Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substance...Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated.The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct.Methods:This retrospective study was undertaken in the department of plastic surgery,over a period of 2 years.Nine patients with scrotal or penile injury and infection were enrolled in the study.Age of the patients ranged 20-60 years.Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection.All patients underwent hyperbaric oxygen therapy before and following surgery.Results:Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients.Five patients(55.5%)had sustained the soft tissue loss due to trauma.The cause of necrotizing fasciitis was found in 4 patients(44.4%).The mean length of hospital stay was 42.5 days.Conclusion:Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need.Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery.展开更多
Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartmen...Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.展开更多
Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion inju...Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.展开更多
Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therap...Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.展开更多
Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modif...Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modified McGregor flap for reliable soft tissue coverage.Methods:Nine patients with eyelids and malar soft tissue defects were treated over a period of 12 months from July 2013 to June 2014.In this prospective study,a McGregor flap was used for the closure of defects in 9 patients(7 men and 2 women),aged 20-36 years(mean age:27 years).Three sessions of hyperbaric oxygen therapy were administered postoperatively,and patients received subsequent follow-up.Results:Six patients presented with malar and lower eyelid defects,2 patients presented with malar defects,and one patient with upper eyelid,lower eyelid and malar defects following trauma.A McGregor flap was performed in all patients.The preexcision defects varied in size from 3 cm×2 cm to 4 cm×3 cm.No secondary procedures were required in any case.Sutures were removed between 7 and 9 days postoperatively.There were no cases of partial or total flap loss over the course of 10-14 months follow-up.Conclusion:The outcome following use of the McGregor flap procedure was functionally and aesthetically satisfactory in all cases.The McGregor flap is a useful option for the reconstruction of defects following trauma to the upper eyelid,lower eyelid,and malar regions.展开更多
Traumatic injuries to the thumb resulting in segmental loss of a digital artery are not uncommon.To bridge the gap and repair a transacted digital artery,the superficial palmar arch or the radial digital artery of the...Traumatic injuries to the thumb resulting in segmental loss of a digital artery are not uncommon.To bridge the gap and repair a transacted digital artery,the superficial palmar arch or the radial digital artery of the index finger can be used to reconstruct the ulnar digital artery of thumb for revascularization.Revascularization following segmental loss resulting from a crushed ulnar digital artery of the thumb can be performed based on the superficial palmar arch or the radial digital artery of the index finger,avoiding anastomosis at two sites and hence providing better results.The digital vein from the index finger can also be used to enhance the venous return of the injured thumb.However,because of known variability in the palmar arch,intraoperative verification is needed to ensure the safe transfer of the arch or the radial digital artery of the index finger.The aim of this article is to discuss the possibilities for thumb revascularization,using a case report in which the injured thumb was revascularized with a superficial palmar arch.展开更多
Aim:Inguinal block dissections for metastasis to inguinal lymph nodes and occasionally trauma are always associated with soft tissue loss over the groin region.A clinical study was undertaken to demonstrate the abilit...Aim:Inguinal block dissections for metastasis to inguinal lymph nodes and occasionally trauma are always associated with soft tissue loss over the groin region.A clinical study was undertaken to demonstrate the ability to utilize a superiorly-based perforatorflap with reliable vascularity and less donor site morbidity to cover defects in the inguinal region.Methods:A prospective study was performed on 7 patients with inguinal soft tissue defects managed in our institution from January 2013 to September 2013.During the study period,a“superiorly-based perforator plusflap”was used for soft tissue coverage over the femoral vessels in the inguinal region.Hyperbaric oxygen therapy was administered postoperatively.The postoperative period,hospital course,and follow-up after radiotherapy was documented in patients with inguinal block dissection.Results:Seven patients presented with soft tissue defects in the inguinal region.Five of the defects were secondary to prior surgery,and 2 were secondary to trauma.A superiorly-based perforator plusflap was performed in all patients.The defect sizes ranged from 9 cm×4 cm to 17 cm×8 cm.Theflap dimensions ranged from 12 cm×5 cm to 20 cm×10 cm.No secondary procedures were necessary following surgery.Postoperatively,there was no evidence of partial or totalflap loss.Noflap revisions were required,and no complications were experienced at either the donor or recipient site following radiotherapy.Patients were followed-up for 10-18 months.Conclusion:Inguinal defects require stable soft tissue coverage to withstand radiotherapy following inguinal block dissection surgery,and are susceptible to wound complications.The superiorly-based perforator plusflap technique is simple,requires little operative time,and is a reliableflap for coverage of the femoral vessels and inguinal region with improved tolerance to postoperative radiotherapy.展开更多
文摘Aim:Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon.The non-availability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated.The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct.Methods:This retrospective study was undertaken in the department of plastic surgery,over a period of 2 years.Nine patients with scrotal or penile injury and infection were enrolled in the study.Age of the patients ranged 20-60 years.Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection.All patients underwent hyperbaric oxygen therapy before and following surgery.Results:Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients.Five patients(55.5%)had sustained the soft tissue loss due to trauma.The cause of necrotizing fasciitis was found in 4 patients(44.4%).The mean length of hospital stay was 42.5 days.Conclusion:Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need.Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery.
文摘Aim:Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities.These injuries often complicated by cellulitis,gangrene,regional lymphadenopathy,compartment syndrome,bleeding abnormalities,septicemia,hypotension,and disseminated intravascular coagulation,resulting in significant morbidity and mortality.The purpose of the study is to share our experience of hyperbaric oxygen(HBO)therapy in the management of snakebite injuries.Methods:All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study.Results:Out of a total 395 patients,174 patients treated with anti-snake venom with a mortality of 17 posttreatment.Forty-four out of the 174 patients was in the pediatric age group.Out of the patients referred to our department,23 presented with cellulitis,7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities.Of the 47 patients,30 involved the lower extremity and rest involved the upper extremity.All patients were subjected to HBO therapy as an adjunct.Six patients required flap cover:cross finger flap(n=2),anterolateral thigh free tissue transfer(n=1),lateral supramalleolar flap(n=1),groin flap(n=1),and dorsal metacarpal artery flap(n=1).There was no need for fasciotomy among the patients who suffered impending compartment syndrome.Conclusion:HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.
文摘Aim:Crush injuries of the foot are often associated with partial or complete degloving of the heel pad.The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries,including hyperbaric oxygen(HBO)therapy in the treatment regimen.Methods:We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013.Heel pad avulsion injuries were classified according to the angiosomal pattern.Partial or complete avulsions were classified and treated accordingly.HBO therapy was administered postoperatively.The postoperative period,hospital course,and follow-up were documented in patients with heel pad avulsion injuries.Results:Of 27 patients,20 cases presented with partial avulsion and 7 cases were complete avulsion.Of 20 cases of partial avulsion,one of the flaps was anchored with K-wire.Nineteen cases of partial heel pad avulsion were managed by suturing.Eight patients out of 20 required skin grafting as a secondary procedure at a later date.Out of 7 cases of complete avulsion,one was managed by full-thickness skin grafting,one case by reverse sural artery flap coverage,and four cases were managed by free tissue transfer.No flap revisions were required,and no complications were experienced for the transferred flaps.Conclusion:HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.
文摘Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.
文摘Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modified McGregor flap for reliable soft tissue coverage.Methods:Nine patients with eyelids and malar soft tissue defects were treated over a period of 12 months from July 2013 to June 2014.In this prospective study,a McGregor flap was used for the closure of defects in 9 patients(7 men and 2 women),aged 20-36 years(mean age:27 years).Three sessions of hyperbaric oxygen therapy were administered postoperatively,and patients received subsequent follow-up.Results:Six patients presented with malar and lower eyelid defects,2 patients presented with malar defects,and one patient with upper eyelid,lower eyelid and malar defects following trauma.A McGregor flap was performed in all patients.The preexcision defects varied in size from 3 cm×2 cm to 4 cm×3 cm.No secondary procedures were required in any case.Sutures were removed between 7 and 9 days postoperatively.There were no cases of partial or total flap loss over the course of 10-14 months follow-up.Conclusion:The outcome following use of the McGregor flap procedure was functionally and aesthetically satisfactory in all cases.The McGregor flap is a useful option for the reconstruction of defects following trauma to the upper eyelid,lower eyelid,and malar regions.
文摘Traumatic injuries to the thumb resulting in segmental loss of a digital artery are not uncommon.To bridge the gap and repair a transacted digital artery,the superficial palmar arch or the radial digital artery of the index finger can be used to reconstruct the ulnar digital artery of thumb for revascularization.Revascularization following segmental loss resulting from a crushed ulnar digital artery of the thumb can be performed based on the superficial palmar arch or the radial digital artery of the index finger,avoiding anastomosis at two sites and hence providing better results.The digital vein from the index finger can also be used to enhance the venous return of the injured thumb.However,because of known variability in the palmar arch,intraoperative verification is needed to ensure the safe transfer of the arch or the radial digital artery of the index finger.The aim of this article is to discuss the possibilities for thumb revascularization,using a case report in which the injured thumb was revascularized with a superficial palmar arch.
文摘Aim:Inguinal block dissections for metastasis to inguinal lymph nodes and occasionally trauma are always associated with soft tissue loss over the groin region.A clinical study was undertaken to demonstrate the ability to utilize a superiorly-based perforatorflap with reliable vascularity and less donor site morbidity to cover defects in the inguinal region.Methods:A prospective study was performed on 7 patients with inguinal soft tissue defects managed in our institution from January 2013 to September 2013.During the study period,a“superiorly-based perforator plusflap”was used for soft tissue coverage over the femoral vessels in the inguinal region.Hyperbaric oxygen therapy was administered postoperatively.The postoperative period,hospital course,and follow-up after radiotherapy was documented in patients with inguinal block dissection.Results:Seven patients presented with soft tissue defects in the inguinal region.Five of the defects were secondary to prior surgery,and 2 were secondary to trauma.A superiorly-based perforator plusflap was performed in all patients.The defect sizes ranged from 9 cm×4 cm to 17 cm×8 cm.Theflap dimensions ranged from 12 cm×5 cm to 20 cm×10 cm.No secondary procedures were necessary following surgery.Postoperatively,there was no evidence of partial or totalflap loss.Noflap revisions were required,and no complications were experienced at either the donor or recipient site following radiotherapy.Patients were followed-up for 10-18 months.Conclusion:Inguinal defects require stable soft tissue coverage to withstand radiotherapy following inguinal block dissection surgery,and are susceptible to wound complications.The superiorly-based perforator plusflap technique is simple,requires little operative time,and is a reliableflap for coverage of the femoral vessels and inguinal region with improved tolerance to postoperative radiotherapy.
