Aim:Snakebite injuries are common in tropical India among those who are involved in outdoor activities. These injuries results in cellulitis, gangrene at the bite area, bleeding manifestations, compartment syndrome, regional lymphadenopathy, septicemia, hypotension, and disseminated intravascular coagulation (DIC) resulting in significant morbidity and mortality. The purpose of this study is to share our experience of multidisciplinary approach in the management of snakebite injuries of the extremities with various treatment modalities including hyperbaric oxygen (HBO) therapy, surgical debridement, and soft tissue reconstruction to provide an effective treatment for snake bite injuries.Methods:The study was conducted in the Department of Plastic Surgery, during the period October 2012–December 2014, wherein all the patients who were admitted with snakebite injuries were enrolled and the patients treated in plastic surgery department were included into the study. Out of total 766 patients, there were 323 patients treated with anti snake venom (ASV) and 29 died among the treated patients; 205 patients belonged to pediatric age group.Results:Out of 112 patients referred to Department of Plastic Surgery, 50 cases presented with cellulitis, 24 patients with compartment syndrome, and 38 patients were referred for the management of soft tissue cover over the extremities. Among 112 patients, 77 involved the lower extremity and 35 the upper extremity.Conclusion:Multidisciplinary approach including hyperbaric oxygen (HBO) therapy improves outcome in the management of snakebite injuries of the extremities.
Background: The distribution of body fat and its variation is of great importance in determining the pathogenesis of insulin resistance. Central obesity has been recognized as an independent risk factor for diabetes. The objective of the study was to evaluate the predictive accuracy of various anthropometric measures of body fat in determining impaired glucose tolerance (IGT) or prediabetes among South Indian population. Methodology: This was a community-based comparative cross-sectional study where the anthropometric measures of a representative sample of 171 individuals with glycosylated hemoglobin (HbA1c) in the range for IGT were compared with age- and gender-matched controls with HbA1c in the normal range. The predictive accuracy of the various anthropometric measures of obesity to identify individuals with IGT was estimated using the area under the receiver operating characteristic (ROC) curve. Results: Patients with IGT in both genders had significantly higher BMI, waist circumference (WC), neck circumference (NC), and waist-to-height ratio (WHtR). ROC analysis revealed WHtR in females and NC among males to have the largest area under the curve for predicting IGT. In both genders, WC, WHtR, and NC had better predictive accuracy for prediabetes as compared to BMI and waist-to-hip ratio (WHR). Conclusion: It is suggested that the WHtR and WC are better screening tools for prediabetes in comparison to BMI and WHR among the South Indian population.
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 perforator fl ap 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 plus fl ap" 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 plus fl ap was performed in all patients. The defect sizes ranged from 9 cm × 4 cm to 17 cm × 8 cm. The fl ap 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 total fl ap loss. No fl ap 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 plus fl ap technique is simple, requires little operative time, and is a reliable fl ap for coverage of the femoral vessels and inguinal region with improved tolerance to postoperative radiotherapy.
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