Background:Graft fixation is important for graft take. Fibrin glue has been proposed as an ideal material, because of its human origin and it provides firm adhesion in seconds or minutes.Objective:To evaluate the efficiency of fibrin glue, in increasing the take of skin graft. Assessment includes surgical time taken for graft fixation, haematoma/seroma formation, engraftment and wound closure by day 14.Methods:The study is an observational prospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, from January 2016 to June 2016. Sixteen patients who underwent split skin grafting were assessed during the study period. Fibrin glue was used on the recipient bed before grafting.Results:Better haemostasis and graft adhesion, with a significant reduction of surgical time, were noted.Conclusion:The safety profile of fibrin glue was excellent as indicated by the lack of any related serious adverse experiences. These findings demonstrate that it is safe and effective for attachment of skin grafts, with outcomes at least as good as conventional methods.
Until, sometime ago, microsurgery meant mainly covering a defect or replanting severed parts back to where they belong. Now, restoration of original function and aesthetic consideration is a must in planning reconstructive procedure. Hand transplant combines hand surgery and microsurgery with complex multidisciplinary care. At the anniversary of our first cadaveric bilateral proximal forearm transplantation done in the country's government institute, we would like to share our experience in performing the surgery, outcomes so far, complications, and lessons learned, to contribute to the growing knowledge of vascularized composite allotransplant.
Tangential excision and autologous split-thickness skin grafting is the standard management of the burn wound, but autograft has limitation of donor-site availability and morbidity. Human skin allograft is an alternate option of wound coverage when autograft is not available. Various synthetic skin substitute dressings are now available in the market, and thus use of human skin allograft has decreased. This case report explores the role of human skin allograft in burn wound management. Allograft facilitates excision of burn wounds during acute phase of burn injury in pediatric patients. It is cost-effective, reduces pain and risk of infection, and avoids frequent dressing changes. Availability of allograft and risk of infection are the two main constraints in its regular use.
Diabetic mellitus, a metabolic disorder, has a high incidence and morbidity. Of all complications, diabetic foot ulcer is one of the commonest with 25% likelihood of a diabetic to develop diabetic for ulcers. Infection in a diabetic foot ulcer is a dreaded complication with often complicates the clinical course of the patient and is managed by local and systemic antibiotics. Local antibiotics are generally deemed ineffective in various studies due to lack of an appropriate drug delivery system. The Vit D level is inversely related to development of diabetic vascular disease. A novel strategy for treating diabetic foot ulcer with osteomyelitis may be using topical antibiotics with drug delivery system which will have minimum systemic side effects. Our case, a middle age male, having right foot diabetic ulcer with (Wagner stage 2) uncontrolled sugar levels. A trial of topical antibiotic therapy with tobramycin using cholecalciferol granules as a drug delivery system was given. Regular dressing was continued and serial wound cultures were taken. The wound culture was became sterile after 4 application of the therapy (14 days) with cholecalciferol granules with healthy granulation. The wound was fit for reconstruction after 5 applications. This report is an attempt to bring to the notice that such a drug delivery system is efficacious and may be validated using a larger trial.
Organ transplant has, arguably, been the pinnacle of the advancement in medical science so far and vascularized composite allotransplantation has been the most recent addition to it. The scope of vascularized tissue allotransplantation has been widening with each passing day and more and more reports regarding the safety and efficacy of the procedure have been described.Due to the limited available literature on the management of the complications and implications of the hand transplant, the importance of each report on the procedure is paramount.A mid-arm allotransplant is a challenge in terms of expected motor recovery, and many controversies exist over the efficacy of the procedure altogether. Moreover, our case was complicated by a long ischemia time due to logistic reasons.We share our experience of a transhumeral upper limb allotransplantation, the complications associated with it along with the early postoperative results at 10 months follow up.
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