Indian Journal of Plastic Surgery
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   2009| July-December  | Volume 42 | Issue 2  
    Online since January 29, 2010

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A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients
PS Baghel, S Shukla, RK Mathur, R Randa
July-December 2009, 42(2):176-181
DOI:10.4103/0970-0358.59276  PMID:20368852
To compare the effect of honey dressing and silver-sulfadiazene (SSD) dressing on wound healing in burn patients. Patients (n=78) of both sexes, with age group between 10 and 50 years and with first and second degree of burn of less than 50% of TBSA (Total body surface area) were included in the study, over a period of 2 years (2006-08). After stabilization, patients were randomly attributed into two groups: 'honey group' and 'SSD group'. Time elapsed since burn was recorded. After washing with normal saline, undiluted pure honey was applied over the wounds of patients in the honey group (n=37) and SSD cream over the wounds of patients in SSD group (n=41), everyday. Wound was dressed with sterile gauze, cotton pads and bandaged. Status of the wound was assessed every third and seventh day and on the day of completion of study. Patients were followed up every fortnight till epithelialization. The bacteriological examination of the wound was done every seventh day. The mean age for case (honey group) and control (SSD group) was 34.5 years and 28.5 years, respectively. Wound swab culture was positive in 29 out of 36 patients who came within 8 hours of burn and in all patients who came after 24 hours. The average duration of healing in patients treated with honey and SSD dressing at any time of admission was 18.16 and 32.68 days, respectively. Wound of all those patients (100%) who reported within 1 hour became sterile with honey dressing in less than 7 days while none with SSD. All of the wounds became sterile in less than 21 days with honey, while tthis was so in only 36.5% with SSD treated wounds. The honey group included 33 patients reported within 24 hour of injury, and 26 out of them had complete outcome at 2 months of follow-up, while numbers for the SSD group were 32 and 12. Complete outcome for any admission point of time after 2 months was noted in 81% and 37% of patients in the honey group and the SSD group. Honey dressing improves wound healing, makes the wound sterile in lesser time, has a better outcome in terms of prevention of hypertrophic scarring and post-burn contractures, and decreases the need of debridement irrespective of time of admission, when compared to SSD dressing.
  6,780 193 9
Interposition arthroplasty in post-traumatic temporomandibular joint ankylosis: A retrospective study
Satyaswarup Tripathy, Mohd Yaseen, Nitya N Singh, LM Bariar
July-December 2009, 42(2):182-187
DOI:10.4103/0970-0358.59277  PMID:20368853
Temporomandibular joint ankylosis which is most frequently caused by trauma, presents with restriction in mouth opening in early stages and if children are the victim and not treated early, it presents with growth retardation of the involved mandibular side. Various methods are available for surgical correction. We have reviewed our experience with the efficacy of different interpositional materials in post-traumatic cases in our set up with special reference to temporal fascia over last three years. Twenty seven patients with history of trauma, mostly fall from height, have been studied. They were evaluated clinically and by computed tomography (CT) scan, orthopantogram and x- ray lateral oblique view. The most common age group was 10-15 years with mean 12.5 years and male to female ratio 1:2. Preoperative mouth opening (inter incisor distance) was 1-2 mm in 17 cases and 2-4 mm in 10 cases. We have used temporalis fascia in nine, costochondral graft in seven, silastic sheets in five and T-plates in six cases. Post-operatively, adequate mouth opening of 30-50 mm was observed in six months follow-up and more than 50 mm at one year follow up in 21 cases out of which nine cases have interpositional material as temporalis fascia alone. The postoperative period was uneventful in all cases and none required re-operation for recurrences. We conclude that interpositional arthroplasty, especially with pedicled temporal fascia, is the best method to prevent recurrences and establish good mouth opening and full range of jaw movements.
  5,726 204 3
Surgical outcomes following nerve transfers in upper brachial plexus injuries
PS Bhandari, LP Sadhotra, P Bhargava, AS Bath, MK Mukherjee, Tejinder Bhatti, Sanjay Maurya
July-December 2009, 42(2):150-160
DOI:10.4103/0970-0358.59272  PMID:20368849
Background: Brachial plexus injuries represent devastating injuries with a poor prognosis. Neurolysis, nerve repair, nerve grafts, nerve transfer, functioning free-muscle transfer and pedicle muscle transfer are the main surgical procedures for treating these injuries. Among these, nerve transfer or neurotization is mainly indicated in root avulsion injury. Materials and Methods: We analysed the results of various neurotization techniques in 20 patients (age group 20-41 years, mean 25.7 years) in terms of denervation time, recovery time and functional results. The inclusion criteria for the study included irreparable injuries to the upper roots of brachial plexus (C5, C6 and C7 roots in various combinations), surgery within 10 months of injury and a minimum follow-up period of 18 months. The average denervation period was 4.2 months. Shoulder functions were restored by transfer of spinal accessory nerve to suprascapular nerve (19 patients), and phrenic nerve to suprascapular nerve (1 patient). In 11 patients, axillary nerve was also neurotized using different donors - radial nerve branch to the long head triceps (7 patients), intercostal nerves (2 patients), and phrenic nerve with nerve graft (2 patients). Elbow flexion was restored by transfer of ulnar nerve motor fascicle to the motor branch of biceps (4 patients), both ulnar and median nerve motor fascicles to the biceps and brachialis motor nerves (10 patients), spinal accessory nerve to musculocutaneous nerve with an intervening sural nerve graft (1 patient), intercostal nerves (3rd, 4th and 5th) to musculocutaneous nerve (4 patients) and phrenic nerve to musculocutaneous nerve with an intervening graft (1 patient). Results: Motor and sensory recovery was assessed according to Medical Research Council (MRC) Scoring system. In shoulder abduction, five patients scored M4 and three patients M3+. Fair results were obtained in remaining 12 patients. The achieved abduction averaged 95 degrees (range, 50 - 170 degrees). Eight patients scored M4 power in elbow flexion and assessed as excellent results. Good results (M3+) were obtained in seven patients. Five patients had fair results (M2+ to M3).
  5,623 269 17
Treating transsexuals in India: History, prerequisites for surgery and legal issues
Richie Gupta, Anil Murarka
July-December 2009, 42(2):226-233
DOI:10.4103/0970-0358.59287  PMID:20368863
Authors in their clinical practice came across transsexual patients, who were determined to get their gender affirmed by undergoing a change of sex. This motivated the authors to review the literature extensively regarding transsexualism and report their experience. Opinions were taken from legal luminaries practicing in related fields. They also took inputs from several patients who were at various stages of psychiatric analysis and hormone therapy and also those, who had completed their treatment procedures. A paucity of the Indian inputs in medical literature concerning transsexualism was noted by the authors They also found deficiencies in the Indian Law, as applied to the individuals undergoing gender affirmation surgery (GAS). In this paper they have enumerated these deficiencies. Though GAS has been legally allowed in U.K. since 1967, in America since 1972, and in various other countries, Indian Laws are silent on the issue. An Indian surgeon dealing with transsexual patients is faced with a number of issues like consent for the procedure, safe guarding the surgeon or gender team from future litigation. Another issue is postoperative sexual and legal status of the patient. Present Indian Laws regarding marriage, adultery, sexual and unnatural offences, adoptions, maintenance, succession, labour and industrial laws will require modifications when dealing with these individuals and protecting their rights. Authors have tried to deal with all these issues that an individual surgeon faces when he manages a transsexual patient.
  5,502 225 3
Versatile use of vacuum-assisted healing in fifty patients
Ahmad Al Fadhli, George Alexander, James Roy Kanjoor
July-December 2009, 42(2):161-168
DOI:10.4103/0970-0358.59273  PMID:20368850
Context: Wound management can often be a challenging experience, especially in the presence of diabetes mellitus, vascular or immunological compromise. While no single technique can be considered by itself to be ideal, vacuum-assisted healing, which is a recent innovation, is fast becoming a necessary addition as adjuvant therapy to hasten wound healing. Aims: To determine the efficacy of vacuum-assisted healing. Settings and Design: Plastic surgery centre. Ministry of Health Hospital, Kuwait. Materials and Methods: Patients from Kuwait in a wide variety of clinical situations were chosen for study: Patients (n=50) were classified by diagnosis: Group 1: pressure sore- sacral (n= 3), trochanteric (n=6), ischial (n= 2); Group 2: ulcers (n= 11); Group 3: traumatic soft tissue wounds (n =15); Group 4: extensive tissue loss from the abdominal wall perineum, thigh and axilla (n =5); Group 5: sternal dehiscence wounds (n =4) and Group 6: wounds from flap necrosis (n =4). All wounds were subjected to vacuum by wall unit or portable unit, using pressure of 100-125 mm - continuous or intermittent. Closure of wounds, significant reduction in size and refusal by patient for continuation of vacuum-assisted closure therapy were end points of vacuum application. Results: Sixteen per cent of patients showed complete healing of the wound. Seventy per cent of patients showed 20-78% reduction in wound size. In 14% of patients treatment had to be discontinued. All patients showed improvement in granulation tissue and reduction in bacterial isolates and tissue oedema. Conclusions: The application of subatmospheric pressure or negative pressure promotes healing in a wide range of clinical settings and is an advanced wound healing therapy that can optimize patient care, promote rapid wound healing and help manage costs. It may be used in most instances in both hospital and community settings.
  4,246 187 -
The pedicled thoraco-umbilical flap: A versatile technique for upper limb coverage
Sharad Mishra, Ramesh Kumar Sharma
July-December 2009, 42(2):169-175
DOI:10.4103/0970-0358.59274  PMID:20368851
Injuries to upper limb has been on the increase and is invariably associated with significant soft tissue loss requiring a flap cover. Local tissue may not be available for cover in a majority of situations, necessitating import of tissue from a distant source. We have utilized the thoraco-umbilical flap taken from the trunk for this purpose. This flap is based on the perforators of the deep inferior epigastric artery that are maximally centred on the periumbilical region.This flap was used in 83 patients. The patients were observed for at least 3 weeks and any flap or donor site complications were recorded. The patients were again followed up at 3 months interval and the donor site scar was assessed. The flaps survived in 81 patients; there was marginal flap necrosis in five patients and partial flap necrosis in two patients. None of these patients required any additional procedure for coverage. The flap is technically easy to plan, almost effortless to drape around upper limb defects, with no significant donor site morbidity and also the post operative immobilization was fairly comfortable. The thoraco-umbilical flap thus is a very useful technique for coverage of the upper limb and is recommended as a first line flap for this purpose.
  3,698 349 -
Lip adhesion revisited: A technical note with review of literature
Krisztian Nagy, Maurice Y Mommaerts
July-December 2009, 42(2):204-212
DOI:10.4103/0970-0358.59283  PMID:20368859
Context (Background): Lip adhesion is a direct edge approximation without changing lip landmarks or disturbing tissue required for definitive closure. This converts a complete cleft into an incomplete cleft, facilitating and enhancing subsequent definitive lip and nose repair. Aim: The study aims to describe our technique of lip adhesion and its morbidity, and discuss the rationale for its use. Settings and Design: Retrospective follow-up study of complete clefts operated upon in the Bruges Cleft and Craniofacial Centre, at the supra regional teaching hospital AZ St. Jan, Bruges, between June 1, 1991 and May 1, 2009. Methods and Material: The group comprised 33 unilateral and 24 bilateral lip adhesion procedures. The medical files were reviewed for changes in surgical technique, morbidity, and complications and their treatment. Results: The lip adhesion procedure was performed at the age of two to eight weeks postnatal, and definitive lip closure, at the age of four to six months. In all cases, segment repositioning was further controlled by a palatal guidance plate. Wound dehiscence occurred in eight patients (14.0%), and three patients (5.3%) required reoperation. Conclusions: Although complications occurred, the beneficial effects of lip adhesion in combination with a guidance plate outweighed the risks for anatomical reconstruction of a platform for definitive lip and nose repair. Modifications are suggested to reduce these complications.
  3,405 162 -
Bilateral cleft lip nasal deformity
Arun Kumar Singh, R Nandini
July-December 2009, 42(2):235-241
DOI:10.4103/0970-0358.59289  PMID:20368865
Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM) too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it's management both at the time of cleft lip repair and also secondarily, at a later date. It also discusses the practices followed at our centre.
  3,174 242 1
Evaluation of cosmetic appearance of herniotomy wound scars in African children: Comparison of tissue glue and subcuticular suturing
AO Ademuyiwa, OA Sowande, O Adejuyigbe, UE Usang, TIB Bakare, LJC Anyanwu
July-December 2009, 42(2):199-203
DOI:10.4103/0970-0358.59282  PMID:20368858
Aim: To evaluate the cosmetic appearance of herniotomy wound scars closed using either the tissue glue or subcuticular suturing technique. Materials and Methods: Prospective randomised control study; randomisation into tissue glue and suturing groups. Ethical clearance obtained. Cosmetic outcome were based on visual analogue scale by parents and Hollander wound evaluation scale by a Plastic Surgeon blinded to the wound closure method. Results: Fifty one wounds were evaluated, 26 in the tissue glue group and 25 in the suturing group. Parents' evaluation using Visual Analogue scale (VAS) showed that in the suturing group, 17 parents (68%) gave a VAS of 8cm while six parents (24%) gave a score of 7cm. Two parents (8%) gave a score of 9cm. In the tissue glue group, 22 parents (84.6%) scored the scar of their children as 8 or 9cm on the VAS while four parents (15.4%) gave a score of 7cm. The median VAS was 8cm for both groups with a range of 7 to 9cm. The Chi- square test showed that the parents preferred tissue glue compared with subcuticular suturing (X2 = 7.90, P < 0.05). The Hollander Wound Evaluation Scale (HWES) used by Plastic Surgeon showed 21 herniotomy wounds (84%) had a score of 6 in the suturing group while four wounds (16%) had a score of 5. In the tissue glue group, 19 wounds (73%) had a score of 6, six wounds (23.1%) had a score of 5 and a patient (3.8%) had a score of 4. The median score is 6 for both groups. There was no statistically significant difference between both groups (X 2 = 1.481, P = 0.393). Conclusion: This study has shown that the cosmetic outcome of wound closure using the tissue glue technique and subcuticular suturing technique are similar.
  3,229 70 2
Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India-A 13-year study, Part I-Bacteriological profile
Shankar Srinivasan, Arvind M Vartak, Aakanksha Patil, Jovita Saldanha
July-December 2009, 42(2):213-218
DOI:10.4103/0970-0358.59284  PMID:20368860
Aim: To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief. Method: Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years. Result: Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text. Conclusion: Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.
  2,827 156 3
Principles and Practice of Burn Care
Surajit Bhattacharya
July-December 2009, 42(2):275-276
  2,718 141 -
Use of a hypogastric flap and split-thickness skin grafting for a degloving injury of the penis and scrotum: A different approach
S Sengathir Selvan, Ganesh S Alagu, R Gunasekaran
July-December 2009, 42(2):258-260
DOI:10.4103/0970-0358.59296  PMID:20368872
Penile and scrotal skin avulsions are not common events and are caused usually by accidents with industrial machines or agricultural machines. We report a case of a 27-year-old newly married thin-built patient with avulsion and traumatic degloving of the penile and scrotal skin, with exposure of the corpora cavernosa and copus spongiosum of penis and testes as his loose clothes got entangled in a paddy harvesting machine accidently. Reconstruction was performed using a hypogastric flap and split skin graft, achieving a satisfactory aesthetic result and sexual functions.
  2,745 107 6
Dr. R. N. Sharma
Arun Kumar Singh
July-December 2009, 42(2):145-145
DOI:10.4103/0970-0358.59270  PMID:20368847
  2,589 83 -
Splinting of penis following microvascular reconstruction- A simple inexpensive method
Abhishek Sharma, Ashutosh Misra, Sandip Basu
July-December 2009, 42(2):245-247
DOI:10.4103/0970-0358.59291  PMID:20368867
We present a simple method of splintage following microvascular reconstruction of penis. The splint is made by removing the bases of two thermocol glasses and joining them with paper adhesive tapes to form a hollow cylinder to protect and support the penis and keep it vertical. The splint is slid over the catheter and the reconstructed penis and fixed to the lower abdominal wall and the thighs with paper tapes for stability. A window at the base of the splint is made for the purpose of observation, while the tip is monitored from the open end at the top.
  2,574 87 1
Aplasia cutis congenita: Two cases of non-scalp lesions
Tarek A Abulezz, Mahmoud A Shalkamy
July-December 2009, 42(2):261-264
DOI:10.4103/0970-0358.59297  PMID:20368873
Aplasia cutis congenita (ACC) is a rare condition characterized by a localized absence of skin and in some cases, the subcutaneous tissues. The majority of cases occur in the scalp; however, the lesion may occur anywhere in the trunk and extremities. ACC is most often an isolated defect, but it can be associated with other anomalies. Most reported cases are sporadic with a few reports of familial occurrence. Neither the pathogenesis nor the aetiology is clarified. Healing is spontaneous in most cases, and apart from keeping the lesion clean, no specific treatment is required. In this report, two cases of non-scalp ACC occurring in the lower limbs are presented and a brief review of the literature is conducted.
  2,579 80 6
Pattern and outcome of children admitted for burns in Benin City, mid-western Nigeria
OO Oludiran, PFA Umebese
July-December 2009, 42(2):189-193
DOI:10.4103/0970-0358.59279  PMID:20368855
Children are a vulnerable to burns, an injury, which is often preventable. A study of the profile of cases of children admitted for burns will provide background information to suggest locally doable preventive strategies as well as supply basic information for future reference. We studied the records of 62 children aged 0-16 years, admitted for burns, at the University of Benin Teaching Hospital, Benin City, between January 2002 and December 2006. There were 34 male and 28 female children. Children under three years constituted 56.5%. Whereas the leading cause of burns in all the children was flame burns from kerosene explosions (52%), scalds were responsible for 68.6% of cases in those under three. The extent of burn injury ranged from 6 to 50% and most of them presented late. 64.6% were discharged within three weeks. Wound sepsis and post burn contractures were the most frequently encountered complications (19.4% and 9.7% respectively). There were two deaths (3.2%) related to sepsis. Particular attention to burn safety precautions in children (especially, in the >3 years age group), safer storage and dispensing of combustible chemicals particularly petroleum products is advocated. Fire safety awareness, correct first aid measures and early presentation in the hospital will reduce morbidity and mortality. Early physiotherapy and splinting strategies will reduce contractures. There is the need locally for the establishment of specialized burn centres both to treat these children and to stimulate interest in burn management.
  2,377 85 7
Temporomandibular joint ankylosis
Mukund Jagannathan
July-December 2009, 42(2):187-188
  2,134 258 1
Burn epidemiology - An Indian perspective
Sameek Bhattacharya
July-December 2009, 42(2):193-194
  2,201 174 3
Evaluation of skin graft take following post-burn raw area in normovolaemic anaemia
Pawan Agarwal, Brijesh Prajapati, D Sharma
July-December 2009, 42(2):195-198
DOI:10.4103/0970-0358.59281  PMID:20368857
Background: Traditional wisdom is that wound healing is directly related to haemoglobin level in the blood; therefore blood transfusion is given in anaemic patients to raise the haemoglobin level for better wound healing. Methods: Evaluation of wound healing in the form of split thickness skin graft take was done in 35 normovolaemic anaemic patients (haemoglobin level of < 10 gm/ dl) and compared with control group (patients with haemoglobin level of 10 or > 10 gm/ dl). Results: There was no statistically significant difference in mean graft take between the two groups. Conclusion: It is not mandatory to keep haemoglobin level at or >10 g/dL or PCV value at or >30% for skin graft take, as mild to moderate anaemia per se does not cause any deleterious effect on wound healing; provided perfusion is maintained by adequate circulatory volume. Prophylactic transfusion to increase the oxygen carrying capacity of the blood for the purpose of wound healing is not indicated in asymptomatic normovolemic anaemic patients (with haemoglobin levels greater than 6g/dL) without significant cardiovascular or pulmonary disease.
  2,287 82 -
Through the mists of time: Sushrutha, an enigma revisited
Philip Philip Puthumana
July-December 2009, 42(2):219-223
DOI:10.4103/0970-0358.59285  PMID:20368861
Sushrutha had been viewed in textbooks of plastic surgery as belonging to the caste of potters who performed surgery in India. We have examined the available source documents and other references to the technology of the period to examine this assertion and are convinced that there is no evidence to support this. The period, technology and geographic references in Sushrutha Samhitha are correlated with settled positions on these to arrive at an understanding of the time and knowledge which is described. Source of erroneous interpretation of Sushrutha as a potter is also examined and clarified.
  2,253 112 3
Successful management of free osteocutaneous fibula flap with anomalous vascularity of the skin paddle
Prabha S Yadav, Quazi G Ahmad, Vinay Kant Shankhdhar, GI Nambi
July-December 2009, 42(2):255-257
DOI:10.4103/0970-0358.59295  PMID:20368871
The free osteocutaneous fibula flap is an established method of reconstruction of maxillary and mandibular defects. The vascularity of the skeletal and the cutaneous components is provided by the peroneal artery via the nutrient artery and the septo- and musculocutaneous perforators. In rare situations, these perforators may arise from other major leg arteries. In such circumstances, the procedure has to be either abandoned or modified so that neither the vascularity of the flap nor the donor limb is compromised. We present a case of an anomalous musculocutaneous perforator, which originated from the proximal part of the posterior tibial artery, passed through the soleus muscle and supplied the skin paddle. The flap was elevated as a single composite unit and was managed by two separate vascular anastomosis at the recipient site, one for the peroneal vessels and the other for the anomalous perforator.
  2,241 119 3
Vascularised fibula osteocutaneous flap for cervical spinal and posterior pharyngeal wall reconstruction
Krishnakumar Thankappan, Sandip Duarah, Nirav P Trivedi, Dilip Panikar, Moni Abraham Kuriakose, Subramania Iyer
July-December 2009, 42(2):252-254
DOI:10.4103/0970-0358.59294  PMID:20368870
We report a case of vascularised fibula osteocutaneous flap used for composite cervical spinal and posterior pharyngeal wall reconstruction, in a patient with recurrent skull base chordoma, resected by an anterior approach via median labio-mandibular glossotomy approach. Bone stability and pharyngeal wall integrity were simultaneously restored
  2,048 79 -
Designing body parts
Surajit Bhattacharya
July-December 2009, 42(2):143-144
DOI:10.4103/0970-0358.59269  PMID:20368846
  2,036 84 -
Effect of surgical traumas on microcirculation
Visweswar Bhattacharya, Biswajit Mishra, Binayak Mishra, Umesh Kumar, Siddhartha Bhattacharya
July-December 2009, 42(2):146-149
DOI:10.4103/0970-0358.59271  PMID:20368848
Background: Adequate microcirculation in different tissues maintains the physiological function and heals surgical wounds. In any surgical procedure, the commonly used instruments are cautery, tissue forceps, and clamps. The fact that their inappropriate use produces an adverse effect on microcirculation is often not realized. By this study, we could demonstrate live, the effect of these surgical traumas. Methods: The study was conducted on the inferiorly based fasciocutaneous flap with a fascial extension in patients with a distal leg defect. The extended fascial flap was mounted on a glass slide and observed for live microcirculation under x160 magnification. Three methods were used: (a) cautery in low power, (b) microcrushing forceps to crush the vessels, and (c) noncrushing clamps at the base of the fascial flap. Results: It was observed that the vessels are well protected within the deep fascia. Once the fascia was pierced the current damaged the vessel wall. As the wattage was increased, it caused charring of the tissue and multiple vessels ultimately leading to cessation of blood flow. Once the vessel wall was crushed by forceps, blood extravasated in a variable intensity depending upon the size of the vessel. Clamping led to gradual slowing of blood flow with microclot formation. In certain vessels, there was discontinuity in the blood column and ultimately the blood flow stopped. Conclusion: This study showed live demonstration of the effect of surgical traumas on microcirculation. It should guide the surgeons to select the use of appropriate instruments which will cause minimal damage to vascularity and thereby lead to a better surgical outcome.
  2,018 96 1
Sushrutha - our proud heritage
Surajit Bhattacharya
July-December 2009, 42(2):223-225
  1,931 99 1
Comments on foucher's flap
B Jagannath Kamath
July-December 2009, 42(2):270-271
DOI:10.4103/0970-0358.59300  PMID:20368876
  1,774 82 -
Congenital upper auricular detachment: Report of two unusual cases
Pawan Agarwal
July-December 2009, 42(2):265-268
DOI:10.4103/0970-0358.59298  PMID:20368874
Two unusual cases of congenital bilateral ear deformity have been presented. The deformity is characterized by upper auricular detachment on the right side with anotia on the left side in the first case and upper auricular detachment on the left side with normal ear on the right side in the second case. An attempt has been made to correlate the presented deformity with the embryological - foetal development of the auricle. Satisfactory correction can be obtained by repositioning the auricle back in to its normal position.
  1,785 68 -
The steroid benefit in treating complicated haemangioma
Kamal H Saleh
July-December 2009, 42(2):242-244
DOI:10.4103/0970-0358.59290  PMID:20368866
The clinical study included 30 patients with complicated cutaneous haemangioma (ulceration, bleeding, obstruction of anatomical orifices, and interference with function or movement). The patients were studied regarding the age group, sex, site of lesion, size of lesion, and the percentage of regression after treatment with steroid. The age ranged from three months to six years, there were 20 female patients and 10 male patients. We used local injection of diluted triamcinolone 4 mg with 5 ml. 0.9% NACI (normal saline), injected through 23-guage syringe under local or general anaesthesia every two weeks for six to eight sessions depending on the severity of the case, followed by a local pressure dressing. We measured the size of the lesion before each session and recorded the regression of the lesion. The patients were followed up for two years. Haemangioma commonly presents in infants and children, most commonly in females, especially in the head and neck and are usually of a small size. It regresses if the treatment is started earlier.
  1,728 87 -
Trans-sexuality: Cultural issues involved in the management
Devendra K Gupta
July-December 2009, 42(2):233-234
  1,664 96 -
Lymphangiectasis of lower limb: A rare challenging case
Visweswar Bhattacharya, Biswajit Mishra, Partha Sarathi Barooah, Gaurab Ranjan Chaudhuri, Siddhartha Bhattacharya
July-December 2009, 42(2):248-250
DOI:10.4103/0970-0358.59292  PMID:20368868
Lymphangiectasis usually occurs in the viscera. Involvement of the lower limb is very rare. It is difficult to establish the diagnosis without detailed investigations. Clinical features are peculiar and may mimic lymphoedema of different origins which needs to be ruled out. Contrary to the expectation, the post-operative result is excellent in the long-term follow-up.
  1,648 66 1
Internal jugular vein duplication
Biondi Paolo, Colella Giuseppe, Gherardini Giulio, Tartaro Gianpaolo, Rauso Raffaele
July-December 2009, 42(2):273-274
DOI:10.4103/0970-0358.59303  PMID:20368879
  1,645 41 1
Use of Thomas splint in salvaging free flaps of the lower limb in violent postoperative patients
KG Bhaskara, Subhash M Kale
July-December 2009, 42(2):271-272
DOI:10.4103/0970-0358.59301  PMID:20368877
  1,461 59 1
Another use of Foucher's flap
Ananta A Kulkarni, Suhas V Abhyankar, Rohit R Singh, Ganesh S Chaudhari
July-December 2009, 42(2):269-269
DOI:10.4103/0970-0358.59299  PMID:20368875
  1,307 90 -
Dand: Reply
Prabha S Yadav, Quazi G Ahmad, Vinay K Shankhdhar, GI Nambi
July-December 2009, 42(2):272-273
  1,336 58 -
Lymphangiectasis of lower limb
SB Gogia
July-December 2009, 42(2):250-251
  1,149 51 -
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