tag:blogger.com,1999:blog-17011316181776211072024-03-23T03:14:49.564-07:00VIDHUNS PLASTIC SURGERY AND COSMETIC WORLDWorld class website exhibiting before and after plastic surgery cases with pictures and also an educational tool for budding surgeonsDr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.comBlogger405125tag:blogger.com,1999:blog-1701131618177621107.post-83828607496445196752022-02-27T22:34:00.001-08:002022-02-27T22:34:14.441-08:00Acute Lip Split Injury Managed ResultsAdult male presented with Lip split Injury And was acutely repair cosmetic /aesthetic appearances taken into account and managed accordingly to result in final smile and same before injury.<div><br></div><div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-30326186828760017092022-02-27T22:30:00.001-08:002022-02-27T22:30:50.169-08:00Dog Bite Lip Loss Single Stage Reconstruction estlander /Abbe FlapTHIS IS CHILD WITH DOG BITE WITH LIP LOSS .<div><br></div><div>Managed with immunoglobulin intralesional and antiviral injection in acute setting and flap cover done in a single stage reconstruction .</div><div><br></div><div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com3tag:blogger.com,1999:blog-1701131618177621107.post-23359147333370377232021-07-30T01:59:00.001-07:002021-07-30T01:59:23.452-07:00Gynecomastia Male Breast Reduction SurgeryGynecomastia is a condition of overdevelopment or enlargement of the breast tissue in men or boys. The breasts become larger. They may grow unevenly. Gynecomastia often happens when a preteen or teenage boy is going through the hormonal changes of puberty.<div><br></div><div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div><div>People also ask</div><div>Does gynecomastia go away?</div><div>It's almost always temporary, and it's very unusual for the breasts to stay developed — they will eventually flatten out completely within a few months to a couple of years. Gynecomastia usually goes away without medical treatment.</div><div><br></div><div>Gynecomastia is most commonly caused by an imbalance between the hormones estrogen and testosterone. Estrogen controls female traits, including breast growth. Testosterone controls male traits, such as muscle mass and body hair.</div><div><br></div><div>Gynecomastia is a benign growth of male breast glandular tissue.</div><div>...</div><div>The following are some steps that people can take to help reduce puffy nipples.</div><div>Improve diet. Share on healthul diet may reduce excess fat in the chest area. ... </div><div>Exercise and target lifting. ... </div><div>Take supplements to boost testosterone. </div><div>Undergo surgery.</div><div><br></div><div><div class="separator" style="clear: both; text-align: center;">
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</div><br><br><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-30833492126752202502021-07-30T01:53:00.001-07:002021-07-30T01:53:19.153-07:00Abdminoplasty with Tummy Tuck<p>Are sit-ups not giving you the taut tummy you want? If you've got too much flab or excess <a href="https://www.webmd.com/skin-problems-and-treatments/picture-of-the-skin" data-metrics-link="" data-crosslink-type="article">skin</a> in your <a href="https://www.webmd.com/digestive-disorders/picture-of-the-abdomen" data-metrics-link="" data-crosslink-type="article">abdomen</a> that doesn't respond to <a href="https://www.webmd.com/diet/default.htm" data-metrics-link="">diet</a> or <a href="https://www.webmd.com/fitness-exercise/guide/default.htm" data-metrics-link="">exercise</a>, you may be considering a "<a href="https://www.webmd.com/beauty/cosmetic-procedures-tummy-tuck" data-metrics-link="" data-crosslink-type="article">tummy tuck</a>," which doctors call "abdominoplasty."</p><p>This surgery flattens the abdomen by removing extra fat and skin, and tightening muscles in your abdominal wall.</p><p>It's not the same as <a href="https://www.webmd.com/skin-beauty/guide/cosmetic-procedure-liposuction" data-metrics-link="">liposuction</a>, although you may choose to get <a href="https://www.webmd.com/beauty/cosmetic-procedure-liposuction" data-metrics-link="" data-crosslink-type="article">liposuction</a> along with a tummy tuck.</p><p><br></p><p><div class="separator" style="clear: both; text-align: center;">
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</div>Who Are the Best Candidates For a Tummy Tuck?</p><p>A tummy tuck is suitable for men and women who are in good health.</p><p><br></p><p>Women who have had several pregnancies may find the procedure useful for tightening their abdominal muscles and reducing skin.</p><p><br></p><p>A tummy tuck is also an option for men or women who were once obese and still have excess fat deposits or loose skin around the belly.</p><p>Who Should Not Consider a Tummy Tuck?</p><p>If you're a woman who plans to get pregnant, then you may want to postpone a tummy tuck until you're done having children. During surgery, your vertical muscles are tightened, and future pregnancies can separate those muscles.</p><p><br></p><p>Are you planning to lose a lot of weight? Then a tummy tuck also is not for you. A tummy tuck should be a last resort after you've tried everything else. It should not be used as an alternative to weight loss.</p><p><br></p><p>You should also consider the appearance of scars after a tummy tuck. You can talk about scar placement and length with the doctor before the surgery.</p><p><br></p><p><div class="separator" style="clear: both; text-align: center;">
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</div>The first step is to choose a surgeon and see them for a consultation. At that meeting, you'll talk about your goals and the following options:</p><p><br></p><p> Complete abdominoplasty. The surgeon will cut your abdomen from hipbone to hipbone and then contour the skin, tissue, and muscle as needed. The surgery will involve moving your belly button, and you may need drainage tubes under your skin for a few days.</p><p> Partial or mini abdominoplasty. Mini-abdominoplasties are often done on people whose fat deposits are located below the navel. During this procedure, the surgeon most likely will not move your belly button, and the procedure may only take up to two hours, depending on your case.</p><p>Taking Care of Yourself After Surgery</p><p>Whether you're having a partial or complete tummy tuck, the area that's operated on will be stitched and bandaged. It's very important to follow all your surgeon's instructions on how to care for the bandage in the days following surgery. The bandage used will be a firm, elastic band that promotes proper healing. Your surgeon will also instruct you on how to best position yourself while sitting or lying down to help ease pain.</p><p><br></p><p>You will have to severely limit strenuous activity for at least six weeks. You may need to take up to one month off work after the surgery to ensure proper recovery. Your doctor will advise you on what you need to do or not do.</p><p><br></p><p><div class="separator" style="clear: both; text-align: center;">
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</div><br></p><p><br></p>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com13tag:blogger.com,1999:blog-1701131618177621107.post-76856708760065131112021-04-15T23:32:00.001-07:002021-04-15T23:32:52.711-07:00Blepaharoplasty - Drooping eyelid correction surgery <b>Blepharoplasty</b> is a type of surgery that repairs droopy eyelids and may involve removing excess skin, muscle and fat. As you age, your eyelids stretch, and the muscles supporting them weaken<div><br></div><div><br></div><div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div><div><br></div><div>Around six weeks, you will start to see the final result of your eyelid surgery. Mild residual swelling may still be present as the delicate tissues around your eyes continue to adjust, but your eyes will be noticeably refreshed, alert and younger-looking</div><div><br></div><div>Some patients are as young as 25, while others are 65 years old. The American Society of Plastic Surgeons reports that more than 90 percent of patients seeking an eyelid lift are over 40, and most of this segment is over 55. But patients with naturally hooded eyelids seek treatment in their 20s and 30s.</div><div><br></div><div><br></div><div>The expert surgeons at the Cosmetic Surgery and any plastic surgery can be “worth it” at any point in your life. We see so many clients who have been unhappy with their appearance once again feel beautiful and confident after an eyelid lift.</div><div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com3tag:blogger.com,1999:blog-1701131618177621107.post-16731049164548797252021-04-15T01:08:00.001-07:002021-04-15T01:08:52.884-07:00Dermabrasion treatment for Acne Scars Wrinkles Anti ageing face <div><br></div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div><div><br></div><div><b>Dermabrasion</b></div><div><br></div><div>Dermabrasion is a skin-resurfacing procedure that uses a rapidly rotating device to remove the outer layer of skin. </div><div><br></div><div>Dermabrasion can decrease the appearance of fine facial lines and improve the look of many skin flaws, including acne scars, scars from surgery, age spots and wrinkles. Dermabrasion can be done alone or in combination with other cosmetic procedures</div><div><br></div><div><b>During dermabrasion</b>, your doctor numbs your skin with anesthetics</div><div><br></div><div>Skin treated with dermabrasion will be sensitive and blotchy for several weeks. It might take about three months for your skin tone to return to normal</div><div><br></div><div>Dermabrasion can be used to treat or remove:</div><div><br></div><div><b>Scars caused by acne, surgery or injuries</b></div><div><b>Fine wrinkles, especially those around the mouth</b></div><div><b>Sun-damaged skin, including age spots</b></div><div><br></div><div>Redness and swelling. After dermabrasion, treated skin will be red and swollen. Swelling will begin to decrease within a few days to one week, but might last for weeks or even months.</div><div><br></div><div>Your new skin will be sensitive and blotchy for several weeks. It might take about three months for your skin tone to return to normal.</div><div><br></div><div>Acne. You might notice tiny white bumps (milia) on treated skin. These bumps usually disappear on their own or with the use of soap or an abrasive pad.</div><div>Enlarged pores. Dermabrasion might cause your pores to grow larger.</div><div>Changes in skin color. Dermabrasion often causes treated skin to temporarily become darker than normal (hyperpigmentation), lighter than normal (hypopigmentation) or blotchy. These problems are more common in people with skin of color and can sometimes be permanent.</div><div>Infection. Rarely, dermabrasion can lead to a bacterial, fungal or viral infection, such as a flare-up of the herpes virus, the virus that causes cold sores.</div><div>Scarring. Dermabrasion that's done too deeply can cause scarring. Steroid medications can be used to soften the appearance of these scars.</div><div>Other skin reactions. If you often develop allergic skin rashes or other skin reactions, dermabrasion might cause these reactions to flare up.</div><div><b>Dermabrasion isn't for everyone. </b>Your doctor might caution against dermabrasion if you:</div><div><br></div><div>Have taken the oral acne medication isotretinoin (Myorisan, Claravis, others) during the past year</div><div>Have a personal or family history of ridged areas caused by an overgrowth of scar tissue (keloids)</div><div>Have acne or another pus-filled skin condition</div><div>Have frequent or severe outbreaks of cold sores</div><div>Have burn scars or skin that's been damaged by radiation treatments</div><div><br></div><div><b>Before dermabrasion, you might also need to:</b></div><div><br></div><div>Stop using certain medications. Before having dermabrasion, your doctor might recommend not taking aspirin, blood thinners and certain other medications.</div><div>Stop smoking. If you smoke, your doctor might ask you to stop smoking for a week or two before and after dermabrasion. Smoking decreases blood flow in the skin and can slow the healing process.</div><div>Take an antiviral medication. Your doctor will likely prescribe an antiviral medication before and after treatment to help prevent a viral infection.</div><div>Take an oral antibiotic. If you have acne, your doctor might recommend taking an oral antibiotic around the time of the procedure to help prevent a bacterial infection.</div><div>Have onabotulinumtoxinA (Botox) injections. These are usually given at least three days before the procedure and help most people achieve better results.</div><div>Use a retinoid cream. Your doctor might recommend using a retinoid cream such as tretinoin (Renova, Retin-A, others) for a few weeks before treatment to help with healing.</div><div>Avoid unprotected sun exposure. Too much sun exposure before the procedure can cause permanent irregular pigmentation in treated areas. Discuss sun protection and acceptable sun exposure with your doctor.</div><div>Arrange for a ride home. If you'll be sedated or receive a general anesthetic during the procedure, arrange for a ride home.</div><div><br></div><div><b>On the day of your procedure,</b> wash your face. Do not apply any makeup or facial creams. Wear clothes that you don't have to pull over your head because you'll have a facial dressing after your procedure.</div><div><br></div><div>Your care team will give you anesthesia or sedation to decrease sensation. If you have questions about this, ask a member of your care team.</div><div><br></div><div><br></div><div><b>During the procedure, </b>the doctor moves a small motorized device across the skin with constant, gentle pressure. The device has an abrasive wheel or brush for a tip that removes the outer skin layers.</div><div><br></div><div>Dermabrasion can take a few minutes to more than an hour, depending on how much skin is being treated. If you have deep scarring or you're having a large amount of skin treated, you might have dermabrasion done more than once or in stages.</div><div><br></div><div><b>After the procedure</b></div><div>After dermabrasion, treated skin will be covered with a moist, nonstick dressing. You will receive self-care instructions to follow at home and you might be given prescription pain medication.</div><div><br></div><div>You'll likely need to schedule a checkup soon after treatment so that your doctor can examine your skin and change your dressing.</div><div><br></div><div>At home, change your dressing as directed by your doctor. Your doctor will also let you know when you can begin regularly cleaning the treated area and applying protective ointments. Your self-care instructions will vary depending on the extent of your procedure.</div><div><br></div><div><b>While you're healing</b>:</div><div><br></div><div>Treated skin will be red and swollen</div><div>You'll likely feel some burning, tingling or aching</div><div>A scab or crust will form over treated skin as it begins to heal</div><div>The growth of new skin might be itchy</div><div>To relieve pain after the procedure, take prescribed pain medication or an over-the-counter pain reliever, such as aspirin, ibuprofen</div><div><br></div><div><b>Results</b></div><div>After dermabrasion, your new skin will be sensitive and red. Swelling will begin to decrease within a few days to a week, but can last for weeks or even months. It might take about three months for your skin tone to return to normal.</div><div><br></div><div>Once the treated area begins to heal, you'll notice that your skin looks smoother. Protect your skin from the sun for six to 12 months to prevent permanent skin color changes.</div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com4tag:blogger.com,1999:blog-1701131618177621107.post-64062320206798212622021-04-11T10:33:00.001-07:002021-04-11T10:33:48.044-07:00Ear lobe Repair / Lobuloplasty<div><br></div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div><div><b>What is Earlobe?</b></div><div><b><br></b></div><div>The ear lobe has a special importance among facial structures. It is particularly important due to the practice in many parts of the world of piercing it in order to wear ear rings.</div><div><br></div><div>The ear lobe consists of skin and fat. Unlike the rest of the ear, it does not have any thick cartilage. Hence, it is easy to perforate an ear lobe. Many cultures encourage the piercing of the ear lobe for adorning jewellery. </div><div><br></div><div>Piercing the ear lobe adds to the possibility of ear lobe rupture. While some ear lobe tears may heal with time, many require medical attention. </div><div><br></div><div>Most of the times, ear lobe repair is needed due to damage induced by wearing heavy ear rings or other such jewellery. In some cases, it may be because of someone (mostly a child) tugging on the earlobe / ear ring.</div><div><br></div><div><b>Ear lobe repair can be classified as:</b></div><div><b><br></b></div><div><b>Incomplete cleft </b>– this is usually bilateral and frequently found in elderly women who have worn heavy earrings for many years</div><div><br></div><div><b>Full cleft</b> – usually unilateral, caused by direct local trauma like sudden pulling of earrings</div><div><br></div><div>There is another way of classifying earlobe repair:</div><div><br></div><div>The cleft extension does not go beyond half the distance between the initial orifice and the lower border of the ear lobe</div><div>The cleft extension goes beyond half of the distance between the initial orifice and the lower ear lobe border</div><div>Progressive cleft extension until it becomes a complete defect.</div><div><br></div><div>Most earlobe tears are operated upon using local anesthesia and a vasoconstrictor. In some instances, a second procedure may be needed to correct the defect. </div><div><br></div><div>For simple splits, surgeons use sutures to repair the earlobe. This operation can last for about an hour or so. </div><div><br></div><div>For droopy earlobes, the skin lining the tear is excised. Earlobe tears that do not reach the bottom may be treated immediately.</div><div><br></div><div><b>Complications</b> from earlobe repair include keloids, hypo/hyper pigmentation and suture dehiscence in some individuals.</div><div><br></div><div>Pain, if any is minimal for earlobe repairs. It can be taken care of by over the counter medication. <br></div><div><br></div><div>It is important to note that ear lobe repair is different from otopalsty, or ear correction surgery.</div><div><br></div><div><b>Repair/Lobuloplasty</b></div><div><b><br></b></div><div>Lobuloplasty is the surgical procedure prescribed to repair a split or torn earlobe. The cosmetic surgeon extends the split downwards to complete the ear. </div><div><br></div><div>He then stitches together the split with minimum sutures to make the ear whole again. The sutures are kept in place for a week after which the doctor will remove them during a follow-up visit.</div><div><br></div><div>The split/torn earlobe is repaired under local anaesthesia. The procedure is performed as a day-care procedure. </div><div><br></div><div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-14596121183261126712021-04-09T23:00:00.001-07:002021-04-09T23:00:40.034-07:00PRP in managing hair loss both male and female. <div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div><div><br></div><div><br></div>For the first 3 days, use shampoo that is pH balanced. Do not use any hair products for at least 6 hours after your treatment. Avoid saunas, steam rooms, swimming for 2 days after your treatment. <div><br></div><div>The PRP Process</div><div>Platelet-rich plasma involves taking a small sample of blood and spinning it in a centrifuge to concentrate and separate the platelets and plasma from the other components of your blood. This concentrated solution is then injected back.</div><div><br></div><div>But WHY does PRP work?</div><div>Platelets are the part of the blood that contain growth factors and proteins. These are very important in the repair and regeneration of damaged tissue.</div><div><br></div><div>Prior to your PRP Therapy session, our physician will discuss what to expect during your treatment. However, it is helpful to remember that there are a few things to take into consideration before your session:</div><div><br></div><div>At least three to four days before your procedure, discontinue anti-inflammatory medications</div><div>One to two weeks before your procedure, discontinue any blood thinning herbs, supplements, or vitamins</div><div>One to two weeks before your procedure, discontinue systematic steroids</div><div>At least one month before your procedure, discontinue steroid injections</div><div>On the day of your procedure, eat a full, healthy breakfast and be sure to drink plenty of water.</div><div><br></div><div>discontinue use of any of these medications post-procedure for best results:</div><div>Anti-inflammatory medications for at least 2 weeks post-procedure</div><div>Blood-thinning herbs, supplements, or vitamins for 3-4 days post-procedure</div><div>Systematic steroids for 2 weeks post-procedure.</div><div><br></div><div>Other important guidelines to follow after your PRP procedure are:</div><div>Avoid applying ice or heat to the injection site for the first 72 hours post-procedure</div><div>Don’t take a hot bath or go to a sauna for the first few days post-procedure</div><div>Avoid consumption of any alcoholic beverages for the first week post-procedure</div><div>Avoid showering for the first 24 hours following your procedure</div><div>Limit caffeine consumption for the first week post-procedure</div><div>Avoid smoking.</div><div><br></div><div>3 – 14 days post-procedure guidelines.</div><div>At this point in your healing, you should gradually increase your daily activities. This is also when you can begin exercises. Proper exercise is a vital part of long-term results, and we can help you determine which exercises are best suited for your needs prior to your procedure.</div><div><br></div><div>Ice can be applied 3-4 times a day for 15-20 minutes as needed for comfort</div><div>Anti-inflammatory medications (such as Tylenol) can be taken to help manage any residual pain at this time, take as directed</div><div>Continue to avoid alcoholic beverages, smoking, or excessive amounts of caffeine</div><div> </div><div><br></div><div>3 – 4 weeks post-procedure guidelines.</div><div>At this point in your healing, we highly encourage you to begin physical therapy to aid in your long-term healing and continued recovery. During a follow-up appointment will be made for you to meet with our physician to review your healing process. It is important that you keep this follow up visit even if your recovery is going well. If there are any adjustments to your customized treatment plan, this is when our physician will be able to make those decisions.</div><div><br></div><div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-38366088693745512552021-03-21T00:05:00.001-07:002021-04-27T09:45:40.972-07:00Vitiligo Face - Grafting and Cure<div>Grafting in Vitiligo: How to Get Better Results</div><div><br></div><div>Grafting procedures in vitiligo have become quite popular over the last one or two decades especially in India. </div><div><br></div><div>Vitiligo is a common acquired disorder of skin pigmentation characterized by localized loss of skin pigment secondary to melanocyte damage. </div><div><br></div><div>In general, grafting techniques in vitiligo are divided into two main groups: Tissue grafting and cellular grafting procedures</div><div><br></div><div>Proper selection of the patient is the most important factor for achieving a good cosmetic result with any grafting procedure in vitiligo. The factors that need to be considered are the age of the patient, the site of vitiligo, keloidal tendency and most importantly, the stability of vitiligo</div><div><br></div><div>Use thinner grafts so that the upper surface of the grafts remains at the level of the recipient skin</div><div><br></div><div>Split thickness skin grafting is nowadays considered to be the surgical method of choice for stable, non-responding vitiligo.</div><div><br></div><div>Use ultra-thin grafts of uniform thickness that are free of any dermal tissue.</div><div><br></div><div>The procedure differs from a traditional split-thickness skin grafting in that the graft that is used is totally translucent, without any whitish tissue on the undersurface</div><div><br></div><div>Dermabrade the skin 1–2 mm beyond the margins of the vitiligo lesion and place the grafts beyond the dermabraded margins to minimize the chances of perigraft halo formation </div><div><br></div><div>Secure the grafts firmly at the recipient area with proper dressings and immobilization of the grafted area if needed.</div><div><br></div><div>Use of cyanoacrylate or surgical glue along the periphery of the graft has been shown to minimize the chances of graft displacement.</div><div><br></div><div>Infiltration anaesthesia at the donor site needs to be avoided as it can lead to an irregular surface and thus interfere with the harvesting of a uniform-thickness skin graft. A ring-block is thus preferred at this site.</div><div><br></div><div>Topical anaesthetic creams can be used as an alternate to injectable anaesthetics at the donor and even at the recipient site.</div><div><br></div><div><br></div><div class="separator" style="clear: both; text-align: center;">
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</div><br></div>Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com1tag:blogger.com,1999:blog-1701131618177621107.post-69228369854492581092020-04-06T06:13:00.001-07:002020-04-06T06:17:31.017-07:00Forked Flap - Shoulder joint Defect<div dir="ltr" style="text-align: left;" trbidi="on">
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Forked Flap - Shoulder joint Defect</h2>
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<u>Defects of shoulder joint</u></h3>
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<span style="font-weight: normal;">Always shoulder joint defects are difficult to manage and are rare defects in plastic surgery. Usually, it can be covered with a small flap based on the</span><b> supraclavicular artery</b><span style="font-weight: normal;"> at the clavicle level, when its a large defect other musculocutaneous or fasciocutaneous flap might be required.</span></div>
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<u>Causes and approach</u></h3>
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Very common defects of the shoulder joint is the burns, implant exposed ( as in this case), RTA abrasion injury, post abscess drainage. Since this is an anti dependent area once has to make the wound a chronic one before covering the raw area. early u do a flap infection rate increases, flap failure is at the highest rate.</div>
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<u>Our Case Approach </u></h3>
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This patient a diabetic patient with an avulsion injury of the shoulder joint with implant exposed after fixation of the shoulder joint and humerus fixation was done. Initial suturing primarily was done and the skin necrosis occurred. So patient was put on VAC Therapy and then planned for a flap cover.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEgm9Rm7LG7kNGafUsZm3YNzhRzm98Q27_p5TiIzp33faDCPRiEyhG2mv33u9qUczqK0yoaZxHJF085upvkGlLXWK-g_gWkwh10hHXTyvYV1zZSt-MdmrAU-PlEtxHqLDjRsvPd9t2rbQV/s1600/1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="523" data-original-width="521" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEgm9Rm7LG7kNGafUsZm3YNzhRzm98Q27_p5TiIzp33faDCPRiEyhG2mv33u9qUczqK0yoaZxHJF085upvkGlLXWK-g_gWkwh10hHXTyvYV1zZSt-MdmrAU-PlEtxHqLDjRsvPd9t2rbQV/s320/1.jpg" width="318" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Shoulder Joint Defect with Implant Exposed</td></tr>
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As shown in the above image Two fasciocutaneous flaps Based on supraclavicular artery have been raised and raw area reduction done and flowing which insert was given with bolster stitches with absorbable sutures and flap together with non-absorbable stitches.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEiC64Sfcb8KQtgI-O5l7TyR0WPIVY1pV53gEUr3q-w-bfdnua2R05hTeJfo2E7dxYVaqhAYQLnS4UuLKvSl1A9lnOH0-LTCmCTvBJ21QjKkwicKOrF-YLL9YCjafAMH7nPxuDZrx1_yQr/s1600/2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="947" data-original-width="526" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEiC64Sfcb8KQtgI-O5l7TyR0WPIVY1pV53gEUr3q-w-bfdnua2R05hTeJfo2E7dxYVaqhAYQLnS4UuLKvSl1A9lnOH0-LTCmCTvBJ21QjKkwicKOrF-YLL9YCjafAMH7nPxuDZrx1_yQr/s320/2.jpg" width="177" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"> Forked Flap - Post Operative Follow up</td></tr>
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This picture shows the post-operative follow up with nicely settled flap after suture removal. Follow up the patient with mobilization and scar massage and compression dressings.<br />
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com167, Udayanpatti Main Rd, K K Nagar, Tiruchirappalli, Tamil Nadu 620021, India10.755883613228804 78.692567717321310.740284113228803 78.6723977173213 10.771483113228804 78.712737717321289tag:blogger.com,1999:blog-1701131618177621107.post-89011203309935341942020-02-05T07:03:00.000-08:002020-02-05T07:03:02.285-08:00Forehead Defect Closed with Advancement and Rotation Flap - Dual Flap<div dir="ltr" style="text-align: left;" trbidi="on">
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Forehead Defects</h2>
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Forehead defects are always challenging in the sense that skin cover along with cosmetic appearance has to be taken into account. This case-patient had an RTA skid and fall from the two-wheeler. The patient was assessed For GCS and taken up for surgery.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaCD92WhZvjzX-CxYyxqAvL_aCSEQcmEb5E73dLD0QtPbrOp1iZvgoOl17emZnH5rGdkH5L2oYfXgKLPykyCFDeZXhA8BX9GMi_UfEgXuHRpzZo4zJ3U8UzwnKNQrKRDJZpzWsfayQ1aH5/s1600/IMG-20200205-WA0002.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaCD92WhZvjzX-CxYyxqAvL_aCSEQcmEb5E73dLD0QtPbrOp1iZvgoOl17emZnH5rGdkH5L2oYfXgKLPykyCFDeZXhA8BX9GMi_UfEgXuHRpzZo4zJ3U8UzwnKNQrKRDJZpzWsfayQ1aH5/s400/IMG-20200205-WA0002.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Actual Defect Forehead</td></tr>
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Planning for a cover</h2>
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The defect is assessed then it was noticed that the hair-bearing skin was lost. So what is important in this case is to have a cover as well as to have hair growing pattern maintained. So lateral to the defect advancement flap was planned and rotation was planned from the scalp to the forehead. Finally, a skin when hair would cover the defect.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitgzbuNSSBdn89OYWx9hzByxqCWozpCbJQXPAlm-1sHjnT2F-o0oas4SeQIaTn2f_okEXxpG9Dt3VzcWvTFZvv36Lbm0vVy8nCub5iTBoFO-P1dayb4K21WBe6HupJx02PPOyEZNTNHZay/s1600/IMG-20200205-WA0006.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitgzbuNSSBdn89OYWx9hzByxqCWozpCbJQXPAlm-1sHjnT2F-o0oas4SeQIaTn2f_okEXxpG9Dt3VzcWvTFZvv36Lbm0vVy8nCub5iTBoFO-P1dayb4K21WBe6HupJx02PPOyEZNTNHZay/s400/IMG-20200205-WA0006.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Defect after debridement</td></tr>
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Final inset and cover</h2>
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First, two parallel incisions are made on the lateral aspect and minimal advancement is achieved covering part of the defect. then scalp half rotation is used to cover the remaining defect .note the three-point stitch is more important where the two flaps come together. suturing without tension is needed here. Finally, a drain was kept to avoid hematoma under the flap.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiNzLpbzYxpZ4Hlbnv6nSwNF9qMduynqf4ZJaoPTIL63ckqXOv9-A-y0CZnnqA-yWi6genZWHScBKOXTWIBkbq0FxfBvu6bX6RhQk2FnPrhf7xWDt2j6RsaSE1uYxQj2u5aJ2rrxQY0DU7/s1600/IMG-20200205-WA0005.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiNzLpbzYxpZ4Hlbnv6nSwNF9qMduynqf4ZJaoPTIL63ckqXOv9-A-y0CZnnqA-yWi6genZWHScBKOXTWIBkbq0FxfBvu6bX6RhQk2FnPrhf7xWDt2j6RsaSE1uYxQj2u5aJ2rrxQY0DU7/s400/IMG-20200205-WA0005.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Flap and Final Inset</td></tr>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com1tag:blogger.com,1999:blog-1701131618177621107.post-82394603336254725012020-02-04T07:26:00.001-08:002020-02-04T07:31:03.417-08:00Lateral Heel Defect - Exposed Calcaneum covered with Lateral calcaneal Artery Flap<div dir="ltr" style="text-align: left;" trbidi="on">
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Lateral heel defect with exposed calcaneum - How to Manage in a child?</h3>
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<span style="font-weight: normal;">Its always a challenge to cover a defect over the lateral calcaneum when its exposed , especially in a child. This case is a 7yr old boy who had an RTA with Deep Abrasion over the Lateral calcaneum region, for which he was managed with dressing as usual but after one-week skin got discolored and debridement was done and now the challenge to cover the raw area after debridement since calcaneum was exposed.</span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuKsgFrbAOjPkoAAz4pJ39YjTWIPKRxTtSI9y9_4ldqI-2MLg22pOQeGCNyF_lFb0o87uvMG62ZmxCLRUsT0DYvEy6tmBtAosy5Zh9XnzXHHKVSfnW82rYkCLtDWSiEGeE7oc3phLkRasS/s1600/IMG-20200204-WA0001.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuKsgFrbAOjPkoAAz4pJ39YjTWIPKRxTtSI9y9_4ldqI-2MLg22pOQeGCNyF_lFb0o87uvMG62ZmxCLRUsT0DYvEy6tmBtAosy5Zh9XnzXHHKVSfnW82rYkCLtDWSiEGeE7oc3phLkRasS/s400/IMG-20200204-WA0001.jpg" width="400" /></a></td></tr>
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Flap Cover planned - Lateral Calcaneal Artery Flap</h3>
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Finally, its the Lateral calcaneal artery flap that is planned over the defect with L*B Proportions taken, and then the flap is marked adjacent to the lateral malleolus. Pre-op doppler to mark the LCA pattern is done. The flap has to be transposed over the defect. this case had a dog ear at the base of the flap after inset, which was managed with an SSG. </div>
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Then the donor site is always covered with SSG. A drain tube is kept to avoid hematoma. The graft is secured with bulky dressing and a window is kept for the flap to be monitored. usually, tip necrosis is avoided if too tight insert is not given. ideally, allow the raw area to shrink in size before proceeding with the flap cover so that to avoid going beyond the reach of the flap dimensions.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8ACGlJMlydH77zQvcil26C6y4edH1GzkBD0VrSzvzZt6NYaFph383avwhbqlOJESPhsz_cIAr2S9a9S1X8lC0jcO-wpIPe0TC3dyC7ys67MZAdaopxiEY1zbxd9ssaoEexW5x2IOTNK2g/s1600/IMG-20200204-WA0000.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="532" data-original-width="1152" height="183" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8ACGlJMlydH77zQvcil26C6y4edH1GzkBD0VrSzvzZt6NYaFph383avwhbqlOJESPhsz_cIAr2S9a9S1X8lC0jcO-wpIPe0TC3dyC7ys67MZAdaopxiEY1zbxd9ssaoEexW5x2IOTNK2g/s400/IMG-20200204-WA0000.jpg" width="400" /></a></div>
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Lateral calcaneal Artery Flap</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com2tag:blogger.com,1999:blog-1701131618177621107.post-17022919156257799342020-01-27T07:54:00.001-08:002020-02-04T07:31:36.973-08:00Trochanteric Pressure Sore Management In Paraplegia with Flap Cover<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-weight: normal;"><u>Approach to Long-Standing Pressure Sore</u></span></h3>
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Patient when approaching u on the first visit, he will be emaciated, long-standing ulcer non-healing ulcer over the pressure areas, sometimes over multiple areas since the patient will be on prolonged lying down position. </div>
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<b>Approach 1 :</b></div>
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Routine Blood Investigation and look for Sr.protein which will help in wound healing. Ask the attenders to keep the patient motivated and to have adequate oral intake.</div>
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<b>Approach 2:</b></div>
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Once Clinically improved ask them to mobilize the patient well, clean bath daily, dressing of the wound regularly. One time debridement thoroughly has to be done. Without wasting time put on vac dressing so that the wound shrinks well.</div>
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<b>Approach 3 :</b></div>
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Then examine for the wound and check for x-ray and status of any organism growth in the wound.</div>
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Plan for flap cover, it might be a skin flap or a muscle flap. Usually preferred is a skin flap since most of the time muscle will be flabby and to prevent huge seroma or blood loss post-operative always skin flap is preferred.<br />
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70 yr old male paraplegic come with a pressure ulcer, the wound looks healthy after the approaches are done listed above. Now on table debridement and rotation / Limberg flap is planned for the wound site cover.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglpb0qFMoyK7EHfXIaC-KTC5ZPdtH8J57XGp326UDOBdKWXP06xI9u-CeAeN67-YD3IBGWJyo-LG4dqQb256pGEcAB0lWjli_JVqEvy5wM3YcJZMLs8kg2SHyIpE62tkCS07uDE6O9QKS1/s1600/trochanter+pressure+sore.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglpb0qFMoyK7EHfXIaC-KTC5ZPdtH8J57XGp326UDOBdKWXP06xI9u-CeAeN67-YD3IBGWJyo-LG4dqQb256pGEcAB0lWjli_JVqEvy5wM3YcJZMLs8kg2SHyIpE62tkCS07uDE6O9QKS1/s320/trochanter+pressure+sore.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Trochanteric Pressure Ulcer</td></tr>
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The flap is raised on the plane above the muscle fascia, preoperative a perforator can be located nearby and include the flap. this makes the flap more versatile, to avoid tension at the flap important is to keep the hip flexed all time while doing the flap.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP8pnxH5PoWSCqrKgY0DLS2Gna8Qd1hzhWI4zha15VUnOkaTo8EnanG0jebG8Vb0H_cTc0i5034aXTuGMfYp6-VZS9byqBMnA7jL4CChzvFJbI89zh-eCFme83aDIaBJ4kztstYuuY77si/s1600/debrided+pressure+sore.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP8pnxH5PoWSCqrKgY0DLS2Gna8Qd1hzhWI4zha15VUnOkaTo8EnanG0jebG8Vb0H_cTc0i5034aXTuGMfYp6-VZS9byqBMnA7jL4CChzvFJbI89zh-eCFme83aDIaBJ4kztstYuuY77si/s320/debrided+pressure+sore.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">On table Debridement & Flap Raised</td></tr>
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Flap inset is given with layered closure and the main trick is to mobilize flap around and not the flap alone. measurements of the flap to referred from textbooks. Not the forget is the drain tuber to be secured adequately and kept until the dead space is void inside.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2v51m7CRvJOOzTpPktKxaoQfwOwIeu4aITXQeIp7EvEFVjCsZwyn5wy_ZfpDshGKQ69yy9CakuiTQ03hHPH7XF41zEjkOxYPig0sURN-kOcoPxfYQdJbrgTqzo3OZGSILu7hYlexdtjDD/s1600/post+op+flap+cover.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="145" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2v51m7CRvJOOzTpPktKxaoQfwOwIeu4aITXQeIp7EvEFVjCsZwyn5wy_ZfpDshGKQ69yy9CakuiTQ03hHPH7XF41zEjkOxYPig0sURN-kOcoPxfYQdJbrgTqzo3OZGSILu7hYlexdtjDD/s320/post+op+flap+cover.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Immediate Post Operative Status</td></tr>
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Plan for delayed suture removal as your needs. Mobilize him adequately will on suture before the final suture removal is done. always be prepared for secondary healing and secondary suturing . Give adequate pressure voiding dressing and bed for the right person and prevent further wound elsewhere. keep him under routine voluntary checkup</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9Y0dF6wk0ZlZu0SEHGDZF9hcyZE_2aVTNDokLfiu6LT5ZdZEqnGuLJS3BYK0TBtCTK4OujjuheROrfkI2JIyoqTs_ZEiafz3I76tENDiCK2TPYp7WmdR2iNZMeHfH3oxDnefb6cH1jlpF/s1600/Follow+up+post+op+flap+settled.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="532" data-original-width="1152" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9Y0dF6wk0ZlZu0SEHGDZF9hcyZE_2aVTNDokLfiu6LT5ZdZEqnGuLJS3BYK0TBtCTK4OujjuheROrfkI2JIyoqTs_ZEiafz3I76tENDiCK2TPYp7WmdR2iNZMeHfH3oxDnefb6cH1jlpF/s320/Follow+up+post+op+flap+settled.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Postoperative follow up - 15 days</td></tr>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-66921611412866151632019-04-07T00:12:00.001-07:002019-04-07T07:20:22.705-07:00ACUTE LIP LOSS - RECONSTRUCTION OUTCOME<div dir="ltr" style="text-align: left;" trbidi="on">
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LIP LOSS - MANAGEMENT PROTOCOL</h2>
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<u>ANATOMY OF LIP</u></h3>
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The lip consists of four basic components: the skin and subcutaneous tissue, the muscle, the mucosa, and the vermilion. Each of these structures has unique characteristics that must be considered when planning the reconstruction.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtYdEc3342NMk3JeiGCgweR0uk7V8EidEzC30R3g0lxXkBerIyWwBSAqHVeMYRKuxznYzofBJIpcbnpq93K2_zOOMklgL8RGgCkEuHamOSA8ZcB4JOQBkIdQeMW_74rVMTmFYST9ochjiD/s1600/1.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="512" data-original-width="709" height="288" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtYdEc3342NMk3JeiGCgweR0uk7V8EidEzC30R3g0lxXkBerIyWwBSAqHVeMYRKuxznYzofBJIpcbnpq93K2_zOOMklgL8RGgCkEuHamOSA8ZcB4JOQBkIdQeMW_74rVMTmFYST9ochjiD/s400/1.JPG" width="400" /></a></div>
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<h3 style="text-align: center;">
<u>FUNCTION</u></h3>
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The <b>sphincteric</b> function of the lips allows for oral competence in eating and drinking, speech and sound production, forceful blowing, and kissing.<br />
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The muscular content of the lips allow for their tone. Without this muscular support, the tissue would simply lose its support and become ptotic, as seen in patients with facial palsy who inevitably develop lower-lip laxity and lowerincisor show.<br />
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Similarly if the upper lip was without muscular<br />
tone, the normal upper incisor–upper lip relationship would be lost.<br />
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<u>ETIOLOGY</u></h3>
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The <b>etiology </b>of most lip defects is tumors or trauma. Lip tumors are either congenital or acquired.<br />
<br />
Congenital tumors are most often vascular malformations and hemangiomas. Acquired tumors<br />
are usually basal cell carcinoma in the upper lip and squamous cell carcinoma in the more sun-exposed lower lip.</div>
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<u>NERVE SUPPLY</u></h3>
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The <b>sensory </b>innervation of the lip is provided by the mental and infraorbital nerves.<br />
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<br />
These two distinct nerves allow for local anesthesia to be easily and quickly established for lip procedures. Low volumes of solution, placed accurately, will give complete anesthesia.<br />
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<br />
Intraoral injections have the advantage of being less painful, and simpler to achieve complete blockade as they are based on bony landmarks (teeth) and the entire path of the needle<br />
parallels the bone. </div>
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<b><u>LOWER LIP DEFECT 1/3RD LOSS</u></b></h3>
<div>
This case had a trauma with lip loss in lower segement of 1/3 rd loss managed with muscle mucosal advancement flap.</div>
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<br />
<br />
When analyzing a lip defect, the most important assessment is the amount of remaining lip vermilion. Vermilion, if present, carries with it muscle that can be used to maintain the sphincteric<br />
function of the lip.<br />
<br />
All methods of vermilion reconstruction by using other tissues are suboptimal. Buccal mucosa and tongue look like buccal mucosa and tongue. They do not take<br />
lipstick in the same way, have different light reflection, and have different color.<br />
<br />
Remaining lip skin is also important, but in general, this tissue can be replaced more easily than vermilion.<br />
When deciding on the operative plan, one must decide whether the lip can be reconstructed with lip tissue, which is preferable, or if the defect will require nonlip tissue. Lip tissue not only replaces “like with like,” but most lip reconstruction using lip tissue with orbicularis muscle will eventually have<br />
some element of neurotization.<br />
<br />
This will allow for functional reconstruction that provides a natural appearance both at rest and in conversation. It also allows for the replacement of precious<br />
vermilion tissue. Direct lip closure, or closure with sliding lip tissue, is always the first choice.<br />
<br />
Flaps such as the Abbe and reverse Abbe flap also satisfy</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-FAREeFNqV591ghpH7vgoosf6seI1dmU-Pip8maetmJHNU7B4l3O8ljQEHH28spPBCuiwysIcuerlYuGcQmtL5gfg6TBdJp_-I1AP9nVoguDW-S9-INh9CigPfVTqJHhYYxDHzjnCsEnz/s1600/6.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1349" data-original-width="1600" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-FAREeFNqV591ghpH7vgoosf6seI1dmU-Pip8maetmJHNU7B4l3O8ljQEHH28spPBCuiwysIcuerlYuGcQmtL5gfg6TBdJp_-I1AP9nVoguDW-S9-INh9CigPfVTqJHhYYxDHzjnCsEnz/s320/6.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">lower lip 1/3rd loss</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRurljJabav6VkI1MJZJ2NQ4uGXLQNLIwJzI7Tg8Lgb5Hv5eEqqPDZ1P90zRlZWsRRwqz2ZB2TEh9EY21N1WryEIp4p9Dh2IlICgCXm_j96BX8J-CWm3JarXl_TLgaQIW2pymw5EuOV3z1/s1600/7.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="853" data-original-width="1600" height="169" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRurljJabav6VkI1MJZJ2NQ4uGXLQNLIwJzI7Tg8Lgb5Hv5eEqqPDZ1P90zRlZWsRRwqz2ZB2TEh9EY21N1WryEIp4p9Dh2IlICgCXm_j96BX8J-CWm3JarXl_TLgaQIW2pymw5EuOV3z1/s320/7.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">outcome</td></tr>
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<span style="font-size: 18.72px;"><u>Schuchardt procedure</u></span></h3>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-29635313024371201542019-02-08T06:54:00.003-08:002019-04-07T07:20:52.473-07:00Metatarsal Head Resection in Treatment of Neuropathic Diabetic Foot Ulcers<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Forefoot Ulcers</b><br />
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Are more common ulcers found at the plantar aspect as non healing for prolonged duration.These patients are prone for recurrence as they are treated for the cause,namely surgical offloading , especially excision of metatarsal head , when compared to conservative mangement.<br />
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<b>Non healing ulcer at forefoot</b><br />
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Patient is assesed for blood flow , using doppler. Foot pressure analysis,so that offloading can be planned accordingly.<br />
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<b>Metatarsal Head resection being done As the treatment of choice.</b></div>
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Through a ventral approach , vertical incision made over the MTPjoint of the desired toe.Head with neck is excised.Skin closed after securing hemostasis.</div>
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<b>Plantar Ulcer excision and debridement Done.</b><br />
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Ulcer Debridement , callus excision done . Wound cavity packed with bulky betadine gauze dressing.<br />
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<b>3 Months of post operative follow up .</b><br />
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After wound debridement , followed with regular dressing. Adviced diabetic foot wear, Tendoachilles Strength exercises.<br />
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-90462998642186256492018-01-26T12:16:00.002-08:002019-04-07T09:41:12.664-07:00FLEXOR TENDON REPAIR DEMONSTRATION <div dir="ltr" style="text-align: left;" trbidi="on">
<h2 style="text-align: center;">
Flexor Tendon Repair</h2>
<div>
Most cases of Zone II injury and a cut in the flexor tendon are difficult to repair and retreival is also much more difficult.Specific to this type of injury is that Fdp tendon when cut does not go beyond the Zone III level since its attached to the lumbrical.Following video will demonstrate how this done and repaired.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com1tag:blogger.com,1999:blog-1701131618177621107.post-4260998599787802462018-01-15T00:21:00.001-08:002018-01-15T00:29:58.336-08:00Flexor tendon examination of Cut injury<div dir="ltr" style="text-align: left;" trbidi="on">
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Flexors are two in number namely Flexor digitorum profundus and flexor digitorum superficialis . In this case little finger FDP cut so that finger is out of cascade.Patient when asked to flex or close his finger he was not able to flex his little finger.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com5tag:blogger.com,1999:blog-1701131618177621107.post-56063080255897588532017-12-05T07:46:00.002-08:002019-04-07T08:52:40.231-07:00Trigger Finger Demonstration Video of Surgical Release<div dir="ltr" style="text-align: left;" trbidi="on">
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TRIGGER FINGER</h2>
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This case has a Trigger of Middle finger,which gets stuck as he tries to flex and extend the finger.<br />
Trigger is a condition where there is a nodule in the flexor tendon and flexor sheath.This occurs usually proximal to A1 pulley of the flexor canal,this prevent it from gliding forward.</div>
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Incision is made over the mcpjt level at the skin crease level. A1 pulley is completely removed along with the nodule of the flexor tendon.Note the free movement of finger.</div>
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No rem anent of A1 pulley to be left apart and superficial layer of the flexor tendon need to be removed. </div>
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Wound is closed with ethilon simple stitches. Mobilization of the patient finger can be started immediately post surgery at 10th day sutures are removed followed with scar massage.</div>
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Cause for this nodule is related to diabetes mellitus and hard manual labour situation.</div>
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Patient are well satisfied on table seeing the results, their finger moving well without any resitance.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-71953827717733511082017-12-04T09:36:00.000-08:002019-04-18T10:27:08.464-07:00Inferiorly Based Abdomen Flap<div dir="ltr" style="text-align: left;" trbidi="on">
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INFERIORLY BASED ABDOMEN FLAP</div>
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ABDOMEN FLAP</h3>
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As the name suggests it is taken from the abdomen skin.most commonly used are the superior and inferior based flaps.</div>
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Both the superior and inferior based flaps are taken either as axial pattern based on a particular vessel or as a random pattern</div>
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MARKINGS</h3>
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USual allowed ration for the random pattern flap is 1:1.but one can take accordingly when based on a axial pattern vessel. </div>
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Defect in the hand is measured and lint pattern is taken. Make sure adequate base is marked so that the flap is well perfumed. </div>
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Lie of the flap is assessed with the hand in the abdomen. Temporary markings are made over the abdomen, now the lint kept over the abdomen and then flap is checked in position with the defect of the hand which is to be covered. </div>
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FLAP ELEVATION AND INSET</h2>
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Distal most end of the flap is now incised and then flap is raised upto the level of scarpas fascia,as the flap is raised make sure that the edges are kept in position by skin hook, complete the incision all around. </div>
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Check for perfusion of the flap. Wrap it with wet saline pad. Donor site raw area reduction is done with absorbable stitches. </div>
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Donor site closed with SSG harvested from thigh site.</div>
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Flap inset given with ethilon over the raw area oF the hand. </div>
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Dressing is done with the hand in right position. Elbow is supported with the pillow. </div>
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FOLLOW UP</h2>
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Every day the flap is cleaned and adequate padding is done.day 5 ssg staplers or sutures are removed.day 10 sutures are removed from the flap and adviced daily bath now till day 21,when flap is diveded and insert is given on other business end of the raw area of the hand.</div>
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Further flap might need a small procedure of flap thinning and trimming as and when required.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-57617253228374668902017-12-04T02:08:00.001-08:002019-04-07T08:53:25.690-07:00Malunion # Metacarpal ORIF <div dir="ltr" style="text-align: left;" trbidi="on">
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Malunion # Metacarpal Fixation</h2>
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Malunion</h3>
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There are two variety of healing u will en contour after improper fixation.Either Non union or Malunion.Both of them will result in restricted range of movements. </div>
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Dorsal hump here shows the angulation of distal segment dorsally.</div>
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There is restriction of movements of the Mcpjts.</div>
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X-Ray</h3>
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Always a antero-posterior view and oblique views are required to identify a fracture union.This x-ray shows fracture mal union meaning it has united but not in anatomical position,this results in restricted active range of movements<br />
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Surgery</h3>
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Incision is made at the summit of the swelling.Exposed tendon are separated from bony swelling.Soft callus formed all round the mal union is chiseled out and raw area is created exposing fresh bone with medullary cavity. </div>
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Procedure</h3>
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Saline wash given.K wire inserted proximodistally.Good reduction achieved .</div>
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Volar slab given with hand elevation.</div>
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Closure</h3>
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Final hemostasis is done and a volar slab is applied for 21 days.10th day suture removal.2 weeks post 21 days active mobilisation and followed by active and passive mobilisation until full range of movements.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com1tag:blogger.com,1999:blog-1701131618177621107.post-45671667226270191992017-12-03T07:20:00.001-08:002019-04-07T09:03:29.291-07:00Zone II Acute Injury Primary Repair <div dir="ltr" style="text-align: left;" trbidi="on">
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ZONE II INJURY</h2>
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ZONE II INJURY</div>
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This is called as "No Man's Land".</div>
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This is because of the tight Fibroosseus canal.Basics</div>
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Not to injure the fibroosseous canal. Do a meticulous repair.Good core suturing.Early mobilozation.</div>
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Planning of incision</div>
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PROCEDURE</h3>
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This case had a cut injury transversly in the little finger.</div>
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Both proximal and Distal window is created to expose the zone II injured zone.</div>
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Zig zag incision are made to avoid scar contracture.</div>
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Assesment</div>
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Retrieve the cut ends of the tendon by flexing the finger.</div>
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Proximal end will not go beyond zone III level because of attachment of lumbricals.</div>
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SUTURING</h3>
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By railroad technique using an scalp vein set to retreive and suture the tendons.</div>
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Mod.kessler mason stitches are made .</div>
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Epitendinuous suturing with 5-0 prolene done core stitch with 3-0 prolene.</div>
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Distal end is sutured first.Then tension adjustment is done to suture the proximal end.</div>
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DIGITAL NERVE</h3>
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Digital nerve</div>
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This case had digital nerve cut so primary repaired with 7-0 prolene.</div>
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Closure </div>
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Wound is closed with 3-0 ethilon.</div>
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POST OP FOLLOW UP</h3>
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Note the important Finger are in cascade.</div>
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Meaning to say they are in progressive grade of decreasing flexion from little to index.</div>
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Simple technique is used as its difficult to close wound at the finger level so stay sutures are taken before closing each stitches distal to proximal and closed one by one.</div>
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Dorsal blocking splint is given.</div>
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After 21 days to start on mobilization or any of the early mobilization protocol can be used depending on the core stitches made.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-84001962900805291422017-12-02T20:00:00.001-08:002019-04-21T07:10:16.326-07:00SCALP DEFECT POST OP FOLLOW UP ROTATION FLAP<div dir="ltr" style="text-align: left;" trbidi="on">
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SCALP RAW AREA</h2>
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FLAPS:</h3>
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1.ROTATION FLAP</div>
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2.TRANSPOSITION FLAP</div>
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3.JURI FLAP ....</div>
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DEFECT<br />
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<span style="font-weight: normal;">Many flaps can be done for scalp defect, including rotation flap, which is done in this case.</span></div>
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<span style="font-weight: normal;">First, the patient is shaved fully before u plan for a procedure.</span></div>
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<span style="font-weight: 400;">Now the defect is assessed and the possibility of a flap is chosen with a lint pattern taken for the same.</span></div>
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ROTATION FLAP</h3>
The patient is taken up for surgery under general anesthesia. on the table, positioning is done either lateral or prone position.<br />
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Approximately 5X times a rotation flap is marked, make sure hairline is not changed too much.<br />
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The flap is raised at the sub galeal plane. until the base of the flap is reached.<br />
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Always triangulate the defect, before marking the rotation and base of the flap.<br />
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FLAP INSET</h3>
This is almost rotation and advancement flap that covers the defect. Now inset is given to the raw area with nonabsorbable sutures. Simple stitches are made. A bulky dressing is made.<br />
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FOLLOW UP</h3>
On the POD 2 dressing is done and look for flap necrosis or any suture is tight or not. review the flap on 5th and 10th POD if everything goes well.<br />
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Suture removal once you are satisfied with the healing.<br />
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Follow up with good scar massage and coconut oil application.<br />
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Scar alopecia is expected and if the hair growth is dense it might cover up your defect which the scar has left.<br />
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Plan for hair transplant in the near future.<br />
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com1tag:blogger.com,1999:blog-1701131618177621107.post-19431511765509501152017-12-01T11:14:00.001-08:002019-04-21T07:13:59.713-07:00Thenar Flap Pulp defect of Middle Finger<div dir="ltr" style="text-align: left;" trbidi="on">
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<u>Thenar Flap</u></h2>
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Indication :</h3>
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Tip /Pulp defects of Index and Middle finger.</div>
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Prerequisites:</h3>
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Lax skin suitable in old age and women</div>
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Not to be used in manual labourers.<br />
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<span style="font-size: 12.8px;">Planning and preparation of defect</span><br />
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Incision:</h3>
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Incision is made over the thenar grease and towards the palm.</div>
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Subcutaneous tissue is included upto muscle dissection done.</div>
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Careful not to injure the digital nerve to thumb.<br />
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Inset:</h3>
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1:1 ratio is allowed. Inset is given tip and the edges.</div>
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<img alt="" border="0" height="224" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEghaLxO7he0WmlZEhVy35obZNrgEYJ0Y2wgc4Ta2jymv6adA_DtZZnem1j2uTTiraK2y7gr7-h4ptLD_VfbCAOlGKx0717CkpKN7mKWtH1WzhvtOPhGl0lQQ9tMh8ar6qtyEFGkaFsp6z8U/s400/IMG-20171201-WA0033.jpg" style="cursor: move; margin-left: auto; margin-right: auto;" title="Flap Elevation and flap inset into defect" width="400" /></div>
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Flap Elevation and flap inset into defect</h3>
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Closure:</h3>
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Closure of the donor defect is done before giving inset.</div>
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Final Suture line of thenar flap</h3>
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Complication:</h3>
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Scar tenderness</div>
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Flap necrosis.</div>
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Follow up:</h3>
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Division at 14th day</div>
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Flap return</div>
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Scar massage.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-44670098500827365772017-11-29T02:45:00.001-08:002019-04-07T09:04:52.590-07:00Stage one of Two Stage Reconstruction Of FDP <div dir="ltr" style="text-align: left;" trbidi="on">
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<u><i>FLEXOR RECONSTRUCTION</i></u></h2>
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<i><u>INDICATION</u></i></h3>
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Patient is a case of electrical burns who sustained injury to his Ring finger.There was no Bony injury at that time only flexor tendons and pulley was damaged.So patient was given groin flap for stable skin cover.</div>
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<u>INCISION</u></h3>
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After flap settling well and joints were all mobilized nicely.Now planned for two stage reconstruction of FDP with silicone rod and pulley reconstruction at first stage then tendon graft in the second stage.</div>
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Here incision is made over the neutral line extending upto the zone 3 level. Separate incision made over the zone 5 level for identifying Fdp and Fds to Ring finger.</div>
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<u>GRAFT</u></h3>
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Sural nerve graft harvested and used to bridge the digital nerve .</div>
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<u>SILICONE ROD</u></h3>
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Distally cut end of FDP identified amd secured as also the cut digital nerve. Proximal zone 3 level tendons are identified and the looping done for later identification. </div>
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Pulleys reconstructed at A2 A4 level using Fds grafts.</div>
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SilIcone rod anchored over the distal cut end of FDP and passed through the pulley system reconstructed.</div>
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Silicone rod tunneled and kept at the zone 5 level .</div>
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<u>CLOSURE</u></h3>
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Skin closed and drains kept and Dorsal PoP given .</div>
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Post operatively Mobilsation within PoP after 2 days .</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0tag:blogger.com,1999:blog-1701131618177621107.post-70529822615097018142017-11-24T05:35:00.001-08:002019-04-07T09:05:15.803-07:00Glomus Tumour of Nail Bed <div dir="ltr" style="text-align: left;" trbidi="on">
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<i><b><u>Glomus Tumour</u></b></i></h2>
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<i><u>Location</u></i></h3>
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Painful condition occupying the space between nailbed and terminal phalanx bone.</div>
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<i><u>Incision</u></i></h3>
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Incision is made along non contact side from nail and skin junction .</div>
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Raising the nail plate , skin flap away from nailbed.</div>
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<i><u>Flap dissection</u></i></h3>
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Germinal matrix of nailbed is opened, tumour is identified brownish in colour</div>
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Excised in total from bone leaving it bare .</div>
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<i><u>Closure of Nail</u></i></h3>
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Nailbed repair with 6-0 vicryl done. Nail plate with skin sutured with 3- 0 ethilon.</div>
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Finger bandage dressing done.</div>
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Dr. Vidhun Raj Barath., M.ch.,http://www.blogger.com/profile/15242212356738226087noreply@blogger.com0