Parag Sahasrabudhe

Awareness and Perception of Plastic Surgery among Healthcare Professionals in Pune, India: Do They Really Know What We Do?

Purpose. The aim of this study is to understand the level of awareness and knowledge of plastic surgery in healthcare professionals in a tertiary health care facility in Pune, India. This study also aims to highlight the perception of the medical professionals about plastic surgery and what they think a plastic surgeon does. Materials and Methods. A questionnaire-based survey was done at B.J Medical College and Sassoon Hospital, Pune in 2011. Feedback evaluation forms from hundred resident doctors and faculty were evaluated and analyzed. Results. There is not much awareness about plastic surgery as a specialty amongst health care providers. Plastic surgery is mostly perceived as cosmetic surgery, and the other spectrum of the patients we cater to goes largely unnoticed. Of all the clinical conditions given to the participants, there was not a single clinical condition where the respondents favored unanimously for plastic surgeons. Conclusion. Plastic surgery as a specialty is poorly understood by our medical colleagues, and the onus of creating and improving the awareness and perception of our specialty lies on us. Herculean unified efforts at individual as well as global level will help us achieve this goal.

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.

Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature

Background: This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis. Materials and Methods: This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months. Observations and Results: In this study of 505 cases of AVFs, primary patency rates by Kaplan — Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon. Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. Flow rates in patients with vein diam. >2 mm were significantly higher as compared with patients with vein diam. <2 mm (P < 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P < 0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm.

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.

Femoral blowout in a case of Carcinoma Penis

There is considerable literature on the potential for a femoral blowout in case of fungating inguinal lymph nodes in a case of penile carcinoma. However, reported cases of actual femoral blowout are sparse in literature. We encountered one such case of femoral blowout because of fungating inguinal lymph nodes in a case of Ca.Penis. Emergency palliative resection of the fungating nodes, ligation of the femoral vein, and emergency flap cover in the form of a perforator-based anterolateral thigh flap was performed. We believe that patients with a potential of femoral blowout should undergo resection and suitable coverage to prevent fatal hemorrhage.

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.

The Tarsoconjunctival Flap for Lower Lid Reconstruction-Review of Literature and Case Series

Background: Recent literature on the use of Hughes Tarsoconjunctival flap for lower lid reconstruction is sparse.Aim: To study the use of the Hughes Tarsoconjunctival flap for total lower lid reconstruction.Materials and methods: We have analyzed the use of Hughes flap for the posterior lamella recreation after post malignancy defects in nine patients with certain modifications in the existing techniques. Anterior lamella was reconstructed using the cheek skin. All flaps were divided at two weeks.Result and conclusion: All the flaps did well. There was post operative ectropion and tarsal fracture in one patient each. The Tarsoconjunctival flap is based on the principle of like for like and probably gives the best possible functional and aesthetic outcomes in lower lid reconstruction. The evolutions of the Tarsoconjunctival flap over the years with important modifications and our experience with lower lid reconstruction using this technique have been outlined.

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.