Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it... more Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it is rarely diagnosed clinically. Here we present one such case in a 50-year-old lady. She presented with a hard mobile lesion over her nose which was excised. The histologic picture is characterized by a combination of epithelial and myoepithelial structures within a chondromyxoid and fi brous stroma. For these tumors, excision is the treatment of choice.
Introduction Complex traumatic injuries of the lower limb are increasingly being salvaged. The co... more Introduction Complex traumatic injuries of the lower limb are increasingly being salvaged. The common long-term morbidity includes secondary lymphedema. The role of microvascular flaps is often discussed for lymph flow restoration. However, the differential effect of using muscle flap versus fasciocutaneous flap in the lower-limb trauma to avoid secondary lymphedema is not studied. Methods Forty patients who underwent microvascular flap reconstruction were reviewed retrospectively to obtain data regarding clinical demographics and surgical procedure. Assessment for presence of clinical lymphedema was done. The lymphatic drainage in all these patients was assessed by 99mTc lymphoscintigraphy. Results Of the 40 patients included in the study, group A (n = 23) underwent muscle-based free flap reconstruction, and group B (n = 17) had fasciocutaneous flaps. Clinical lymphedema was present in 21 patients, of which 18 were of group A and 3 of group B. On lymphoscintigraphy, 14 patients had either partial or complete obstruction in the reconstructed lower limb, 11 in group A and 3 in group B. All of them (n = 14) were found to have associated clinical lymphedema. The association of clinical lymphedema (P < 0.001) and obstructive pattern on lymphoscintigraphy (P < 0.05) with muscle flaps was found to be statistically significant. Conclusions With the advancement in surgery and techniques, not only salvageability but also stable and morbidity free outcomes are the goals. Fasciocutaneous flaps may have better lymphatic outcomes than the muscle-based flaps, and the criteria for lower-limb reconstruction can be reformed to include simultaneous soft tissue and lymphatic reconstruction.
Skin malignancies are routinely seen in the outpatient department of plastic surgery. It is well ... more Skin malignancies are routinely seen in the outpatient department of plastic surgery. It is well known that patients with albinism are more susceptible to skin malignancies. However, syndromes associated with albinism are not a piece of common knowledge. Among disorders where albinism is part of a more extensive syndrome are HermanskyPudlak syndrome, Chediak-Higashi syndrome, Griscelli syndrome, and Waardenburg syndrome type II [1]. Hermansky-Pudlak syndrome (HPS) is an autosomal recessive syndrome characterized by oculocutaneous albinism and bleeding tendency [2]. The worldwide prevalence of all known forms of OCA is estimated to be 1 per 17,000 [3]. In contrast, HPS is estimated to occur in only 1–9 persons per 1,000,000 worldwide [2]. We had recently encountered a patient with this syndrome and wanted to share our experience
Background Post-operative monitoring of flap is equally important as harvesting of a flap. Early ... more Background Post-operative monitoring of flap is equally important as harvesting of a flap. Early diagnosis of flap failure can salvage the flap by appropriate intervention. The monitoring methods used should be rapid, inexpensive, and accurate. The purpose of this study is to evaluate the usefulness of blood glucose monitoring (BGM) of the flap as our monitoring modality. Methods This study includes 60 flaps which were monitored by measuring their capillary glucose level by pricking the distal end of the flap. Out of the 60 flaps, 18 were free flaps, 23 were pedicled, and 19 were of the random variety. Quantitative data was expressed in frequency, percentage, mean value, and standard deviation for capillary glucose levels of the flap. Result Out of the 60 flaps, 44 survived well, 10 flaps were having minor distal necrosis (< 10% of flap area), major flap necrosis occurred in 3 flaps while 3 flaps failed completely. Failed flaps have shown lower glucose levels. Using the receiver operating characteristic curve (ROC), the cutoff value for BGM was 61 mg/dl, with a sensitivity of 93% and a specificity of 80%. Conclusion Blood glucose monitoring reveals the state of perfusion of the flap in the postoperative period. Flap capillary glucose levels less than 61 mg/dl is suggestive of ischemia of the flap with a sensitivity and a specificity of 93% and 80%, respectively. It has prognostic value as it allows early detection of vascular compromise and also defines the forthcoming line of demarcation in partial necrosis. Level of Evidence: Type IV, diagnostic study.
Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla bei... more Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had ...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2022
INTRODUCTION Complex cubital fossa injuries with bony and vascular injuries are not an uncommon c... more INTRODUCTION Complex cubital fossa injuries with bony and vascular injuries are not an uncommon clinical presentation after trauma to the elbow. The revascularization of the upper limb by brachial artery repair with the venous graft is paramount, followed by immediate cover with a sturdy flap to salvage the limb. The use of local muscle and fasciocutaneous flaps is limited in the setting of vascular injury. The pedicled latissimus dorsi muscle flap and abdominal flaps are routinely used with few advantages. This article describes the use of a pedicled thoracodorsal artery perforator flap in the management of acute traumatic cubital fossa defect. MATERIAL AND METHODS A retrospective observational study was performed from September 2015 to December 2020 with patients who underwent the pedicled TDAP flap as a soft-tissue cover of cubital fossa injuries primarily. Patient variables, including the size of defect and flap, the number of perforators, the complications, and the outcome, were recorded. RESULTS Eleven patients were included in the study. The majority of the patients were males (n = 10) and presented with a history of trauma in a road traffic accident (n = 6) or because of a fall from height (n = 4). All of them (n = 11) had some form of bony injury. Seven patients in this group required brachial artery repair with an interposition vein graft successfully covered with a TDAP flap. There was a constant dominant musculocutaneous perforator about 10-13 cm from the apex of the axilla. At discharge, all flaps had settled well. On follow-up ranging from 2 months to 2 years, the patients reported satisfactory outcomes.
Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challengin... more Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea. Reconstruir lesao do estoma traqueal em pacientes submetidos a laringectomica total e um desafio, especialmente, quando a pele do peristoma esta lesionada devido a radioterapia. A reconstrucao e complexa e geralmente requer mais de uma abordagem. Apresenta-se tecnica simples utilizada com sucesso em paciente de 80 anos com deiscencia de lesao do estoma traqueal e retracao da traqueia.
Background: Sepsis-3 guidelines published in the Journal of American Medical Association is thoug... more Background: Sepsis-3 guidelines published in the Journal of American Medical Association is thought to be a pathbreaking effort in the diagnosis of sepsis,[1],[2],[3],[4] but it has limitations with respect to burns population.[5] On the other hand, the American Burn Association (ABA) 2007 guideline[6] for sepsis in burn patients is noted for low specificity rate. However, an independent biomarker procalcitonin (PCT) could augment clinical findings and improve sepsis predictability rate in burn patients. This study is the first attempt to assess diagnostic validity of PCT in Indian population and to highlight its role in diagnosing sepsis in burns despite newer sepsis-3 guidelines. Materials and Methods: This prospective study involved 33 consecutive thermal burn patients with 66 samples estimated for PCT. Samples were sent at each suspected episode of sepsis based on ABA guidelines. Baseline PCT estimation was done when the patient did not have sepsis. The positive blood or tissue culture was taken as a reference standard. The sample was divided into sepsis and nonsepsis group. All the parameters were documented on the graphical sheet which was interpreted by an independent analyzer. The sensitivity and specificity of each coordinate were plotted on receiver operating characteristic curve to identify the predictive ability of the test. Results: The sensitivity and specificity of the test was 94.7% and 85.7%, respectively. The cutoff value to diagnose sepsis in burn patients was 3.5 ng/ml with an area under the curve of 0.974 at 95% confidence interval. Conclusion: Good correlation between documented sepsis and elevated PCT levels makes PCT a promising biomarker in burns population.
Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various ... more Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula. Methods: All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed. Results: The study included a total of 90 patients, about 86.7% (n ¼ 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/ h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001). Conclusion: The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.
Defects around the distal one third of the leg and ankle are difficult to manage by conservative ... more Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5e76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4e50) cm 2. The mean operating time was 75 (60e90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.
Background: Burn wound infection is a dynamic entity that is one of the major determining factors... more Background: Burn wound infection is a dynamic entity that is one of the major determining factors of the patient's hospital stay, mortality and morbidity. The analysis of the changing trends in the burn wounds microbiological profile will help deciding a more effective empirical therapy for burn wound infection. Objectives: To identify the changing trends of the organisms cultured from the burn wounds during the time of admission, and over a period of last 5 years in the burn unit and their antibiotic susceptibility profile. Methodology: Analysis of the burn wound culture sensitivity results sent to the microbiology lab on weekly basis and interpretation of the results. Results: The gram-positive organisms have become more common in 2017 in the first week of burn admission as compared to previous years. From the second week onwards the gram-negative organisms are the more prevalent organisms. Non-fermenting gram-negative bacilli, Pseudomonas aeruginosa and Staphylococci are the most commonly seen organisms. The patients with a rapid progression of sepsis with burn wound infected with Pseudomonas and non-fermenting gram-negative bacilli will benefit from starting of Colistin at an early stage. Similarly, those with Staphylococci growing in the burn wounds can benefit from Linezolid, Chloramphenicol.
BackgroundMultiple modalities to manage scalp and underlying skull defect due to high-voltage ele... more BackgroundMultiple modalities to manage scalp and underlying skull defect due to high-voltage electrical burns have been discussed. We aimed to describe our experience and to propose an algorithm for the management of skull injury which could be helpful in decision-making.MethodsA retrospective study of patients who sustained electrical burns to the head from May 2007 to April 2012 was carried out. Sex, age, size of scalp defect, and method of reconstruction and management were analyzed.ResultsThirteen patients were identified. Out of 13, 11 patients had scalp defects which were covered using local scalp flap. Free latissimus dorsi (LD) muscle flap and pedicle trapezius flap were used in two patients. The largest defect covered with local scalp flap was the size of 80 cm2. Free LD flap was used to cover a defect of 144 cm2. Of the nine patients who presented early (immediately after injury), seven required debridement of the outer table and the other two patients required full-thickness excision of the skull. The remaining four patients who presented late (after 3 months) were found to have osteomyelitic segments which required full thickness excision of the skull.ConclusionsMost of the soft tissue defects of the scalp due to high-voltage electrical burns can be managed with local scalp flaps. However, if the local tissue is injured or not sufficient to close the defect, then free flap should be considered. In management of calvarium injury, the emphasis should be debridement of necrotic bone to provide infection-free site followed by soft tissue cover.Level of Evidence: Level IV, therapeutic study.
Syringe-based wound irrigating device Sir, Wound irrigation is an important aspect of wound treat... more Syringe-based wound irrigating device Sir, Wound irrigation is an important aspect of wound treatment, which helps decrease bacterial contamination. The hydraulic forces generated by the stream of fluid acts on the debris on the wound surface and flush it from the wound. In order to remove the wound debris, the force of the irrigation stream has to be greater than the adhesion forces holding the debris to the wound surface. In 1994, Agency for Health Care Policy and Research (AHCPR) recommended a pressure of 10-15 pound per square inch (psi) to be ideal for wound irrigation. [1] Compared to swabbing or bathing, wound irrigation is considered to be most effective in wound cleansing. [2] Many techniques of wound irrigation are currently in use. [3] Some of these, such as bulb syringe irrigation, deliver low pressure and may not be effective in decreasing bacterial load. [4] High-pressure, pulsatile irrigation devices are expensive, cumbersome, and difficult to keep sterile. A more pra...
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2014
Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challengin... more Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea.
Xeroderma pigmentosum is a autosomal recessive genetic disorder in which cutaneous malignancies a... more Xeroderma pigmentosum is a autosomal recessive genetic disorder in which cutaneous malignancies are very common. We report a rare case where four different varieties of cutaneous malignancies were seen in the same patient.
Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve b... more Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. The lip is a part of the face that is frequently affected by burn injury. Lower lip deformity can be due to an extrinsic or intrinsic cause. Post-burn sequelae in this area results in
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2007
Heminasal aplasia is a rare congenital malformation. It is often associated with other malformati... more Heminasal aplasia is a rare congenital malformation. It is often associated with other malformations of the facial region, including abnormalities of the eye and lacrimal system, facial bone malformations and proboscis lateralis. We present two cases of heminasal aplasia, discuss their embryological basis and nasal reconstruction of the same.
Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it... more Chondroid syringoma is a rare appendagel skin tumor. Due to its uncharacteristic presentation, it is rarely diagnosed clinically. Here we present one such case in a 50-year-old lady. She presented with a hard mobile lesion over her nose which was excised. The histologic picture is characterized by a combination of epithelial and myoepithelial structures within a chondromyxoid and fi brous stroma. For these tumors, excision is the treatment of choice.
Introduction Complex traumatic injuries of the lower limb are increasingly being salvaged. The co... more Introduction Complex traumatic injuries of the lower limb are increasingly being salvaged. The common long-term morbidity includes secondary lymphedema. The role of microvascular flaps is often discussed for lymph flow restoration. However, the differential effect of using muscle flap versus fasciocutaneous flap in the lower-limb trauma to avoid secondary lymphedema is not studied. Methods Forty patients who underwent microvascular flap reconstruction were reviewed retrospectively to obtain data regarding clinical demographics and surgical procedure. Assessment for presence of clinical lymphedema was done. The lymphatic drainage in all these patients was assessed by 99mTc lymphoscintigraphy. Results Of the 40 patients included in the study, group A (n = 23) underwent muscle-based free flap reconstruction, and group B (n = 17) had fasciocutaneous flaps. Clinical lymphedema was present in 21 patients, of which 18 were of group A and 3 of group B. On lymphoscintigraphy, 14 patients had either partial or complete obstruction in the reconstructed lower limb, 11 in group A and 3 in group B. All of them (n = 14) were found to have associated clinical lymphedema. The association of clinical lymphedema (P &lt; 0.001) and obstructive pattern on lymphoscintigraphy (P &lt; 0.05) with muscle flaps was found to be statistically significant. Conclusions With the advancement in surgery and techniques, not only salvageability but also stable and morbidity free outcomes are the goals. Fasciocutaneous flaps may have better lymphatic outcomes than the muscle-based flaps, and the criteria for lower-limb reconstruction can be reformed to include simultaneous soft tissue and lymphatic reconstruction.
Skin malignancies are routinely seen in the outpatient department of plastic surgery. It is well ... more Skin malignancies are routinely seen in the outpatient department of plastic surgery. It is well known that patients with albinism are more susceptible to skin malignancies. However, syndromes associated with albinism are not a piece of common knowledge. Among disorders where albinism is part of a more extensive syndrome are HermanskyPudlak syndrome, Chediak-Higashi syndrome, Griscelli syndrome, and Waardenburg syndrome type II [1]. Hermansky-Pudlak syndrome (HPS) is an autosomal recessive syndrome characterized by oculocutaneous albinism and bleeding tendency [2]. The worldwide prevalence of all known forms of OCA is estimated to be 1 per 17,000 [3]. In contrast, HPS is estimated to occur in only 1–9 persons per 1,000,000 worldwide [2]. We had recently encountered a patient with this syndrome and wanted to share our experience
Background Post-operative monitoring of flap is equally important as harvesting of a flap. Early ... more Background Post-operative monitoring of flap is equally important as harvesting of a flap. Early diagnosis of flap failure can salvage the flap by appropriate intervention. The monitoring methods used should be rapid, inexpensive, and accurate. The purpose of this study is to evaluate the usefulness of blood glucose monitoring (BGM) of the flap as our monitoring modality. Methods This study includes 60 flaps which were monitored by measuring their capillary glucose level by pricking the distal end of the flap. Out of the 60 flaps, 18 were free flaps, 23 were pedicled, and 19 were of the random variety. Quantitative data was expressed in frequency, percentage, mean value, and standard deviation for capillary glucose levels of the flap. Result Out of the 60 flaps, 44 survived well, 10 flaps were having minor distal necrosis (< 10% of flap area), major flap necrosis occurred in 3 flaps while 3 flaps failed completely. Failed flaps have shown lower glucose levels. Using the receiver operating characteristic curve (ROC), the cutoff value for BGM was 61 mg/dl, with a sensitivity of 93% and a specificity of 80%. Conclusion Blood glucose monitoring reveals the state of perfusion of the flap in the postoperative period. Flap capillary glucose levels less than 61 mg/dl is suggestive of ischemia of the flap with a sensitivity and a specificity of 93% and 80%, respectively. It has prognostic value as it allows early detection of vascular compromise and also defines the forthcoming line of demarcation in partial necrosis. Level of Evidence: Type IV, diagnostic study.
Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla bei... more Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory disease, with the axilla being the most commonly affected site. Radical excision of the involved tissue is a definitive treatment. There are numerous techniques described for the reconstruction of the axilla. Patients and methods Patients with axillary HS who underwent wide excision and posterior arm flap cover between August 2017 and December 2020 were reviewed. Results A total of 15 flaps were done in eight patients in the study period. Bilateral radical excision of the disease was done simultaneously in all eight patients with the help of a two-team approach. Reconstruction of the axilla was done with a posterior arm flap bilaterally, except one side in a single patient, wherein the split-thickness skin graft was performed. All flaps settled well without significant complications. On follow-up ranging from 12 to 42 months, one patient complained of disease recurrence on one side. The flap and the donor site had ...
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2022
INTRODUCTION Complex cubital fossa injuries with bony and vascular injuries are not an uncommon c... more INTRODUCTION Complex cubital fossa injuries with bony and vascular injuries are not an uncommon clinical presentation after trauma to the elbow. The revascularization of the upper limb by brachial artery repair with the venous graft is paramount, followed by immediate cover with a sturdy flap to salvage the limb. The use of local muscle and fasciocutaneous flaps is limited in the setting of vascular injury. The pedicled latissimus dorsi muscle flap and abdominal flaps are routinely used with few advantages. This article describes the use of a pedicled thoracodorsal artery perforator flap in the management of acute traumatic cubital fossa defect. MATERIAL AND METHODS A retrospective observational study was performed from September 2015 to December 2020 with patients who underwent the pedicled TDAP flap as a soft-tissue cover of cubital fossa injuries primarily. Patient variables, including the size of defect and flap, the number of perforators, the complications, and the outcome, were recorded. RESULTS Eleven patients were included in the study. The majority of the patients were males (n = 10) and presented with a history of trauma in a road traffic accident (n = 6) or because of a fall from height (n = 4). All of them (n = 11) had some form of bony injury. Seven patients in this group required brachial artery repair with an interposition vein graft successfully covered with a TDAP flap. There was a constant dominant musculocutaneous perforator about 10-13 cm from the apex of the axilla. At discharge, all flaps had settled well. On follow-up ranging from 2 months to 2 years, the patients reported satisfactory outcomes.
Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challengin... more Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea. Reconstruir lesao do estoma traqueal em pacientes submetidos a laringectomica total e um desafio, especialmente, quando a pele do peristoma esta lesionada devido a radioterapia. A reconstrucao e complexa e geralmente requer mais de uma abordagem. Apresenta-se tecnica simples utilizada com sucesso em paciente de 80 anos com deiscencia de lesao do estoma traqueal e retracao da traqueia.
Background: Sepsis-3 guidelines published in the Journal of American Medical Association is thoug... more Background: Sepsis-3 guidelines published in the Journal of American Medical Association is thought to be a pathbreaking effort in the diagnosis of sepsis,[1],[2],[3],[4] but it has limitations with respect to burns population.[5] On the other hand, the American Burn Association (ABA) 2007 guideline[6] for sepsis in burn patients is noted for low specificity rate. However, an independent biomarker procalcitonin (PCT) could augment clinical findings and improve sepsis predictability rate in burn patients. This study is the first attempt to assess diagnostic validity of PCT in Indian population and to highlight its role in diagnosing sepsis in burns despite newer sepsis-3 guidelines. Materials and Methods: This prospective study involved 33 consecutive thermal burn patients with 66 samples estimated for PCT. Samples were sent at each suspected episode of sepsis based on ABA guidelines. Baseline PCT estimation was done when the patient did not have sepsis. The positive blood or tissue culture was taken as a reference standard. The sample was divided into sepsis and nonsepsis group. All the parameters were documented on the graphical sheet which was interpreted by an independent analyzer. The sensitivity and specificity of each coordinate were plotted on receiver operating characteristic curve to identify the predictive ability of the test. Results: The sensitivity and specificity of the test was 94.7% and 85.7%, respectively. The cutoff value to diagnose sepsis in burn patients was 3.5 ng/ml with an area under the curve of 0.974 at 95% confidence interval. Conclusion: Good correlation between documented sepsis and elevated PCT levels makes PCT a promising biomarker in burns population.
Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various ... more Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula. Methods: All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed. Results: The study included a total of 90 patients, about 86.7% (n ¼ 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/ h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001). Conclusion: The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.
Defects around the distal one third of the leg and ankle are difficult to manage by conservative ... more Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5e76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4e50) cm 2. The mean operating time was 75 (60e90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.
Background: Burn wound infection is a dynamic entity that is one of the major determining factors... more Background: Burn wound infection is a dynamic entity that is one of the major determining factors of the patient's hospital stay, mortality and morbidity. The analysis of the changing trends in the burn wounds microbiological profile will help deciding a more effective empirical therapy for burn wound infection. Objectives: To identify the changing trends of the organisms cultured from the burn wounds during the time of admission, and over a period of last 5 years in the burn unit and their antibiotic susceptibility profile. Methodology: Analysis of the burn wound culture sensitivity results sent to the microbiology lab on weekly basis and interpretation of the results. Results: The gram-positive organisms have become more common in 2017 in the first week of burn admission as compared to previous years. From the second week onwards the gram-negative organisms are the more prevalent organisms. Non-fermenting gram-negative bacilli, Pseudomonas aeruginosa and Staphylococci are the most commonly seen organisms. The patients with a rapid progression of sepsis with burn wound infected with Pseudomonas and non-fermenting gram-negative bacilli will benefit from starting of Colistin at an early stage. Similarly, those with Staphylococci growing in the burn wounds can benefit from Linezolid, Chloramphenicol.
BackgroundMultiple modalities to manage scalp and underlying skull defect due to high-voltage ele... more BackgroundMultiple modalities to manage scalp and underlying skull defect due to high-voltage electrical burns have been discussed. We aimed to describe our experience and to propose an algorithm for the management of skull injury which could be helpful in decision-making.MethodsA retrospective study of patients who sustained electrical burns to the head from May 2007 to April 2012 was carried out. Sex, age, size of scalp defect, and method of reconstruction and management were analyzed.ResultsThirteen patients were identified. Out of 13, 11 patients had scalp defects which were covered using local scalp flap. Free latissimus dorsi (LD) muscle flap and pedicle trapezius flap were used in two patients. The largest defect covered with local scalp flap was the size of 80 cm2. Free LD flap was used to cover a defect of 144 cm2. Of the nine patients who presented early (immediately after injury), seven required debridement of the outer table and the other two patients required full-thickness excision of the skull. The remaining four patients who presented late (after 3 months) were found to have osteomyelitic segments which required full thickness excision of the skull.ConclusionsMost of the soft tissue defects of the scalp due to high-voltage electrical burns can be managed with local scalp flaps. However, if the local tissue is injured or not sufficient to close the defect, then free flap should be considered. In management of calvarium injury, the emphasis should be debridement of necrotic bone to provide infection-free site followed by soft tissue cover.Level of Evidence: Level IV, therapeutic study.
Syringe-based wound irrigating device Sir, Wound irrigation is an important aspect of wound treat... more Syringe-based wound irrigating device Sir, Wound irrigation is an important aspect of wound treatment, which helps decrease bacterial contamination. The hydraulic forces generated by the stream of fluid acts on the debris on the wound surface and flush it from the wound. In order to remove the wound debris, the force of the irrigation stream has to be greater than the adhesion forces holding the debris to the wound surface. In 1994, Agency for Health Care Policy and Research (AHCPR) recommended a pressure of 10-15 pound per square inch (psi) to be ideal for wound irrigation. [1] Compared to swabbing or bathing, wound irrigation is considered to be most effective in wound cleansing. [2] Many techniques of wound irrigation are currently in use. [3] Some of these, such as bulb syringe irrigation, deliver low pressure and may not be effective in decreasing bacterial load. [4] High-pressure, pulsatile irrigation devices are expensive, cumbersome, and difficult to keep sterile. A more pra...
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2014
Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challengin... more Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea.
Xeroderma pigmentosum is a autosomal recessive genetic disorder in which cutaneous malignancies a... more Xeroderma pigmentosum is a autosomal recessive genetic disorder in which cutaneous malignancies are very common. We report a rare case where four different varieties of cutaneous malignancies were seen in the same patient.
Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve b... more Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. The lip is a part of the face that is frequently affected by burn injury. Lower lip deformity can be due to an extrinsic or intrinsic cause. Post-burn sequelae in this area results in
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2007
Heminasal aplasia is a rare congenital malformation. It is often associated with other malformati... more Heminasal aplasia is a rare congenital malformation. It is often associated with other malformations of the facial region, including abnormalities of the eye and lacrimal system, facial bone malformations and proboscis lateralis. We present two cases of heminasal aplasia, discuss their embryological basis and nasal reconstruction of the same.
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