and thrombin from fresh frozen plasma of screened healthy donor. The glue was used in 20 cases requiring skin graft or flap. The results were compared with conventional suturing method. Use of the fibrin glue is simple, safe, cost effective, and rapid technique to fix the skin grafts and flaps with avoidance of peroperative bleeding and postoperative collection. It also has better overall results.
  22,264 526 -
Malignant tumours of the hand and wrist
Binu P Thomas, Kiran Sasi, Samuel CR Pallapati, Anil Mathew, R Sreekanth, Meera Thomas
May-August 2011, 44(2):337-347
DOI:10.4103/0970-0358.85355  PMID:22022044
Malignant tumours are rare in the hand and wrist. The clinical presentation may be similar to that of a benign lesion and a high index of suspicion is necessary so that such lesions are not missed by the treating surgeon. Out of a total of 657 tumours/tumour-like lesions of the hand and wrist seen in a tertiary referral centre in a 10-year period, a total of 39 tumours were identified as malignant (5.9%) and of which majority had origin from the skin (53.8%). The management of these tumours is primarily surgical. Limb salvage surgery may be applied when appropriate, though eradication of disease should be the primary goal rather than preservation of function. A multimodal approach is necessary for appropriate management including chemotherapy and radiotherapy.
  21,883 152 2
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