Indian Journal of Plastic Surgery
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   2008| July-December  | Volume 41 | Issue 2  
    Online since January 10, 2009

 
 
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ORIGINAL ARTICLES
Extravasational side effects of cytotoxic drugs: A preventable catastrophe
Jagdeep S Thakur, C.G.S Chauhan, Vijay K Diwana, Dayal C Chauhan, Anamika Thakur
July-December 2008, 41(2):145-150
DOI:10.4103/0970-0358.44923  PMID:19753254
In addition to their therapeutic effects on malignant cells, cytotoxic agents have the potential of causing destruction of healthy, normal cells. Extravasation of the drug can produce extensive necrosis of the skin and subcutaneous tissue. Management of these extravasational effects differs from one centre to another and prevention is usually strongly emphasized. We analyzed our management of 12 patients referred to us over five years with extravasation of cytotoxic drugs and reviewed the literature for different approaches with regard to prophylaxis and management of extravasational effects. Materials and Methods: This study was done in the department of plastic surgery of a medical college. Five years of retrospective data were studied of patients referred to our department with extravasation of cytotoxic drugs. Results: We managed 12 cases referred to our department with extravasation of cytotoxic drugs. Mitomycin C was used in seven cases (58.33%), vincristine in two cases (16.66%), 5-Florouracil in another two cases while doxorubicin was responsible for extravasational side effects in one case (8.33%). The size of necrosis ranged from 3.75 cm 2 to 25 cm 2 with average size of 9.6 cm 2 . In terms of the area involved, the dorsum of the hand was involved in five cases (41.66%), the wrist in another five cases (41.66%), and the cubital fossa in the remaining two cases (16.66%). All cases were treated with daily debridement of necrotic tissue, saline dressing, and split skin grafting. Conclusion: Extravasation of cytotoxic drugs further increases the suffering of cancer patients. This catastrophe can only be avoided by vigilance and immediate application of antidotes. Once the local toxicity of the drugs takes effect, morbidity is unavoidable
  10 3,142 181
CASE REPORTS
Superficial thrombophlebitis (Mondor's Disease) after breast augmentation surgery
Giovanni Andre P Viana, Fabricio M Okano
July-December 2008, 41(2):219-221
DOI:10.4103/0970-0358.44940  PMID:19753269
Although the aetiology of Mondor's disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of the disease's main etiologic components and preponderant clinical aspects, and determined all appropriate therapeutic measures.
  6 5,189 193
LETTERS TO EDITOR
Congenital dermoid cysts of the anterior fontanel
Masood Majed, Farideh Nejat, Mostafa El Khashab
July-December 2008, 41(2):238-240
DOI:10.4103/0970-0358.44934  PMID:19753276
  5 2,499 137
ORIGINAL ARTICLES
Management strategy for facial arteriovenous malformations
PS Bhandari, LP Sadhotra, P Bhargava, AS Bath, MK Mukherjee, Sanjay Maurya
July-December 2008, 41(2):183-189
DOI:10.4103/0970-0358.44943  PMID:19753261
Arteriovenous malformations (AVMs) are uncommon errors of vascular morphogenesis; haemodynamically, they are high-flow lesions. Approximately 50% of AVMs are located in the craniofacial region. Subtotal excision or proximal ligation of the feeding vessel frequently results in rapid progression of the AVMs. Hence, the correct treatment consists of highly selective embolisation (super-selective) followed by complete resection 24-48 hours later. We treated 20 patients with facial arteriovenous malformation by using this method. Most of the lesions (80%) were located within the cheek and lip. There were no procedure related complications and cosmetic results were excellent.
  5 4,119 301
Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study
Yogesh C Bhatt, Kinnari A Vyas, Mangesh S Tandale, Nikhil S Panse, Harpreet S Bakshi, Rajat K Srivastava
July-December 2008, 41(2):151-159
DOI:10.4103/0970-0358.44925  PMID:19753255
Maxillonasal dysplasia or Binder's syndrome is an uncommon congenital condition characterized by a retruded mid-face with an extremely flat nose. We report here six patients with maxillonasal dysplasia whose noses were corrected with onlay costal cartilage grafts using a combined oral vestibular and external rhinoplasty approach for nasal dorsal augmentation, columellar lengthening, and premaxillary augmentation. The cartilage graft was dipped in a solution of 100 ml 0.9% NaCl and one vial (80mg) gentamicin for 30 min to prevent warping. L struts made for nasal augmentation, columellar lengthening, and premaxillary augmentation were fixed to one another by slots made in the graft. This technique has been used in children, adults, and for secondary cases with promising results. All patients were of class I dental occlusion. The nasal and premaxillary augmentation which was monitored by serial photography was found to be stable over a follow-up period of three years
  3 4,215 284
CASE REPORTS
Intravenous injection of elemental mercury: A report of two cases
A Gopalakrishna, TV Pavan Kumar
July-December 2008, 41(2):214-218
DOI:10.4103/0970-0358.44942  PMID:19753268
Two cases of intravenous injection of elemental mercury are described in this report. One patient succumbed and the other remains asymptomatic two years after the surgical removal of all the injected mercury. Management of intravenous injection of elemental mercury (intended to be an aphrodisiac in these two cases) is discussed here and the need for surgical removal of all accessible mercury has been emphasized.
  3 3,688 160
BRIEF COMMUNICATION
Adnexal carcinomas of the head and neck
Jorge O Guerrissi, Juan Pablo Quiroga
July-December 2008, 41(2):229-234
DOI:10.4103/0970-0358.44950  PMID:19753272
Adnexal carcinomas of the skin are rare and they derive from structures such as sweat glands, sebaceous glands, and hair follicles. Adnexal tumors represent 1-2% of skin cancers. Between 1998 and 2004, eight patients with malignant adnexal tumors of the head and neck were treated in the Plastic Surgery Service in Argerich Hospital in Buenos Aires, Argentina. Four (50%) of them had malignant cylindromas, two (25%) had sebaceous carcinoma, and the other two (25%) syringoid eccrine carcinoma. Tumor resection and local flaps were made in all cases. In one case, a radical neck dissection with superficial parotidectomy was performed to treat the metastatic cervical nodes. Local recurrence observed in two cases (25%) was associated with distant metastasis and death of the patients. In other six cases, the survival rate was 75% after five years.
  3 2,129 141
ORIGINAL ARTICLES
Notch-free vermillion after unilateral cleft lip repair: The Charles Pinto centre protocol
PV Narayanan, HS Adenwalla
July-December 2008, 41(2):167-170
DOI:10.4103/0970-0358.44935  PMID:19753258
A notch on the vermillion is one of the most common complications following the repair of a unilateral cleft lip. Several methods have been described for the secondary correction of a notch. However, there are only a few reports on how the notch can be prevented during primary lip repair. Causes of a vermillion notch were analysed at the Charles Pinto Centre for Cleft Lip and Palate and each possible cause addressed by an appropriate procedure. This protocol was then followed in every patient. In this manner, we have been able to avoid notches in unilateral cleft lips altogether and more significantly, junior trainees in our department have also been able to consistently avoid a notch in their repairs.
  2 2,310 232
The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature
IA Adigun, AO Oladele, JK Olabanji
July-December 2008, 41(2):171-174
DOI:10.4103/0970-0358.44937  PMID:19753259
We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7 th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.
  2 2,238 265
CASE REPORTS
Roberts-SC syndrome, a rare syndrome and cleft palate repair
Jyotsna Murthy, Madhu Dewan, Altaf Hussain
July-December 2008, 41(2):222-225
DOI:10.4103/0970-0358.44939  PMID:19753270
Roberts SC syndrome is a rare syndrome with only 17 previously recognized patients reported in medical literature. The syndrome is characterized by multiple malformations, particularly, symmetrical limb reduction, craniofacial anomalies such as bilateral cleft lip and palate, micrognathia, and severe growth and mental retardation. Our patient, a young child of five years having Roberts-SC, was successfully operated for cleft palate under general anesthesia. The main features of the syndrome and the technical problems of anesthesia and surgery are discussed in this report.
  2 1,822 150
ORIGINAL ARTICLES
Perineal burn contractures: An experience in tertiary hospital of a Himalayan state
Jagdeep S Thakur, C. G. S Chauhan, Vijay K Diwana, Dayal Chand Chuahan, Anamika Thakur
July-December 2008, 41(2):190-194
DOI:10.4103/0970-0358.39666  PMID:19753262
Perineal burn contracture is a rare burn sequel. We conducted a retrospective analysis of cases with perineal burn contractures managed in a tertiary care centre of a Himalayan state. We found that all cases sustained burn injury from burning firewood and the time of presentation was two to six years after the burn injury. We analyzed our treatment method and have classified these contractures into two types.
  2 2,212 156
Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits
Mukund Jagannathan, Maksud Devale, Prashantha Kesari, Siddharth Karanth
July-December 2008, 41(2):110-115
DOI:10.4103/0970-0358.44708  PMID:19753248
Context: Surgery for the release of temporomandibular joint (TMJ) ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA), which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.
  1 2,538 403
The association between blood groups and maxillofacial deformities
Rasoul Gheisari, Mehdi Ghoreishian, Bijan Movahedian, Amrolah Roozbehi
July-December 2008, 41(2):138-140
DOI:10.4103/0970-0358.44921  PMID:19753252
Background: Blood group is a genetic characteristic which is associated with some diseases and deformities. Multifactorial characteristics of facial development make it difficult to predict a genetic pattern in a specific maxillofacial deformity, but epidemiological evaluations can reveal relationships between such deformities and some genetic characteristics or accompanied diseases, and this will help to recognise and treat them. The aim of this study is evaluation of the relationship between blood groups and maxillofacial deformities. Materials and Methods: In this study, blood groups of 190 patients with maxillofacial deformities who had had orthognathic surgery in Alzahra hospital, Isfahan, were compared with the general Iranian population. Results: Among 190 patients, 93 cases (49%) were men and 97 cases (51%) were women. Fifteen cases (8%) were < 20 years old, 130 cases (68%) were 20-30 years old, and the others (45 cases, 24%) were > 30 years old. The blood group distribution in our samples was as follows: blood group O = 76 cases (40%), blood group A = 58 cases (30%), blood group B = 41 cases (22%), and blood group AB = 15 cases (8%). Among these patients, 31 cases (16%) had maxillary deformities and 27 cases (14%) suffered from mandibular deformities while the other 132 cases (70%) had bimaxillary problems. The Chi-square test showed statistically significant differences between the blood group distribution of the patients of this study and the normal Iranian population ( P < 0.001). Conclusion: It was shown that among different blood groups; those with blood group B have a greater likelihood of association with maxillofacial deformities. On the other hand, the probability of the association of such deformities was the least with blood group A.
  1 1,966 187
Surgery of temporomandibular joint under local anaesthesia
Kalpesh J Gajiwala
July-December 2008, 41(2):175-182
DOI:10.4103/0970-0358.44941  PMID:19753260
Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction.
  1 2,362 289
CASE REPORTS
Adenoid cystic carcinoma of the parotid gland: Anastamosis of the facial nerve with the great auricular nerve after radical parotidectomy
Osman Bahadir, Murat Livaoglu, Ahmet Ural
July-December 2008, 41(2):201-205
DOI:10.4103/0970-0358.44948  PMID:19753265
Adenoid cystic carcinoma of the parotid gland is a rare and slowly growing, but highly malignant tumor. Surgical resection of a malignant parotid tumor should include resection of the facial nerve when the nerve is involved in the tumor. Facial nerve reconstruction is required after nerve resection. A 14 year-old female presented with complaints of painless enlargement of the right parotid gland and facial asymmetry. Physical examination revealed a firm mass in the region of the parotid gland as well as right facial paralysis. Biopsy obtained from the mass showed an adenoid cystic carcinoma of the parotid gland. A radical parotidectomy with a modified radical neck dissection was carried out. Grafting material for the facial reconstruction was harvested from the great auricular nerve. The proximal main trunk and each distal branch of the facial nerve were coapted with the greater auricular nerve. The patient received radiotherapy after surgery and was seen to achieve grade IV facial function one year after surgery. Thus, the great auricular nerve is appropriate grafting material for coaptation of each distal branch of the facial nerve.
  1 3,829 158
Microneurovascular reimplantation in a case of total penile amputation
Yogesh C Bhatt, Kinnari A Vyas, Rajat K Srivastava, Nikhil S Panse
July-December 2008, 41(2):206-210
DOI:10.4103/0970-0358.44945  PMID:19753266
Amputation of the penis is a rare condition reported from various parts of the world as isolated cases or small series of patients; the common aetiology is self-mutilating sharp amputation or an avulsion or crush injury in an industrial accident. A complete reconstruction of all penile structures should be attempted in one stage which provides the best chance for full rehabilitation of the patient. We report here a single case of total amputation of the penis, which was successfully reattached by using a microsurgical technique. After surgery, near-normal appearance and function including a good urine flow and absence of urethral stricture, capabilities of erection and near normal sensitivity were observed.
  1 2,887 197
Twenty years' follow-up of a de-epithelialised turnover flap
A Gopalakrishna, TV Pavan Kumar
July-December 2008, 41(2):211-213
DOI:10.4103/0970-0358.44944  PMID:19753267
The authors have used the de-epithelialised turnover flap (Thatte's Flap) for covering compound defects over the tendo-achilles in 31 patients in the period covering 1980-2000. Two of these patients have come up for follow-up after 20 years. In this late follow-up, the results are good and the tendon which was bridged by the dermis of the flap is functioning to allow the patients to stand on their toes. The de-epithelialised turnover flap is a simple and easy technique giving good long-term results. In spite of all the new advances in flap coverage, the de-epithelialised turnover flap is a good alternative for the tendo-achilles area in the armamentarium of a plastic surgeon.
  - 1,220 146
LETTERS TO EDITOR
A simple and cost-effective protocol for the management of anterolateral thigh free-flap donor site
Puneet Tuli, Gautam Biswas, Atul Parashar, Ramesh K Sharma
July-December 2008, 41(2):235-236
DOI:10.4103/0970-0358.44929  PMID:19753273
  - 1,252 111
A simple method to make a reusable volar splint
Roba Khundkar, Emily West
July-December 2008, 41(2):236-237
DOI:10.4103/0970-0358.44931  PMID:19753274
  - 1,483 136
Lipoma of the finger presenting as restricted motion
Sukho Yoon, Sung-No Jung
July-December 2008, 41(2):237-238
DOI:10.4103/0970-0358.44933  PMID:19753275
  - 1,242 122
CASE REPORTS
Double breasting repair of urethral fistula in a patient with perineal abscess secondary to a large urethral stone
Sankalp Dwivedi, SR Joharapurkar, Abhay Deshmukh
July-December 2008, 41(2):226-228
DOI:10.4103/0970-0358.44938  PMID:19753271
We report here a case of urethral fistula managed successfully following incision and drainage for the urethral abscess secondary to a large urethral stone leading to a large diverticulum (another rare condition) by using the technique of double breasting, where we used the redundant urethra and overlying skin.
  - 1,690 102
LETTERS TO EDITOR
Compartment syndrome: A rare complication of tensor fascia lata flap reconstruction following ilio-inguinal block dissection
S Gowthaman, N Kathiresan, B Satheesan
July-December 2008, 41(2):240-241
DOI:10.4103/0970-0358.44936  PMID:19753277
  - 1,730 99
OBITUARIES
Dr. C. V. Mehendale
A Gopalkrishna
July-December 2008, 41(2):242-243
  - 1,146 73
Dr. Paul Tessier
Surajit Bhattacharya
July-December 2008, 41(2):244-245
  - 1,486 103
To sir with respects and affection
K Mathangi Ramakrishnan
July-December 2008, 41(2):246-246
  - 1,161 72
BOOK REVIEW
Acland's Practice Manual for Microvascular Surgery - Third Edition 2008
Mukund R Thatte
July-December 2008, 41(2):247-247
  - 1,982 146
ORIGINAL ARTICLES
Endoscopic resection of forehead lipoma: A subperiosteal single-portal approach
LH Terence Goh, Bien-Keem Tan, Foo Chee Liam
July-December 2008, 41(2):141-144
DOI:10.4103/0970-0358.39665  PMID:19753253
Forehead lumps which are commonly excised for cosmetic reasons, are done through a traditional open excision technique. In the Asian population, open excision commonly results in a pigmented scar which tends not to fade with time and this can be a concern to some patients. The aims of this paper are to describe an endoscopically assisted technique of surgery, with emphasis on the subperiosteal, single-portal approach; to review the outcome of the surgery, and to define the indications for its use. Materials and Methods: We describe here a case series of ten patients, in whom a minimally invasive technique was employed for the removal of a forehead lipoma via an endoscopic, single-portal, subperiosteal approach. Results: The patients' age ranged from 26 to 54 years and the dimensions of the masses removed ranged from 1.0 x 0.5 cm to 3.0 x 3.0 cm. All were confirmed by histological examination to be lipomata. The patients were followed up for an average period of nine months. There were no residual masses or recurrences and no complications of nerve damage. All the patients were very satisfied with their 'scar less' operations. Conclusions: Endoscopic excision of forehead lipomas through a single-port approach is both safe and reliable. It is indicated in patients who are prone to scarring or who are concerned with a forehead scar.
  - 4,633 186
EDITORIAL
Farewell
Mukund R Thatte
July-December 2008, 41(2):105-106
DOI:10.4103/0970-0358.44918  PMID:19753246
  - 1,988 234
GUEST EDITORIAL
Patient satisfaction and ethics in a public hospital practice
Mukund Jagannathan
July-December 2008, 41(2):107-109
DOI:10.4103/0970-0358.44919  PMID:19753247
  - 2,359 294
ORIGINAL ARTICLES
"Oriental anthropometry" in plastic surgery
Vasco Senna-Fernandes
July-December 2008, 41(2):116-127
DOI:10.4103/0970-0358.44947  PMID:19753249
Background : According to Chinese medicine, the acupuncture-points' (acupoints) locations are proportionally and symmetrically distributed in well-defined compartment zones on the human body surface Oriental Anthropometry" (OA). Acupoints, if considered as aesthetic-loci, might be useful as reference guides in plastic surgery (PS). Aim: This study aimed to use aesthetic-loci as anatomical reference in surgical marking of Aesthetic Plastic Surgery. Method: This was an observational study based on aesthetic surgeries performed in private clinic. This study was based on 106 cases, comprising of 102 women and 4 men, with ages varying from 07 to 73 years, and with heights of between 1.34 m and 1.80 m. Patients were submitted to aesthetic surgical planning by relating aesthetic-loci to conventional surgical marking, including breast surgeries, abdominoplasty, rhytidoplasty, blepharoplasty, and hair implant. The aesthetic-surgical-outcome (ASO) of the patients was assessed by a team of plastic surgeons (who were not involved in the surgical procedures) over a follow-up period of one year by using a numeric-rating-scale in percentage (%) terms. A four-point-verbal-rating-scale was used to record the patients' opinion of therapeutic-satisfaction (TS). Results: ASO was 75.3 9.4% and TS indicated that most patients (58.5%) obtained "good" results. Of the remainder, 38.7% found the results "excellent", and 2.8% found them "fair". Discussion and Conclusion : The data suggested that the use of aesthetic-loci may be a useful tool for PS as an anatomical reference for surgical marking. However, further investigation is required to assess the efficacy of the OA by providing the patients more reliable balance and harmony in facial and body contours surgeries.
  - 2,740 216
Project Muskan : Social responsibility of the plastic surgeon
Yogesh C Bhatt, Nikhil S Panse, Kinnari A Vyas, Harpreet S Bakshi, Mangesh S Tandale, Rajat K Shrivastav
July-December 2008, 41(2):128-132
DOI:10.4103/0970-0358.44920  PMID:19753250
Although exact statistics are not available, Indian plastic surgeons see around 7,00,000-8,00,000 burn admissions annually with around 10,00,000 cleft patients yet to be operated. In spite of this voluminous load, India does not have national health programs for the various deformities Indian plastic surgeons typically treat. As Plastic Surgeons, it is our social responsibility to treat these patients and bring ' muskan ' (smile in Hindi) back into their lives. Project Muskan was initiated as an innovative model for targeting these patients and is probably one of its kind in the field of plastic surgery in our country. It is unique because it is a perfect collaboration of government institutions, a Non Government Organization (NGO), and cooperative sectors providing free health care at the doorstep. Identification of the patients was done with the help of the extensive milk dairy network in the state of Gujarat. Provision of transport and other facilities was done by the NGOs and quality health care provision was taken care of by the government hospital. Project Muskan started from a single village but now covers around 3000 villages and tribal areas of Gujarat. It is a system that can be easily reproducible in all hospitals and has reestablished the faith of the common man in government institutes.
  - 1,679 158
Is it safe to combine abdominoplasty and posterior vaginal repair in one surgical session?
Azzam S.M Farroha, Hala S.Y Hanna
July-December 2008, 41(2):133-137
DOI:10.4103/0970-0358.44922  PMID:19753251
Many multiparous women complain of protruded and pendulous abdomens and vaginal outlet relaxation which affect their sexual relationships with their male partners. This study included 47 patients who had these complaints. Some of these patients were working outside the homes and all were mothers of 2-5 children. Due of their home and job responsibilities, they did not have enough time or money for multiple surgeries in more than one session. Material and Methods: The age of these patients was 26-54 years and all patients had poor skin elasticity, pendulous excess subcutaneous fat and skin below the level of the anterior vulvar commissure, and a lax musculoaponeurotic anterior abdominal wall. Also, all patients had a relaxed vaginal outlet and 32 patients had rectocele. Careful perioperative assessment and management was done for each patient to ensure fitness for the long operation and to avoid complications. The combined surgical session consisted of two steps: abdominoplasty and posterior vaginal repair. All the patients were kept in the hospital for two days and they returned to their usual routines in the third week after surgery, and they resumed their sexual relationships with their male partners in the sixth week after surgery. Results: There were no serious complications and this approach was convenient for the patients and their families. The recovery time of the combined surgical session was the same as that of just abdominoplasty, and significantly less than the sum of the recovery periods if the two surgeries had been performed in two sessions. The cost of the combined surgical session was significantly less than doing the surgeries in two sessions. All the patients had significant improvement in their sexual relationships
  - 2,303 248
CASE REPORT
Complete cleft of the upper limb: A very rare anomaly
Yogesh C Bhatt, Harpreet S Bakshi, Kinnari A Vyas, Girish S Ambat, Hitesh Laad, Nikhil S Panse
July-December 2008, 41(2):195-199
DOI:10.4103/0970-0358.44842  PMID:19753263
Background: We describe here a very rare congenital deformity that involves the splitting of the right upper limb with the superior limb articulating with the shoulder joint, and the inferior limb laterally attached to the chest wall. Material and Methods: The child with this rare split limb was treated by transferring the inferior limb on an islanded pedicle to the superior one while creating the hand. Results: A unified limb was reconstructed while creating the hand without any compromise on the existing function and vascularity. The patient is on regular follow-up and further staged procedures have been planned to provide a better functional and aesthetic limb. Conclusion: The congenital deformity described here has not been mentioned in world literature so far and its embryological basis is a matter of discussion. Opinions regarding further management of this anomaly are invited from experts in the field.
  - 1,719 147
INVITED COMMENT
Complete cleft of the upper limb: A very rare anomaly
Edward T Bersu
July-December 2008, 41(2):200-200
DOI:10.4103/0970-0358.44946  PMID:19753264
  - 1,071 82
INVITED DISCUSSION
Maxillonasal dysplasia (Binder's syndrome) and its treatment with costal cartilage graft: A follow-up study
Mukund Jagannathan
July-December 2008, 41(2):160-161
DOI:10.4103/0970-0358.44930  PMID:19753256
  - 1,636 139
ORIGINAL ARTICLES
Irrigation-coupled bipolar cautery unit: A practical, economical, and simple version
Shekhar Sharma, Altaf Gauhar Haji, DK Vijaykumar, AK Shaji
July-December 2008, 41(2):162-166
DOI:10.4103/0970-0358.44932  PMID:19753257
Hemostasis is a fundamental principle of surgery for which electrocoagulation is universally used. Bipolar electrocautery has an advantage over monopolar electrocautery in terms of the precision of the extent of tissue coagulation and the lateral extent of thermal tissue injury. However, secondary to the thermal changes induced in the tissue due to electric current passage, there is charring of tissue, which adheres to the cautery tip. This, not only decreases its effectiveness, but also, by getting avulsed while removing the cautery tip from the surgical field, causes rebleeding and more trauma to the tissue. Irrigation of the surgical field during application of cautery reduces the charring effect, thereby improving the efficiency and efficacy. Irrigation-coupled electrocautery devices are available but are costly to acquire and maintain. We describe a simple and reliable version of an irrigation-coupled cautery device, which is of immense functional utility in our experience. It decreases the amount of charring of the tissue and its adherence to the bipolar forceps tips, thereby decreasing the frustrating loss of effectiveness and also increases the life of the bipolar forceps as cleaning needs to be less frequent. By virtue of its simplicity and cost-effectiveness, it can be used in almost all hospitals and situations.
  - 4,353 193
 
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