Nikhil Panse

The ulnar digital artery perforator flap: A new flap for little finger reconstruction - A preliminary report

An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute.

Reconstruction of complex soft-tissue defects around the knee joint with distally based split vastus lateralis musculocutaneous flap: A new technique

AIMSnThe aim of this study was to report our experience of using distally based spilt vastus lateralis musculocutaneous flaps for soft-tissue defects around the knee joint - a new technique.nnnMATERIAL AND METHODSnCadaver dissection studies were conducted in three cadavers to demonstrate perforators entering the lower third of the vastus lateralis muscle arising from the superior lateral genicular artery. Its application in eight clinical cases for the reconstruction of soft-tissue defects around the knee joint is reported.nnnRESULTSnSeven out of eight flaps survived well without any flap loss. One flap with a skin island measuring 12xa0×xa020xa0cm suffered a loss of 2xa0cm distally. This was later treated with skin grafting. Six out of eight donor sites were closed primarily. Six patients achieved full functional range of motion by 3 months. One patient had a 10° limitation of knee extension. One patient had foot drop due to primary injury and walks with a limping gait.nnnCONCLUSIONSnThis flap is a new reconstructive option for knee defects. It can reach distally up to the tibial tuberosity and does not require an intraoperative change of position. The donor site can be closed primarily and is hidden inside the clothing. The function of the knee is not affected as the majority of the muscle is kept in continuity.

The split tibialis anterior muscle flap - A simple solution for longitudinal middle third tibial defects

Background: The tibialis anterior flap is an underused flap, mainly because it is not an expendable muscle and is small in size. Aim: To study the use of the tibialis anterior muscle flap for longitudinal middle third tibial defects. Materials and Methods: We have analysed the use of tibialis anterior flap in five patients by the function preservation technique. Results and Conclusion: Function preservation techniques used in the harvesting of this flap will be able to cover narrow and linear defects on middle third of tibia comfortably. Size and pliability of the muscle must be assessed before initiation of harvesting of the flap. Flap harvesting is initiated by a saggital split incision to preserve maximum blood supply to the muscle. Transverse incisions may be employed to obtain the desired reach of the flap. This flap is a simple alternative for linear wounds with small transverse dimensions on middle third of the leg, where the tibialis anterior muscle is uninjured.

Anatomical basis of dimple creation - A new technique: Our experience of 100 cases

Background: Cheek dimples are usually considered as an attractive feature of facial beauty. Unfortunately, not all beautiful girls have dimples. Literature on dimple creation surgery is sparse. Aims: We used a new and simple technique for dimple creation, passing a transcutaneous bolster stitch after scraping off the dermis of all mucomuscular attachments. Our aim was to analyse the positive and negative findings of this technique. Materials and Methods: We used this procedure in creation of 100 dimples under local anaesthesia as a daycare procedure and analysed the results. Results and Conclusion: This procedure is safe, reliable and easily reproducible. As no tissue is excised, chances of bleeding and haematoma formation are negligible. With this procedure, the patient satisfaction rate is very high, and patients seen long time after surgery continue to be pleased with their surgically created dimples.

Our experience with pectoralis major flap for management of sternal dehiscence: A review of 25 cases

Objective: To report our experience of the pectoralis major flap as the treatment modality for post coronary artery bypass sternal wound dehiscence. Materials and Methods: A retrospective study of 25 open heart surgery cases, performed between January 2006 and December 2010 at Deenanath Mangeshkar Hospital, Pune, was carried out. Unilateral or bilateral pectoralis major muscle flap by the double breasting technique using rectus extension was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and post-surgery shoulder joint movements to evaluate donor site morbidity. The follow-up ranged from 5 months to 3.5 years. Results: Twenty-three (92%) patients were discharged with complete wound closure. One patient (4%) had wound dehiscence after flap surgery. One patient (4%) died in the hospital in the immediate postoperative period due to mediastinitis. No recurrent sternum infection has occurred till date in 24 patients (96%). For one patient (4%) who had wound dehiscence, daily dressing was done and wound healing was achieved with secondary intension. At follow-up, shoulder joint movements were normal in all the patients. Conclusions: The double breasting technique of the pectoralis major muscle flaps with rectus sheath extension is efficient in covering the entire length of the defect and can reduce the morbidity, without affecting the function of the shoulder joint.

Successful correction of postburn mentosternal contracture and kyphosis of thoracic spine with thoracodorsal artery perforator flap: A case report and review of literature

Postburn kyphosis is extremely rare. Literature on this subject is lacking. We successfully managed a case of postburn mentosternal contracture with kyphosis of thoracic spine by a pedicled thoracodorsal artery perforator (TDAP) flap, postoperative postural bracing and physiotherapy. We had good functional and aesthetic outcomes with a satisfied patient and possible surgery for the spine was avoided. We would like to highlight this rare occurrence of a postburn kyphosis and present a detailed study of this case.

Platysmal book flap for tracheostomy scars

Sir, We read with interest the article on role of platysma muscle flaps for depressed scars of the neck.[1] The authors have mobilised the platyma and sutured it in the midline to augment the soft tissue deformity associated with depressed neck scars with good results. However, in cases of excessive depression of the scar reaching upto the trachea single layer edge to edge approximation of the platysma may not be sufficient to augment the soft tissue deformity.

Splinting of penis after micro vascular reconstruction: A simple inexpensive method.

follows: The protruding end can be cut to 5 mm or so and a plastic bead can be threaded on it and fixed with a drop of superglue (Fevikwik) rendering it safe [Figure1]. It does not catch on clothing. The method is routinely used on all K wires at our centre and is very successful. A variety of beads are used depending on the thickness of K wire used, including those wires used in conjunction with external fixators.