Indian Journal of Plastic Surgery最新文献

Introduction: Work-related musculoskeletal disorders (WRMDs) are a less discussed entity in the medical profession, with surgical specialties being more prone to them. Little is known about these types of injuries in plastic surgeons specifically. Data on WRMDs among Indian plastic surgeons are lacking. The goals of this study were to evaluate the prevalence, nature, particular contributory causal factors and behaviors, and potential remedies of these musculoskeletal injuries among plastic surgeons in India.

Materials and methods: An online voluntary survey was conducted among plastic surgeons in India, collecting their demographics, workload characteristics, musculoskeletal issues, causal factors, and corrective measures, taken using Google Forms. Data were extracted into an MS Excel spreadsheet and analyzed. The prevalence of WRMDs was calculated and the predictors were evaluated with a univariate analysis.

Results: Thirty-three percent of 297 respondents had work-related musculoskeletal injuries or disorders, with the majority experiencing pain (82%), with the neck being the most common site (61%); this was followed by stiffness (61%) and fatigue (52%). The most common causative factors were sustained posture (81%), awkward posture (72%), and inadequate breaks (34%). Age ( p  = 0.041) and average operative hours per week ( p  = 0.036) were found to be statistically significant ( p  < 0.05). The corrective measures cited were stretching exercises, core-strengthening exercises, maintaining proper posture, taking frequent breaks, and yoga.

Conclusion: Plastic surgeons are at high risk of WRMDs, with a significant prevalence in India. Albeit plastic surgeons in India face a higher case load, implementation of ergonomic principles can help in reducing the incidence of these disorders and in preventing the severity of sequelae.

Delayed reconstruction of segmental extensor tendon defects of the hand has been described with auto-tendon grafting or by using local flaps harvested from the native tendon. These reconstructive techniques have been described in certain extensor tendon zones, mainly in zones 2, 4, and 5 of the hand. Borrowing auto-tendon grafts will have donor site morbidity. The use of available local tendon as flap may be considered, the tendon harvesting being done from a part of the native tendon from either proximal or distal location. The index and little fingers have the advantage of having two tendons to do the same function and hence these tendons may be utilized as a whole to our advantage as distally based tendon flip flap to reconstruct zone 4 and 5 extensor tendon defects with good functional outcomes.

Facial fractures are commonly encountered by plastic and maxillofacial surgeons. Although very diversified in nature, their treatment planning requires a thorough knowledge of the facial anatomy and advanced treatment modalities. With the advent of three-dimensional computed tomography, it has become a lot easier to diagnose and treat them accordingly. It is important to categorize facial fractures for an effective liaison between the radiologists, surgeons, and medical staff involved in their management. Various classification schemes have been made to classify them, but they are cumbersome to remember and communicate among treating doctors. We present a new yet simple facial fracture classification that is based on the facial buttresses involved. This helps in better and uniform management of fracture patterns and also anticipates future complications that may arise from such fractures, if any.

Background: Gynecomastia, affecting around 30% of young males, has seen evolving surgical treatments, transitioning from traditional excision methods to contemporary techniques like liposuction. Emotional distress persists when glandular tissue is inadequately addressed, prompting exploration of combined liposuction and glandular excision procedures.

Materials and methods: Patients undergoing gynecomastia surgery over a period of 2 years were assessed, considering their demographics, medical history, and gynecomastia grade. Surgical procedures involved liposuction alone or with glandular excision. Endoscopy was used to assess the presence of fibroglandular tissue and the need for glandular excision. Postoperative assessments, clinical photography, and patient questionnaires spanned a 6-month follow-up.

Results: Thirty-two breasts (17 in liposuction alone and 15 in liposuction with glandular excision groups) were included. Liposuction alone led to bruising and two hematomas, and "puffy nipples" necessitating one redo surgery. Glandular excision resulted in four cases of crater deformity and one case each of superficial skin necrosis, hematoma, and seroma. Cosmetic evaluations showed similar outcomes, with the liposuction alone group having higher redo surgery rates.

Conclusion: This study finds that combining liposuction with glandular excision delivers comparable cosmetic results to liposuction alone for gynecomastia. Despite added complexity, the combined approach proves effective and helps in decision-making, emphasizing the need for tailored techniques and ongoing research to optimize treatment strategies.

Pedicled abdominal flaps continue to be popular in most parts of the world for covering soft tissue defects of the upper limb. There is apprehension if distant pedicled flaps can be used in children for fear of disruption. We recently had a newborn baby with neonatal compartment syndrome (NCS) of her left upper limb in whom a pedicled abdominal flap was successfully used to cover the raw area in the forearm at 41 days of life. A severely swollen limb with ischemic skin lesions associated with lack of motion of the upper limb often points to NCS. Since no guidelines exist for the diagnosis and management of NCS, a high index of suspicion and urgent fasciotomy are required to limit its sequelae. Our patient had an emergency fasciotomy elsewhere was referred to us with a precariously viable limb for salvage. The raw area in the forearm with exposed bone was successfully covered with a pedicled abdominal flap at 41 days of life. Our patient is probably the youngest patient ever to receive a pedicled abdominal flap.

Filler injections for buttock augmentation are becoming more popular as a cosmetic procedure, which leads to an expected increase in the number of complications emphasizing the importance of reporting cases with both well-known, severe, and previously undiscovered complications, as well as their possible treatment strategies. We present an 18-year-old woman who suffered severe long-term complications following Aquafilling injections for buttock augmentation, including filler migration, infection leading to septic shock, and nonparathyroid hypercalcemia, which has the potential to cause renal insufficiency. To date, we have not found any reports describing the association between nonparathyroid hypercalcemia and Aquafilling. Additionally, we outline a treatment regimen involving a minimally invasive approach, which includes daily irrigation, manual compression, and passive evacuation. At follow-up, the patient returned to her everyday life with no lasting sequelae, except for a solid mass medially on the right thigh.

Background  Any deviation from the normal process of wound healing leads to excessive scar formation in the form of keloid or hypertrophic scar. Materials and Methods  The study included 120 candidates with keloids divided equally into two groups, A and B, of 60 patients each. After surgical excision, group A received combination therapy of intramarginal 5-fluorouracil (5-FU) and triamcinolone acetonide (TCA), while group B received only TCA, followed by compression therapy in both. Results  Eighty-seven patients had keloids on ear lobules, 25 (20.8%) on helix, and 8 (6.7%) over multiple locations on ear. Ninety-two (76.7%) had keloids over bilateral, 18 (15%) on left, and 10 (8.3%) on right ear. Sixty-three (52.5%) belonged to third, 65 (54.2%) to fourth, and 8 (6.7%) to fifth decade of life. Overall recurrence rate was 21.7 and 38.3% in group A and B, respectively. Recurrence was seen in 2 from group A (male:female 2:0) and 4 from group B (male:female 3:1) at 3 months, in 7 from group A (male:female 5:2) and 13 in group B (male:female 8:5) at 6 months, and in 4 from group A (male:female 3:1) and 6 from group B (male:female 5:1) at 1 year. Overall, pain was reported by 9 and 7 from group A and B, respectively, and burning sensation by 3 and 1 from group A and B, respectively. Ulceration was noted in 2, wound dehiscence in 1 and transient hyperpigmentation in 2 from group A. Based on the Vancouver Scar Scale, outcome on follow-up had an average of 3.5 at 3 months, 4.2 at 6 months, and 4.8 at 1 year in group A, and 3.8 at 3 months, 4.7 at 6 months, and 5.4 at 1 year in group B. Conclusion  Multimodal approach of combination therapy of intramarginal 5-FU and TCA with compression therapy after surgical excision of keloids in ears yields lower recurrence rate when compared with TCA alone. Chances of recurrence are more common in males than females. Though intramarginal 5-FU in combination with TCA has more localized side effects than TCA alone yet lower recurrence rate and better results in the long term can overcome the mild severity of these side effects.