Indian Journal of Plastic Surgery最新文献

Background: The Association of Plastic Surgeons of India (APSI) felt the need to create an opportunity for the residents to participate in a mock viva voce patterned course on the national platform in front of examiners from the various centers and instill a feeling of confidence and healthy competition among them. Apart from the responsibilities of teaching departments running the formal plastic surgery training programs, the association also took upon itself to further strengthen the academics, especially of residents working at centers that lack regular teaching classes, and started the postgraduate medical education course in October 2022.

Materials and methods: The course module was divided into nine sections: one long case, five short cases, instrument, radiology, operative. It was conducted over 2.5 hours for two consecutive evenings on an online platform (apsi.vidocto.com). The flow comprised presentation by the resident with two faculty examiners for asking questions and two course mentors for observation followed by feedback to the resident on his/her performance. Course feedback was collected in a Google form.

Results: A total of eight courses have been conducted to date. The online synchronous viewership varied from 83 to 172 (mean, 115.94 ± 34.01), out of which 62 to 67% (mean, 74.18 ± 4.06) were residents and 33 to 38% (mean, 40.28 ± 3.93) were faculty. These courses were also archived for later access. The feedback showed that 96.6% participants agreed that the objective to enhance knowledge was achieved and 100% agreed that such a program will benefit in gaining confidence. Thirty-one percent students rated their learning experience after the course as 10 on a scale of 1 to 10. The majority of the faculty and residents preferred the online mode.

Conclusion: Being a maiden initiative of its kind, the APSI-PGME is a competency-driven course that has significantly enhanced the residents' confidence as a result of gain in knowledge and understanding.

Background: In cases of burns affecting the hand, minimizing morbidity and disability is crucial. Early mobilization is essential to prevent persistent contractures and optimize functional outcomes by gradually improving range of motion. The purpose of this study was to determine the efficacy of a glove-based dressing regimen in treating superficial partial-thickness and small deep-dermal hand burns compared to conventional dressings.

Materials and methods: This study was conducted in a burn department affiliated with a tertiary care center over a period of 1 year between January 2018 and December 2018. A total of 75 digits (23 hands of 14 patients) were included in the study with 38 under a case group and 37 under a control group. The primary outcome of study was evaluated by assessing the edema, healing time, and mobility of the affected digit.

Results: Mean healing time in the case group was 12.4 days (range: 11-14, standard deviation [SD]: 0.992). The mean VAS (visual analog scale) score was 8.42 (range: 13-17, SD: 1.136). The percentage increase in mobility was 70.81% in the case group (glove dressing) as opposed to 46.57% in the control group (conventional dressing) at 10 days post-burn, which was statistically significant.

Conclusion: Sterile glove dressing techniques can be handy and a convenient method for dressing of hand burn injuries.

Introduction: Gynecomastia is a common condition characterized by male breast enlargement, which can have a profound psychological impact on affected individuals. Surgical intervention is often sought to alleviate these concerns. This study evaluates the lateral port technique for gynecomastia surgery, which combines power-assisted liposuction (PAL) and ultrasound-assisted liposuction (UAL) to achieve optimal surgical outcomes with no scar on front of chest.

Materials and methods: A retrospective analysis was conducted on 967 patients who underwent gynecomastia surgery using the Out of Sight, No Cut on Front of Chest Using Ultrasound and Power-Assisted Devices through Lateral Incision (OCCULT) technique between January 2022 and December 2023. The procedures were performed at multiple centers located in New Delhi, Gurugram, and Mumbai, India. This technique involves a single lateral chest wall incision and incorporates both PAL and UAL to ensure effective tissue removal and contouring. Outcomes assessed included surgical efficacy, complication rates, and patient satisfaction. The surgeries were performed by a team of experienced surgeons, ensuring the reproducibility and consistency of the method.

Results: The OCCULT technique demonstrated high efficacy and high patient satisfaction. Among the 967 patients, 93.3% reported being satisfied with the surgical results. Excellent scar quality was reported by 97.1% of the patients. Moreover, the scar was out of sight, that is, no scar on the front of chest was made in the OCCULT technique for gynecomastia surgery. Complications were minimal, with only 0.8% experiencing seroma formation and no cases of necrosis observed.

Conclusion: The OCCULT technique for gynecomastia surgery is an effective and reproducible method that provides aesthetically favorable results with minimal complications. Its ability to address the psychological and physical burdens of gynecomastia highlights its value in modern surgical practice.

Background  An anteverted concha is an uncommon ear anomaly that causes anterior ear deformity and falls under auricular deformation. Treatments vary from conservative to surgical. Limited global case reports may be due to under-recognition, prompting a proposed classification. Patients with an anteverted concha were evaluated in our department and a classification system was formulated. Materials and Methods  This study was conducted in a plastic surgery department at a tertiary care teaching hospital over a period of 2 years, from January 2021 to December 2022. This study included 22 ears of 16 patients. One patient underwent surgical correction, and two patients underwent molding therapy with excellent outcomes. In addition to reporting these patients' outcomes, we reviewed their cases to propose a classification system. Additionally, an in-depth review of the literature on the reported cases was performed. Results  Molding therapy during the early neonatal period and surgical correction later in life yielded excellent outcomes. Conclusion  An anteverted concha may be underdiagnosed. Correction is typically straightforward and may not necessitate surgery if it is diagnosed early. Surgical correction leads to excellent outcomes in symptomatic anteverted conchae in adulthood.

Hyperlipidemia is one of the causes of atherosclerotic calcified vessels. Anastomosis of such vessels during surgery may offer various challenges. It is twice as challenging when the limb's and flap's vascularity is compromised together. We present a case of microvascular anastomosis of calcified vessels with compromised limb vascularity (due to an inadvertent injury to the brachial artery, which created a gap between two ends) and low ischemia time for flap (free functioning muscle transfer) that dealt with a Y -shaped vein graft. Using a Y -shaped vein graft in atherosclerotic vessels allowed us to anastomosis with ease and deal with challenges encountered during anastomosis. The Y -shaped vein graft was used to reconstruct the brachial artery and at the same time, another limb of the Y -shaped vein graft was used to anastomose the flap's vessel. Postoperatively vascularity of the limb and flap were restored and computed tomography angiography confirmed patent anastomosis of the Y -shaped vein graft. The Y -shaped vein graft is a novel and simple technique that can be utilized when dealing with calcified vessel anastomosis and can help in restoring the blood supply of the flap and limb together.

Introduction  The primary aim of this paper is to describe an original technique for dorsal augmentation in rhinoplasty. The use of a carved block of costal cartilage or layers of septal cartilage is a well-known technique for dorsal augmentation. However, this is accompanied by the risks of cartilage warping and a hard, unnatural feel to the dorsum. On the other hand, the use of diced cartilage wrapped in the fascia, which has been another popular technique in the last decade, often does not give the structural stability of a solid cartilage. "Fascialage," as innovated by the authors, is a combined construct that incorporates all the advantages of these techniques eliminates the disadvantages of the previous techniques. Materials and Methods  Our technique involves the creation of a construct with three components and three parts. Radix augmentation is done with the cranial part, which consists of mostly rolled-up fascia; augmentation of the mid-dorsum is done with the central part, which has a solid cartilage platform, an overlay of diced cartilage with both being wrapped in the fascia, while the lower dorsum and supra-tip area also have all the same three components but with less diced cartilage. We can plan and alter the composition and dimensions as required for the individual case. Results  As a result of this, we believe that "fascialage" has the advantages of the other two techniques and consistent long-term results. Conclusion  This technique was used in 55 rhinoplasties needing considerable dorsal augmentation in which a postoperative follow-up of 2 to 5 years revealed that this technique yields reliable and sustainable results.

Background: In injuries of the hand or forearm with vascular compromise due to a single vessel supplying blood distally or difficulty in donor vessel access, a pedicled flap is preferred. Skin flaps like the groin flap are commonly used as an interpolation flap. Muscle flaps used as interpolation flaps have scarcely been reported in the literature. However, muscle has been a component of composite flaps used as interpolation flaps like the tongue flap. The authors have used pedicled, interpolated muscle flaps successfully in hand and heel reconstructions.

Materials and methods: Five patients with soft tissue loss due to trauma, in single vessel limbs or difficult donor vessel access, were taken up for interpolation muscle flap. Four of these patients underwent inferiorly based, upper rectus abdominis muscle flap delivered at the umbilicus, by endoscopy or the open method. One patient underwent a proximally based, medial head of the gastrocnemius, cross-leg flap. The muscle flaps were skin grafted. One month later, the flaps were delayed and divided shortly thereafter. The divided end of the muscle was dressed till it healed. All the patients were followed up for healing time, additional procedures, and long-term results.

Results: Five documented cases of reconstruction in single vessel limbs or difficult donor vessel access were reviewed. All five cases achieved good healing and intended reconstructive outcomes without any complications.

Conclusion: An interpolation muscle flap is a safe and effective method for reconstructing limb defects. Both types of interpolation muscle flaps described are novel applications in reconstructive surgery.

Background  The superficial circumflex iliac artery perforator flap (SCIP flap) is an evolution of the conventional free groin flap. Even though the anatomical basis for SCIP flap is well established in general, the same is not described in a South Indian population. Objectives  The objectives of our study were to determine the anatomical variations of the superficial circumflex iliac artery perforators (SCIA perforators) and describe them in relation to the nearby bony landmarks like anterior superior iliac spine (ASIS) and pubic tubercle (PT). Materials and Methods  This observational study was done between October 2020 and December 2021. Cadaveric dissection was done and the required anatomic data were collected. Results  The mean diameter of SCIA was 0.99 mm and the mean pedicle length was 2.97 cm. The average diameters of the medial and lateral perforators were 0.63 and 0.55 mm, respectively. The pedicle lengths of the medial and lateral perforators were 3.03 and 4.31 cm, respectively. The medial perforator was 5.63 cm lateral and 1.66 cm superior to the PT. It was 5.37 cm medial and 5.99 cm inferior to the ASIS. The lateral perforator was 7.97 cm lateral and 2.73 cm superior to the PT. It was 2.86 cm medial and 4.11 cm inferior to the ASIS. Conclusion  Finding the exact location of the medial and the lateral perforators with respect to permanent bony landmarks and having an idea about their average pedicle length are useful for preoperative planning of the SCIP flap.