Dr. Srinjoy Saha | Apollo Hospitals (original) (raw)

Papers by Dr. Srinjoy Saha

Surgical and Cosmetic Dermatology, 2023

Enxertos compostos de gordura para correção de distrofia facial em caso de esclerodermia localiza... more Enxertos compostos de gordura para correção de distrofia facial em caso de esclerodermia localizada Composite fat grafts for correcting facial dystrophy in a case of localized scleroderma RESUMO A esclerodermia localizada (morfeia linear) é uma doença rara que causa distrofia e assimetria faciais em mulheres jovens. É relatado o caso de uma paciente de 20 anos que foi tratada com enxertos compostos de gordura. Após a coleta do lipoaspirado de gordura subcutânea profunda, a microgordura e a nanogordura não filtrada foram processadas separadamente para formar enxertos compostos de gordura. Estes foram meticulosamente transplantados em camadas, para reconstruir o subcutaneo da face da paciente. Após um ano, observou-se boa pega de gordura com correção bem-sucedida da assimetria e restabelecimento do equilíbrio facial.

PubMed, 2023

The goals of treatment for fingertip injuries are maximising digital length, tactile sensation, p... more The goals of treatment for fingertip injuries are maximising digital length, tactile sensation, pulp padding, and fingertip appearance while minimising complications like infection and amputation. Currently, terminalisation, healing by secondary intention, and flap surgeries are widely used for crushing fingertip injuries, but they have their own set of issues and limitations. We present a tissue-engineered method by combining platelet-rich fibrin injections with stacked-up layers of synthetic biodegradable temporising matrix to treat a severely crushed fingertip. This novel therapy minimised reconstructions while successfully regenerating new soft-tissues. Soft-tissue regeneration within the stacked-up biodegradable matrix achieved adequate volume, sensation, function, and mobility of the newly reconstructed fingertip while maintaining its skeletal length. Notably, the regenerated fingertip allowed the patient to resume work normally as a busy software engineer. Thus, minimalistic fingertip reconstruction not only prevented a disability, but also served as a viable alternative to major reconstructive surgeries.

Journal of The American College of Surgeons, Oct 17, 2022

Letters to the Editor, discussing material recently published in the Journal, are welcome. They w... more Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor. Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Research Square (Research Square), Sep 16, 2020

Schwannomas are rare tumours arising from peripheral nerve sheath and are usually related to the ... more Schwannomas are rare tumours arising from peripheral nerve sheath and are usually related to the spinal cord and spinal nerves. Contrast magnetic resonance imaging (MRI) usually helps in establishing a preoperative diagnosis. Rarely, their manifestation may be surprisingly new. Here, a 44-year-old lady came to our clinic with a painless asymptomatic progressively enlarging swelling over her upper back. It was uctuant, with absent neural signs and symptoms. MRI showed a benign, purely-cystic, super cialintermuscular, extra-spinal swelling near the upper thoracic vertebrae. However, classical diagnostic signs of schwannoma were absent. Complete surgical excision was performed with smooth dissection through a well-de ned plane between the lesion and surrounding muscles. A 6.5x5.0x2.5 cm oval lesion with a glistening whitish-grey capsule was excised, and the deep wound was reconstructed in multiple layers. Interestingly, it was not attached to any identi able nerves. Histopathology showed typical hallmarks like Antoni A regions and Verocay bodies. Positive S-100 staining during immunohistochemistry established its diagnosis as schwannoma. The postoperative one-and-half-year follow-up period was uneventful. Cystic schwannomas can surprise and confuse clinicians by arising anywhere in the body and with atypical manifestations. Surgeons need to consider it in the differential diagnoses of any undiagnosed slowly-growing swelling, including purely-cystic ones and perform careful surgical dissection to avoid any inadvertent nerve damage.

A narration of the untold events that led to the minimalistic reconstruction of exposed skull bon... more A narration of the untold events that led to the minimalistic reconstruction of exposed skull bones. A draft of the press release about this event.

Plastic and Reconstructive Surgery - Global Open

Summary: Diabetic foot ulcers are a significant complication of diabetes, affecting millions glob... more Summary: Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 m...

Journal of orthopaedic case reports, 2022

Journal of the American College of Surgeons

Patients have a new option to pay for their plastic surgery and cosmetic treatments at some plast... more Patients have a new option to pay for their plastic surgery and cosmetic treatments at some plastic surgery centers. Some of the top plastic surgeons across the world already believe in the power of cryptocurrency and how it can help patients who need to pay for their medical treatments. Cryptocurrency offers an alternative payment method with several advantages, which is attractive to many people. Cryptocurrency is an investment in a stored value, so its value can increase significantly over time. With its potential and growth, this form of currency has become increasingly popular, especially amongst the millennials. Last year, a plastic surgery center in Texas was one of the first in the world to accept cryptocurrencies. A board-certified plastic surgeon, who founded the idea, said he decided to offer the new payment method as cryptocurrencies have gained popularity. In an interview, another top plastic surgeon said that their practice has patients from all over the world. Adoptin...

The Surgery Journal

Minimally invasive reconstruction combines principles of tissue engineering and regenerative medi... more Minimally invasive reconstruction combines principles of tissue engineering and regenerative medicine for healing complex wounds. This approach was successfully demonstrated on a 64-year-old diabetic and hypertensive male patient, who was brought unconscious to our emergency after surviving an automobile collision with severe brain and right-dominant upper extremity injuries. Uncontrolled hyperglycemia, severe anemia, diffuse axonal brain injury, wrist drop, and loss of thumb extension and abduction were noted. Extensive degloving, skin necrosis, extensor and flexor forearm muscle crush injuries, and ruptured extensor tendons were observed. Serial wound debridement combined with platelet-poor plasma injection into the muscles, platelet-rich plasma injections into the tendons and subcutis, and low-negative pressure wound therapy were performed sequentially to salvage the injured soft-tissues. Improvements were noticed during the second exploration after 5 days. Surviving muscles show...

Surgical Neurology International, 2021

Background: In stable craniovertebral injuries complicated by polytrauma, rigorous spinal immobil... more Background: In stable craniovertebral injuries complicated by polytrauma, rigorous spinal immobilization is essential for neuroprotection. Scalp and forehead reconstruction in these circumstances are safest when performed under local anesthesia, maintaining cervical immobilization.

Case description: A sizeable 10 × 6.5 cm forehead defect was reconstructed utilizing regenerative principles under local anesthesia and sedation in a 54-year-old woman. After adequate debridement of gangrenous soft tissues, exposed outer skull bones were trephined, forehead defect covered with a synthetic biomaterial, and the patient was discharged thereafter. Granulating neodermis regenerated within the biomaterial over the next 6 weeks. Weekly platelet-rich plasma injections along the wound margins facilitated wound regeneration. Dimensions reduced by two-thirds to 6.5 × 3.5 cm with wound regeneration and contraction, while granulating neodermis covered the remaining skull-bones. Split skin-grafting over the neodermis ensured satisfying long-term results, with similar color, texture, soft-tissue thickness, and sensation. Multiple occipitocervical, spinal, scapular, and rib fractures healed well with strict immobilization.

Conclusion: Good long-term results were achieved with significantly reduced dangers, complications, hospitalization, and costs than traditional reconstructive flap surgeries. Minimalistic reconstruction utilizing tissue engineering and regenerative medicine principles appears beneficial for patients with grave spinal injuries.

Keywords: Biodegradable temporising matrix; Craniovertebral injury; Forehead reconstruction; Minimally invasive reconstruction; Platelet-rich plasma.

Additional information: To know in details about the inside story of this patient, and how minimalistic reconstruction saved the life of an injured mother who had lost her only daughter in the same accident, please see here - https://www.srinjoysaha.com/face-regeneration.

Journal of Orthopaedic Case Reports, 2021

Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major... more Introduction: Tissue engineered reconstruction is a minimally invasive approach for healing major complex wounds successfully. It combines accurate, conservative debridement with a specially adapted suction method, platelet-rich plasma (PRP) injections, and biomaterial application to salvage injured tissues and grows new soft tissues over wounds.

Case Report: A healthy young man in his early 30s presented to our emergency department with complex knee-thigh injuries following a high-velocity automobile accident. Degloved anterolateral thigh, severe thigh muscle injuries, and ruptured extensor patellar mechanism were observed. Accurate conservative (as opposed to radical) debridement and PRP injections salvaged the injured muscles and tendons. Specially carved reticulated foam wrapped around the injured ischemic muscles, followed by low negative, short intermittent, cyclical suction therapy. Wound exploration 4 days apart revealed progressive improvements with considerable vascularization of the injured soft tissues within 2 weeks. Thereafter, meticulous reconstruction of the salvaged muscles and tendons restored anatomical congruity. An absorbable synthetic biomaterial covered the sizeable open wound with vast areas of exposed tendons. Five weeks later, exuberant granulating tissue ingrowth within the biomaterial filled up the tissue defect. A split-skin graft covered the remaining raw areas, which “took” completely. Early rehabilitation enabled the patient to return to active work, play contact sports, and perform strenuous activities effortlessly.

Conclusion: Minimally invasive tissue engineered reconstruction is a novel approach using a series of simple minimally invasive procedures. It lessens the duration of surgery and anesthesia, maximizes soft-tissue salvage, lowers morbidity, minimizes hospitalization, saves costs, and improves the patient’s quality of life significantly.

Keywords: Mangled extremity, Limb salvage, Financial, Trauma, Modified negative pressure wound therapy, Wounds, Wound healing, Soft tissue defect, Knee joint, Tissue engineering, Biodegradable temporising matrix.

Postgraduate Medical Journal, 2021

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Publish... more © Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. A 26yearold newlywed woman attended our clinic with gigantic breasts associated with neck and back pain, and severe bleeding from breast ulcers. Her breasts had enlarged rapidly within the first 2 months of her first pregnancy, causing approximately 25 kg of weight gain and later, swelling over both the lower limbs. Medical therapy was instituted, but failed to halt breast tissue growth or relieve symptoms. Ultimately, she underwent an abortion at the end of the first trimester of pregnancy, which finally stopped breast enlargement. However, bleeding breast ulcers were problematic. Once, profuse bleeding caused haemorrhagic shock, necessitating multiple blood transfusions. Examination revealed anaemia, enlarged axillary nodes and engorged subcutaneous veins. Breast tissues were visibly reddish, firm and nontender on palpation. Sternal notchtonipple distances were 62 cm (right) and 60 cm (left), inframammary foldtonipple distances were 42 cm (left) and 40 cm (right), with areolar diameters 21 cm bilaterally (figure 1). Multiple ulcerations with granulating bases were present, with the largest sized 8×7 cm near the left areola (figure 2). Highfrequency ultrasonography

Journal of Medical and Scientific Research, 2020

Introduction:Reconstructing posttraumatic facial defects to achieve aesthetically pleasing result... more Introduction:Reconstructing posttraumatic facial defects to achieve aesthetically pleasing results is challenging. Different flaps, including many modifications of cheek flaps, are commonly performed, but several problems persist.Aim:To evaluate the effectiveness of an augmented facelift flap for reconstructing posttraumatic facial defects. Fundamentally a rotation-advancement flap inspired by extended facelift markings and deep-plane facelift dissection, it incorporates retroauricular and cervical tissues whenever necessary. Materials and Methods:Ten patients (eight males, two females) with cheek, lateral orbit, and lower eyelid defects were reconstructed with augmented facelift flaps between January 2009 and December 2019. Size of defects ranged between 10.5 to 27 cm2, and patients age between 21 to 78 years (mean, 49.3). Deep-plane facelift dissection was performed for extensive facial defects and subcutaneous dissection for smaller ones. Flap design was based on the principles of extended facelift surgery with necessary extensions. Meticulous dissection and anchoring ‘key sutures’ in four different facial regions were vital in preventing complications.Results:Augmented facelift flap aptly reconstructed defects over the medial cheek, lateral orbit, and lower eyelid with aesthetically pleasing results. Nine patients (90%) healed well without any long-term complications. Among short-term complications, superficial necrosis was found in one patient (10%) and mild venous stasis in three patients (30%). Flap loss and infection were absent. Lower eyelid ectropion and deep marginal necrosis occurred in one patient (10%). Overall, patient satisfaction scores ranged between 50-90 percent (mean, 78%).Conclusion:Augmented facelift flap successfully reconstructed posttraumatic facial defects over the cheek, lateral orbit, and lower eyelids with satisfying aesthetic results.

The Journal of clinical and aesthetic dermatology, 2021

Botulinum toxin has been used to treat persistent erythema and flushing in rosacea for several ye... more Botulinum toxin has been used to treat persistent erythema and flushing in rosacea for several years. Here, we describe two women and one man, each with rosacea with flushing and permanent erythema refractory to conventional treatment, who achieved satisfactory and lasting results following intradermal application of botulinum toxin. Two different botulinum toxin types were used. Toxin concentrations of 3.75U per 0.1 mL (abobotulinum) and 1.25U per 0.1 mL (incobotulinum) were used for each patient were used for each patient. The outcomes were measured using polarized photography to evaluate the decrease in vascular involvement. In the three cases presented here, botulinum toxin was effective for controlling erythema and flushing associated with rosacea; we also observed a prolonged duration of these improvements without the rebound effect of topical therapies.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to l... more Hidradenitis Suppurativa (HS) causes chronic inflammation around the hair follicles, leading to localised immunosuppression. Sometimes, it causes superadded Non tuberculous mycobacterial infections that require radical surgeries. After an extensive literature search, no Indian case report on this rare topic could be found, and this case report aims to fill up the void. A 28-yearold female presented with recurrent ulcers over her left axilla, which were refractory to medical treatments and surgeries for the last 5 years. Earlier, she had received a 6 month course of antitubercular drugs after Acid-Fast Bacilli (AFB) were found on pus examination. When the ulcers recurred afterward, she was empirically diagnosed as Non tuberculous mycobacterial infection in Thailand and treated with appropriate antibiotics for 3 months. However, multiple ulcers in new areas recurred over her axilla about a month after her treatment schedule was completed. To achieve complete surgical cure, radical exc...

Neurologico Spinale Medico Chirurgico, 2020

Narrated in pictures and words, the sequence of events where minimalistic reconstruction was perf... more Narrated in pictures and words, the sequence of events where minimalistic reconstruction was performed on a middle-aged lady with several life-threatening injuries.

International Journal of Recent Surgical and Medical Sciences, 2020

Introduction Reconstruction of large (>20 cm2) posttraumatic forehead defects, with esthetical... more Introduction Reconstruction of large (>20 cm2) posttraumatic forehead defects, with esthetically pleasing results and without distorting the surrounding anatomical landmarks like eyebrow and hairline, is a significant surgical challenge. This study was aimed to determine the effectiveness of a triple-plane dissection technique of significantly-sized flaps, combining forehead, and scalp to cover large forehead defects. Materials and Methods A retrospective review from January 2009 to December 2019 revealed that 12 patients with large defects over the forehead were operated on. Significantly-sized rotation and advancement flaps, combining both the forehead and scalp tissues, were performed. Triple-plane dissection and careful galeal scoring recruited more tissues and increased the reach of these flaps while maintaining adequate flap vascularity. Results Large forehead posttraumatic defects in all 12 patients were covered in a single surgery with this combined flap. Eight patients w...

Wilderness & Environmental Medicine, 2021

Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which ma... more Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, we performed early primary repair of all facial injuries. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, except for few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.

Keywords:
bites and stings, dog bite, facial injuries, facial injury treatment, rabies prevention and control.

Additional information: To know in details about the different delicate methods of facial plastic surgery employed in reconstructing the mauled face of this small child, please see here - https://www.plastangel.com/facial-plastic-surgery.