Indian Journal of Plastic Surgery最新文献

It is extremely challenging to deal with a complex full-thickness abdominal wall defect following serious trauma. We aim to share our experience in applying an anterolateral thigh flap in abdominal wall defect reconstruction. This is a retrospective case report of a 40-year-old male patient with a large area of full-thickness defect in the abdominal wall complicated with multiple organ damage identified due to acute trauma. Immediate organ repair surgeries were performed. Meanwhile, the patients underwent complete debridement in the zone of the abdominal wall defect, together with negative pressure wound therapy. Then the appropriate timing was chosen to perform a pedicled anterolateral thigh flap with vastus lateralis muscle for reconstructing a large area of full-thickness defect involving the abdomen. The outcome of the patients was also good. Thus, we conclude that the pedicled anterolateral thigh flap and vastus lateralis muscle flap are feasible to repair full-thickness defect in the abdominal wall and serve as lifesaving options.

Background: The tibialis anterior muscle flap (TAMF) is a reliable option to provide coverage for the middle third of the leg. Identification of multiple segmental vessels for the TAMF often proves to be a tedious procedure. A single dominant vascular pedicle, if identified, can be consistently used for harvesting the TAMF. There are no anatomical studies in the literature that propose to identify the main vascular pedicle of the tibialis anterior muscle, which can be consistently used for transfer.

Materials and methods: Forty lower limbs of 20 cadavers were used for the study. Microdissection of the limbs was done to identify the tibialis anterior muscle and the vessel along their entire length. The number of vascular pedicles and the location of each pedicle from the knee joint line and tibial tuberosity were noted.

Results: There were a mean of 7.45 (minimum: 5; maximum: 9) segmental perforators from the anterior tibial artery. The average diameter of the dominant perforator was 1.10 ± 0.12 mm. The mean distance of the dominant pedicle from the knee joint line and the tibial tuberosity was 12.15 ± 0.98 and 7.7 ± 1.8 cm, respectively.

Conclusion: The dominant vascular pedicle of the tibialis anterior muscle is consistently found at an average distance of 12 cm from the knee joint line and 7.5 cm from the tibial tuberosity. The dominant pedicle could perfuse about 70% of the muscle bulk. A partial TAMF can be devised based on this dominant pedicle for middle one-third leg defects.

Introduction: The two-flap technique, superior pedicle flap and central pedicle retro glandular (RG) flap, represents a novel advancement in breast reduction surgery, addressing issues such as upper pole deflation, asymmetry, and overall breast contour irregularities seen with traditional methods. This study evaluates the outcomes, efficacy, and safety of the two-flap technique, emphasizing its ability to provide enhanced aesthetic results and high patient satisfaction.

Materials and methods: A retrospective study was conducted on 165 patients who underwent the two-flap technique between February 2022 and February 2024. The technique involved preoperative skin markings for precise flap creation, using superior and central pedicles to ensure optimal vascularity and contour. Tissue reduction was performed based on individual patient needs, and post-surgical follow-ups ranged from 6 months to 1 year. Data collected included demographic details, tissue reduction volumes, postoperative complications, and patient satisfaction. Statistical analysis was conducted using SPSS software.

Results: The majority of patients (66.67%) were aged 31 to 40 years, with a mean age of 34.59 years. Tissue reduction ranged from 200 to 800 g, with 48.49% of patients having 200 to 400 g removed. Complications included seroma in 7.27% and wound dehiscence in 3.64%. Patient satisfaction was high, with 89.09% reporting being "highly satisfied." The technique demonstrated significant improvements in upper pole fullness and breast contour.

Conclusion: The two-flap technique offers a safe, effective, and aesthetically pleasing solution for breast reduction surgery. Its innovative approach minimizes complications and maximizes patient satisfaction, though further studies are recommended to validate its efficacy in larger breast sizes.

Plant thorn synovitis is a frequently missed and neglected injury. We report a delayed case of suspected thorn injury to the left middle finger in a 5-year-old child, which was treated with thorn removal and complete flexor synovectomy to achieve good results. Proper history, clinical examination, and correlated radiological findings can help in the diagnosis. Patients may seek late treatment due to persistent swelling and pain. Antibiotic may be given; however, in a delayed case, its role is debatable. Thorn removal and complete tenosynovectomy offers complete recovery.

Following proximal ulnar nerve repair, there will be a delay in innervating the distally placed intrinsic muscles of the hand, which can lead to irreversible damage to the intrinsic motor end plates. Supercharging with end-to-side anterior interosseous nerve (AIN) transfer can augment the results of nerve repair by babysitting the motor end plates and thus preventing its denervation. Recently, there have been discussions regarding whether AIN, which contains only 500 axons, can augment the ulnar motor branch, which contains approximately 1,500 axons. In one of our cases, electromyogram following surgery showed activity in the first dorsal interossei and abductor digiti minimi without any signs of reinnervation in the flexor carpi ulnaris. This may support the contribution of AIN in supplying the intrinsic muscles. Considering the low morbidity of the procedure and potential improvements in muscle strength, all patients undergoing ulnar nerve repair in high ulnar nerve palsies can be counseled to undergo an end-to-side AIN transfer.

Objective: To introduce a simple and innovative low-fidelity microsurgical model using daily articles available in any plastic surgery operation theatre and to determine its quality, ease of use and cost-effectiveness.

Materials and methods: The model is essentially made by rolling a loose disposable glove upon a K-wire to create a true micro-vessel (< 2 mm). Adjustment in the size and thickness of the conduit can be made. Model was assessed by data obtained from subjective questionnaire to 29 experienced microsurgeons with more than 5 years of independent microsurgical practice. This experience of our model was compared with their experience with other material and animal tissue.

Results: The chicken femoral is the best compared to rat model overall, but rolled latex is as good or second best as far as some of the features assessed.

Conclusion: "Eklavya" microsurgical model provides a valuable alternative to traditional animal models, allowing trainees to practice and hone their skills without the ethical and financial concerns associated with live animal use.

Background: Maxillofacial trauma is quite commonly encountered either in isolation or in association with polytrauma. The present observational study aims to analyze the changing trends of maxillofacial injuries and mull over some probable reasons for the same.

Materials and methods: This is an observational retrospective study done at a tertiary care center in Mumbai, India, for a period of 12 years (2008-2019) after getting clearance from the institutional ethics committee. All patients who were admitted in the plastic surgery unit with maxillofacial trauma were included in the study and data were collected from case record sheets in the archives of the department. The data obtained were tabulated and analyzed.

Results: A total 1,046 patients were included in the study. The most common age group involved was 21 to 30 years (50.19%). Males outnumbered females in terms of hospital admissions (92.7 vs. 7.3%). Road traffic accidents (RTA) were found to be the major etiological factor (72.27%). Out of 756 RTA victims, 533 (70.5%) were due to two-wheeler accidents. In the present study, the zygomaticomaxillary complex (middle third) was most commonly fractured (40.73%) followed by the mandible (38.91%). Panfacial fractures (i.e., those involving at least two facial thirds) comprised 10.71% of all the cases.

Conclusion: The incidence of maxillofacial trauma is showing an increasing trend in the recent past. The majority of the patients are victims of RTAs and two-wheeler accidents are increasingly responsible for such injuries. The classical injury patterns and the fracture patterns that were described in the past are not routinely observed now. The injury and fracture pattern itself has become more complex. We observed a statistically significant raise in midface fractures in our study.

Background  Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of young adults. Severe and refractory disease commonly requires surgical excision of the affected skin. To date, there is no consensus regarding the most appropriate reconstructive algorithm. Materials and Methods  We conducted a retrospective cohort study including all HS patients who underwent surgical excision in the framework of our multidisciplinary clinic. Operative data and postoperative outcome measures were compared between patients who underwent immediate versus delayed reconstruction. Additionally, reconstructive methods were compared and risk factors for adverse postoperative outcome were identified. Results  A total of 103 patients underwent 158 surgeries for HS excision. The overall complication rate was significantly higher in patients who underwent immediate versus delayed wound closure (31 vs. 16%, p  = 0.039). Any intervention for wound closure (immediate or delayed) was associated with increased risk of postoperative complications in comparison to secondary healing (33 vs. 4%, p  < 0.001). With delayed closure, the average time to wound closure was 85.4 days with secondary healing only and 57 days with negative pressure wound therapy assisted closure. Conclusion  Risk factors for adverse postoperative outcome in HS surgery are multifactorial and involve both timing and method of reconstruction in addition to various patient factors. The findings of this study strengthen the notion that delayed closure of post-HS excision wounds leads to the most uneventful course in regard to postoperative adverse events; however, this may take up to 3 months. Upon deciding on a reconstructive plan, the risk-to-benefit ratio should be assessed individually weighing the pros and cons of immediate closure and delayed secondary intention.

Hyaluronic acid filling to correct the nose contour has gained popularity in recent years. Although many techniques are described about the amount of the product and steps to follow to obtain, practitioners still need clarification about the amount of product and steps to follow obtain natural and safe results. We aim to demonstrate a new technique with a systematic sequence that considers the anatomy and individual characteristics. The nonsurgical elementary rhinoplasty (NOSER) technique is performed in five steps using cannulas, a high G prime hyaluronic acid, and two injection entry points. The areas to be treated and the specific quantity of filler to be used are based on the assessment. Steps 1 to 3 are for the tip's projection, support and lift, and step 4 is for filling the radix area and straightening the dorsum. Step 5 is used for refinement and softening of the supratip. All five steps are done in small aliquots in the central area, at the deep plane. Through the procedure, it is possible to achieve an aesthetic improvement in the nose by widening the labial columellar angle, exposing the columella, projecting the tip, and aligning the dorsum (disguising the hump), even without performing all five steps. This technique could be a good and highly reproducible alternative for upgrading the nose contour.