Indian Journal of Plastic Surgery最新文献

Background  Extensive postmastectomy defects and soft-tissue defects often require some additional flap cover of reconstruction after excision. The reconstruction aim in this group should be a diligent and easy closure with a quality skin cover, early recovery, and brief stay in hospital so that the patients can receive early postoperative radiotherapy/chemotherapy. Medially based abdominal transposition flap is a type C fasciocutaneous flap based on medial perforating vessels. We present our experience in significant postmastectomy defects, especially in high-risk morbid patients. Materials and Methods  This is a retrospective study conducted by the department of plastic surgery, from an analysis of the breast cancer database maintained by our hospital from 2019 to 2023. A total of 826 breast cancer patients underwent surgery, of which 547 were locally advanced breast cancer (LABC) patients and 138 (32.5%) LABC patients needed flap cover for mastectomy defect. Medially based abdominal transposition flap was used in 56 of 138 (40.5%) LABC patients for defect closure, and 42 of the 56 patients were stage IIIB patients. Upfront surgery was primarily done in 20 patients and 36 patients underwent surgery after neoadjuvant chemotherapy. This analysis aimed to assess the operative duration, postoperative morbidity, hospital stay, and time taken to start adjuvant treatment by analyzing the medical records of patients who underwent this procedure. Results  Fifty-six patients with breast cancer underwent surgical intervention, whereby 8 patients presented with tip and edge necrosis, and 3 patients were infected. The mean duration of operation was 58.852 minutes, and the average length of hospital stay was 5.39 days. It took 24.57 days for the patients to stabilize sufficiently for adjuvant therapy. The average age of the patients in the study was 48.73 years. Conclusion  Our clinical experience has demonstrated that the medial abdominal transposition fasciocutaneous (MATF) flap represents a straightforward, reliable, and cost-effective method for managing extensive postmastectomy soft-tissue defects in a subset of patients with LABC. This group typically consists of high-risk and comorbid patients. The procedure holds considerable promise for developing countries with limited infrastructure and expertise, owing to its ease of execution and short learning curve. By its simplicity and affordability, the MATF flap offers a viable and sustainable solution for treating LABC-associated soft-tissue defects.

From time immemorial, human beings have always tried to decorate themselves to look more beautiful and attractive to an onlooker, in turn improving their own self-esteem. Thus, Ayurveda in India and Ebers Papyrus in Egypt, written thousands of years ago, mention a variety of cosmetics being used for the same. However, operative interventions were mainly reconstructive and any improved aesthetics was a by-product only (e.g., restoration of amputated nose). The surgery for purely cosmetic reasons started less than 150 years ago after the availability of anesthesia and antisepsis. Initially, the medical profession and the common man were skeptical of these interventions and even ridiculed the patient and the clinician. The pioneers were labeled as quacks and working against the law, and some of them had to even commit suicide, while the patients were labeled as "psychiatric." The past 50 years have seen aesthetic procedures, both surgical and nonsurgical, being performed by highly qualified superspecialists. This article attempts to trace this change.

An aesthetically pleasing neck is an important component of a youthful appearance of the face. It is frequently targeted by many surgical and nonsurgical methods to achieve the best results. Today, patients are looking for a minimally invasive option that gives permanent results and has a quick recovery. Therefore, ultrasound-assisted liposuction of the chin and jawline has become an important part of the cosmetic surgeon's armamentarium. The objective of this article is to describe the technique, mechanism of action, and most common complications and to establish ultrasound-assisted face liposuction under local anesthesia as an effective method to achieve facial slimming especially in the Indian population.

Background  The medial sural artery perforator (MSAP) flap is reliable in resurfacing defects of the popliteal fossa. There is possibility of resurfacing the popliteal fossa defects after postburn contracture release with scarred MSAP flaps with good overall long-term outcomes. Materials and Methods  A study was conducted from June 2017 to July 2023 to evaluate the functional and surgical scar aesthetic outcome in patients with soft-tissue defects in the popliteal fossa after postburn contracture release that were reconstructed using scarred and unscarred MSAP flap with 10 patients in each group. Results  The clinical outcome was assessed in terms of the perioperative and late postoperative complications, range of motion of the knee joint along with surgical scar outcome using the Patient and Observer Scar Assessment Scale (POSAS). The functional results in the scar tissue flap group were comparable with those in the normal tissue flap group, but the aesthetic outcome of surgical scar was found to be better in the normal tissue flap group. Conclusion  The MSAP flap provides ideal tissue for soft-tissue reconstruction with minimal donor site morbidity for popliteal fossa defects after postburn contracture release in both the scarred and unscarred flap groups.

Management of complex wounds in the pediatric population is a herculean task due to the decreased surface area available for flaps and the added scars from flap reconstruction. Biodegradable temporizing matrix (BTM) has proven useful, particularly in adult burns and complex wounds. Only a few have documented the use of BTM in complex wounds in children. A 2-year-old child presented with tendoachilles exposure of the right ankle due to a crush injury in the spokes of a motorcycle. The wound was debrided and covered with BTM. After 5 weeks, the same was delaminated, healthy granulation tissue was found covering the tendoachilles, and the raw area was grafted. BTM proved to be a versatile option for converting a complex wound to a superficial wound, and it abetted the drawbacks of a flap cover: extended hospital stay, discomfort, prolonged immobilization, and additional scars.

Background  There is no normative study of transregional grip strength data available from India. Hence, a multicenter study is designed to obtain reference value. Materials and Methods  This is a prospective observational study conducted as a part of the Indian normative data project of the Indian Society for Surgery of the Hand. The study included three participating centers: one from the northern part and two from the southern part. Certified calibrated Jamar dynamometer and Jamar pinch gauge were used to measure the grip strength, key pinch strength, tip pinch strength, and tripod pinch strength as per the guidelines of the American Society of Hand Therapists. Results  A total of 1,019 volunteers in the age group of 18 to 60 years were studied. The mean grip strength in males and females was 38.18 and 24.06 kg, respectively. The mean key pinch strength was 8.52 kg in males and 5.97 kg in females. The mean tip pinch strength was 4.86 kg in males and 3.59 kg in females. The mean tripod pinch strength was 5.41 kg in males and 4.16 kg in females. Conclusions  All four strengths were lower in value when compared with American and other populations. The men had more strength than women. There was no relation to hand dominance. There was a correlation for age and height but no correlation with body mass index (BMI).

Background  The absence of the palmaris longus (PL) varies with race. The presence of a functional flexor digitorum superficialis (FDS) of the little finger also varies widely. The aim of this study is to determine the prevalence of the absence of the PL and functional FDS of the little finger in the Indian population. Materials and Methods  This is a prospective observational study conducted as a part of the Indian normative data project of the Indian Society for Surgery of the Hand. The presence of the PL was assessed by Schaeffer's test. The function of the FDS was assessed by the standard test and modified test and its function designated as absent, present independently, or present combinedly with the ring finger FDS. Results  A total of 200 volunteers including 84 males and 116 females in the 21- to 60-year age group were examined. Of the 400 hands examined, the PL was absent in 26 upper limbs (6.5%). The PL was absent unilaterally in 12 individuals (6%) and bilaterally in 7 individuals (3.5%). Of the 400 little fingers examined, FDS function was absent in 72 fingers (18%), while 67 fingers (16.75%) had a common function and 261 fingers (65.25%) had an independent function. Only 2% had a bilateral absence of both the PL and functional FDS tendons and 5% had a unilateral absence of both tendons. Conclusion  The PL and FDS of the little finger were more absent in the right side than in the left side, but the difference was not statistically significant. There was no significant association between the absence of the PL and the absence of the functional FDS of the little finger.