Shashank Lamba

A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients

INTRODUCTION Split-thickness skin grafting (SSG) is a technique used extensively in the care of burn patients and is fraught with suboptimal graft take when there is a less-than-ideal graft bed and/or grafting conditions. The technique of Negative Pressure Dressing (NPD), initially used for better wound healing has been tried on skin-grafts and has shown to increase the graft take rates. However, comparative studies between the conventional dressing and vacuum assisted closure on skin grafts in burn patients are unavailable. The present study was undertaken to find out if NPD improves graft take as compared to conventional dressing in burns patients. MATERIALS AND METHODS Consecutive burn patients undergoing split-skin grafting were randomized to receive either a conventional dressing consisting of Vaseline gauze and cotton pads or to have a NPD of 80 mm Hg for four days over the freshly laid SSG. The results in terms of amount of graft take, duration of dressings for the grafted area and the cost of treatment of wound were compared between the two groups. RESULTS A total of 40 split-skin grafts were put on 30 patients. The grafted wounds included acute and chronic burns wounds and surgically created raw areas during burn reconstruction. Twenty-one of them received NPD and 19 served as controls. Patient profiles and average size of the grafts were comparable between the two groups. The vacuum closure assembly was well tolerated by all patients. Final graft take at nine days in the study group ranged from 90 to 100 per cent with an average of 96.7 per cent (SD: 3.55). The control group showed a graft take ranging between 70 and 100 percent with an average graft take of 87.5 percent (SD: 8.73). Mean duration of continued dressings on the grafted area was 8 days in cases (SD: 1.48) and 11 days in controls (SD: 2.2) after surgery. Each of these differences was found to be statistically significant (p<0.001). CONCLUSION Negative pressure dressing improves graft take in burns patients and can particularly be considered when wound bed and grafting conditions seem less-than-ideal. The negative pressure can also be effectively assembled using locally available materials thus significantly reducing the cost of treatment.

Post burn pruritus—A review of current treatment options

Post burn pruritus is a well recognised symptom in almost all burn patients. Yet, there is insufficient awareness about the etiopathogenesis and a lack of a systematic approach in the assessment and treatment of this distressing symptom. The current standard therapies include antihistamines, which are effective as sole therapy in only 20% patients, and emollients. There is a lacunae of clear consensus on the care of patients not responding to antihistamines. We review the literature on the etiology and pathogenesis of post burn pruritus, which has both central and peripheral pathways. The published studies on the currently available therapeutic options to treat itch in burns are discussed. On the basis of current evidence in literature, gabapentin used in the treatment of neuropathic pain, has demonstrated great promise, and is suggested as the next option for this subset of patients, not relieved with antihistamines.

A novel and accurate technique of photographic wound measurement

Context: Wound measurement is an important aspect of wound management. Though there are many techniques to measure wounds, most of them are either cumbersome or too expensive. Aims: To introduce a simple and accurate technique by which wounds can be accurately measured. Settings and Design: This is a comparative study of 10 patients whose wounds were measured by three techniques, i.e. ruler, graph and our technique. Materials and Methods: The graph method was taken as the control measurement. The extent of deviation in wound measurements with our method was compared with the standard technique. The statistical analysis used was ANOVA. Results: The ruler method was highly inaccurate and overestimated the wound size by nearly 50%. Our technique remained consistent and accurate with the percentage of over or underestimation being 2-4% in comparison with the graph method. Conclusions: This technique is simple and accurate and is an inexpensive and non-invasive method to accurately measure wounds.

The Morel-Lavallee lesion: a review and a proposed algorithmic approach

Morel-Lavallee lesions (MLL) are rarely diagnosed posttraumatic sequel. They follow closed degloving injuries due to accumulation of blood and debris in the subcutaneous plane. Though they are not uncommon, they are rarely diagnosed which results in delay in their treatment. Diagnosis is through a combination of clinical examination, history, and imaging studies. MRI is the diagnostic modality of choice. Different treatments have been used for their management like compression therapy, sclerosant injection, pulse lavage, and open debridement. These treatments have met with varying success. Treatment protocols vary when managing acute and chronic MLL. The knowledge of such lesions hastens their diagnosis and treatment.

Role of Facial Artery Musculomucosal Flap in Large and Recurrent Palatal Fistulae

Objective Palatal fistulas are not uncommon after palatoplasty. Although there are currently many techniques that can be used to close large palatal fistulae, most of these procedures are usually cumbersome and mostly unreliable with high recurrence rates. The facial artery musculomucosal (FAMM) flap was described to circumvent these problems. The purpose of this study was to review our experience with the FAMM flap to reconstruct palatal fistulas, most of them being recurrent. Materials and Methods A retrospective analysis was done of 11 FAMM flaps performed between January 2007 and March 2012. Results There were no major complications. Venous congestion was seen in two cases. Two flaps developed terminal marginal necrosis. One patient had suture line dehiscence. There were no recurrences of the fistula after repair. All patients had a satisfactory closure of the fistula. Conclusion FAMM flap is a reliable and versatile flap that provides like with the like tissue and is a good option for closure of recurrent wide palatal fistulae.

Trend of India's Contribution to the Field of Plastic and Reconstructive Surgery.

Being the second most populous nation inthe world, there has been a significant surgein various scientific and research domains inIndia. The 2007 Essential Science Indicatorsdatabase revealed that the scientific output ofIndia (215,847 papers and 895,528 citations)hasshownagradualupwardtrend,andIndiaisnowrankedat13thpositionamongthe20mostcited countries in all fields.

Arteriovenous malformation of the scrotum: Is preoperative angioembolization a necessity?

Arteriovenous malformations (AVMs) of the scrotum are uncommon lesions, usually picked up incidentally during the evaluation of scrotal masses or infertility. They have also been reported to present with acute bleeding. We present a case who presented with acute pain following an abandoned surgical attempt at excision, elsewhere. Diagnosis was confirmed by duplex ultrasound and magnetic resonance imaging. Angioembolization was deferred quoting concerns with radiation exposure. The patient underwent a near total excision of the scrotal mass. This is the first reported case, in the English literature, of a surgical resection of a scrotal AVM without a preceding angioembolization. Patients should be counselled about radiation exposure risks before angioembolization, and allowed to make an informed decision.

Chondroid syringoma with extensive ossification

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 fibrous stroma. For these tumors, excision is the treatment of choice.

Ethanol sclerotherapy for treatment of venous malformations of face and neck— a single centre experience

Due to complicated anatomy of the face and neck, complete surgical excision of venous malformation is rarely possible and may lead to bleeding, nerve damage and cosmetic deformity. Sclerotherapy is an alternative method of treatment with few complications. Ethanol shows the lowest rate of malformation recurrence and is the most reliable substance of all of the sclerosing agents. This study aims to evaluate the efficacy of ethanol instillation in venous malformation of the face and neck. Between July 20, 2008, to December 30, 2009, 15 patients with venous malformation of the face and neck were included in the study. After confirmation of diagnosis (combination of history, physical findings and magnetic resonance imaging), percutaneous ethanol (99.5% ethyl alcohol) sclerotherapy was used under DSA road mapping using general anaesthesia. Sclerotherapy provided significant improvement of symptoms for all patients, with no major complications. All patients experienced pain and swelling to a variable degree in the immediate post procedure period that resolved over few days. Ethanol sclerotherapy for venous malformations of the face and neck is a safe and effective treatment option.

Management of scalp defects due to high-voltage electrical burns: a case series and proposed algorithm to treat calvarium injury

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.