Introduction: Salvage of complex limb injuries is not only dependent on the skill, experience and attitude of the surgeon but also on the ischemia time. If the revascularisation is not possible within the golden period then the outcome is unfavourable. There are very few reports of delayed replantation. We are presenting a case series of replantation beyond the golden hours i.e. 6 hours of warm ischemia by immediate revascularisation before undertaking definitive replantation. The definitive sequence of replantation is carried out after the limb gets revascularised and the viscious cycle of ischemia is broken. Study aimed to salvage amputated limbs in the borderline ischemia time by immediate revascularisation.
This study was done to evaluate and compare the surgical outcomes of primary repair of Complete Unilateral Cleft lip by Millard’s rotation advancement technique and Randall-Tennison’s Triangular flap technique in terms of Quantitative and qualitative assessments like cupid bow pouting, vermilion symmetry, nasal floor alar base symmetry and scar appearance was analysed by 5 different Plastic surgeons. 40 patients of complete Unilateral Cleft Lip operated using either Millard’s technique or Randall-Tennison’s Triangular flap technique (20 each) in the Department of Burns, Plastic and Reconstructive Surgery, SCB Medical College and Hospital, Cuttack for 2 years. They were compared with 20 normal patients (control). Overall mean age was 5.07 ± 1.41 months and 1st birth order comprised of 45.0%. Family history was found among 6.7% cases. 78.3% patients were in age group 3 – 6 month, 21.7% in 6 -12 months age group. Postoperatively there was significant difference in total nasal width between Tennison and control , Millard and Tennison but insignificant between Millard and Control.There was no statistical difference between Modified Millard’s rotation advancement technique and Randall-Tennison’s Triangular flap technique for the primary repair of the unilateral cleft lip under the hands of a qualified and skilled Plastic Surgeon.
Introduction: Long-standing burns at major joints like the elbow and knee often lead to contractures, despite of best treatments and their management poses a great challenge owing to underlying contracted tendons, neurovascular bundle, and joint ligaments. Attempts at release and correction of contractures may lead to injury to the adjacent neurovascular structures. Aim: To evaluate the effectiveness of staged release as a means of definitive treatment of severe burn contracture. Materials and Methods: A prospective interventional study was conducted on 30 patients in the Department of Burns, Plastic and Reconstructive Surgery Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India, from December 2018 to December 2020. In the first stage, the maximum excisional release of contracture was done, avoiding any stretching of the neurovascular bundle, then bedside graded traction was applied at the joint until the complete release of contracture was observed. The resultant raw area was covered with a split-thickness skin graft in the second stage. The collected data included- site and side of the contracture, cause of initial burn, Improvement in flexion arc (in degrees), duration of splintage after surgical release, complications and Patient and Observer Scar Assessment Scale (POSAS). Paired t-tests were performed to analyse changes in preoperative versus postoperative measurements. Results: Eighteen cases of knee contractures and 12 cases of elbow contractures were included in the study. Among the patients that were analysed, 17 were females and 13 were males, with a female-to-male ratio of 1.3:1. The age range was 18-50 years, with a mean age of 36±8.79 years. The mean Range Of Motion (ROM) of elbow contracture with a severe degree of contracture improved from 25% of functional ROM to 124.29% at 6 months postoperatively. Similarly, the mean ROM of knee contracture with a severe degree of contracture improved from 25.76% of functional ROM to 102.58% at 6 months postoperatively. For both elbow and knee contracture cases the differences in mean ROM were statistically significant with all p-values <0.05. The average time at which the patients reported to the hospital, after developing contracture was 36.8 months, and it ranged from 24 months to 62 months. According to POSAS patient scale, the overall score was 6 and 5 for the elbow and knee respectively and the POSAS observer scale overall score was 6 for both the elbow and knee, respectively. Conclusion: The staged release procedure applied in the present study was an effective way of dealing with long-standing contractures with minimal complications.
Introduction Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon.The aim of this study is to analyse the outcome of free anterolateral thigh(ALT) flaps for soft tissue reconstruction of defects following tumor excision,trauma and post burn. Methods : A retrospective review of 19 patients undergoing ALT Flaps for various reasons from Dec 2018 to Jan 2021 was performed to determine perioperative factors, demographic profile , complications and outcomes. Results : The mean age the study population was 47.2 years. The male to female ratio was 2.16:1 (68.5 % male, 31.5% females). The etiology of soft tissue defect was post- tumor resection – 47.36%, truam-36.8%, post burn reconstruction- 10.5% . The defect sites were most commonly leg-31.5%, upper extremity- 26.3%, buccal mucosa- 15.7%, scalp-10.5%, tongue- 10.5%,breast- 5.2%.Flaps were harvested from right thigh in 52% of cases and left thigh in 58% of the cases. Donor site was closed primarily in 11 cases (57.8%), SSG coverage was done for 8 cases ( 42.8%). The minimum operating time was 205 minutes and maximum was 435 minutes, with an average time of …………..The minimum hospital stay post op was 12 days , maximum being 45 days.
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