Haŕi Venkatramani - Academia.edu (original) (raw)

Papers by Haŕi Venkatramani

BMC Proceedings, May 19, 2015

Journal of Skin and Sexually Transmitted Diseases

There has been a paradigm shift in the management of lymphedema with a better understanding of th... more There has been a paradigm shift in the management of lymphedema with a better understanding of the functioning of lymphatics with the introduction of “lymphosome concept” and with the recent advances in super-microsurgical techniques. The most frequently used intraoperative imaging modality now is indo cyanine green lymphangiography. In endemic countries, any patient with lymphedema without prior history of trauma or, oncosurgical or radiotherapy interventions must undergo Alere filariasis test strip. Patients in early stages of disease can benefit from complex decongestive therapy and physiologic surgical procedures such as lymphovenous anastomosis or vascularized lymph node transfers. However, in advanced disease, excisions or debulking through radical reduction with preservation of perforators will be required. The localized adipose tissue deposits in lymphedema can be removed by liposuction. At present, there is still no cure for lymphedema, but emerging research in tissue engin...

Plastic and Reconstructive Surgery, 1999

Journal of hand surgery global online, Apr 1, 2023

BMC Proceedings, May 19, 2015

The Journal of Hand Surgery, Jul 1, 2021

Major upper-extremity degloving injuries with distal dysvascularity are rare and challenging surg... more Major upper-extremity degloving injuries with distal dysvascularity are rare and challenging surgical problems. When these degloving injuries occur over nonexpendable regions, such as the glabrous skin of the palm and digits, revascularization or replantation may be the treatment of choice. Because the degloved skin flap is often separated in the suprafascial plane, direct arterial repair may be impossible. We present a rare case of circumferential degloving of the hand and forearm with distal dysvascularity, treated successfully with revascularization with arterial anastomosis, venous anastomosis, and arteriovenous shunt creation. The patient required reoperation for partial flap loss and ligation of the arteriovenous fistula. At final follow-up 16 months after the injuries, she showed independence in activities, reported good functional use of the hand, and worked full-time at her original occupation.

Indian Journal of Plastic Surgery, 2019

Journal of Hand Surgery (European Volume), Oct 9, 2021

Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The mo... more Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The most important factor in salvage of a mutilated hand is involvement of a senior surgeon at the time of initial assessment and debridement. A regional block given on arrival helps through assessment and investigations in a pain-free state. Infection still remains the important negative determinant to outcome and is prevented by emergent radical debridement and early soft tissue cover. Radical debridement and secure skeletal stabilization must be achieved on day one in all situations. Dermal substitutes and negative pressure wound therapy are increasingly used but have not substituted regular soft tissue cover techniques. Ability to perform secondary procedures and the increased use of the reconstructed hand with time keeps reconstruction a better option than prosthesis fitting. Toe transfers and free functioning muscle transfers are the two major secondary procedures that have influenced outcomes.

Indian Journal of Orthopaedics, Aug 1, 2017

We describe a case of entrapment neuropathy of the infrapatellar branch of the saphenous nerve as... more We describe a case of entrapment neuropathy of the infrapatellar branch of the saphenous nerve as it pierces sartorius muscle. This is a rare cause of anteromedial knee pain that is easily overlooked and may be mistaken as arising from other anatomical structures in that region. The pain was successfully treated by partially dividing the sartorius muscle and translocating the nerve away from the site of entrapment. It is important to consider entrapment neuropathy of the infrapatellar branch of the saphenous nerve as a differential diagnosis when assessing a patient with anteromedial knee pain.

Plastic and Reconstructive Surgery, Oct 1, 1999

Jurnal Plastik Rekonstruksi, 2020

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a r... more Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 we...

2005 IEEE Aerospace Conference, 2005

An 1 easily-adopted 2 method of adding Prognostics/Health Management (PHM) to electronic systems ... more An 1 easily-adopted 2 method of adding Prognostics/Health Management (PHM) to electronic systems is described. As an example, a PWM-type switching power supply was chosen for analysis in this paper, due to the u biquitous nature of these Power Converters in Mil/Aero systems, and the criticality of their reliable performance. Switch mode power supplies (SMPS) provide significant advantages to users in terms of conversion efficiency, weight, and size. According to Industry Analysts, over $7.7 Billion of SMPS Power Systems were produced worldwide in 2002. However, SMPS's have unique reliability issues when used within a system due to size constraints, heat dissipation and varying load conditions.

Plastic and Reconstructive Surgery, Dec 1, 2015

BACKGROUND-Absence of plantar sensation is a critical factor considered in favor of amputation fo... more BACKGROUND-Absence of plantar sensation is a critical factor considered in favor of amputation for patients with lower limb-threatening injuries. This study aims to assess outcomes of limb salvage in a group of patients with severe lower extremity injuries associated with posterior tibial nerve transection. METHODS-We studied eight cases of limb salvage after traumatic injuries with documented tibial nerve laceration managed at Ganga Hospital, India. Functional and health-related quality of life outcomes were assessed. Outcomes from this case series were compared to outcomes of studies from a systematic literature review on salvage of the severely injured lower extremity. RESULTS-Patients in this case series reported mild pain (median score 20 on a 100 scale visual analog scale) with some return of plantar sensation in patients with tibial nerve repairs (median score 2/5). Patients demonstrated a decrease in ankle motion (27.5 degrees plantar flexion, 10 degrees extension) and muscle strength (median heel flexor score 3/5). All patients could ambulate independently. Quality of life and function measured by validated instruments revealed minimal disability. We identified 1,767 articles on lower extremity trauma and 14 articles were systematically reviewed. Relative to the case series, published articles reported similarly diminished ankle motion and muscle strength, with reports of mild pain in select studies. Patient reported outcome instruments found variations in the degree of physical disability based on time from the injury. CONCLUSIONS-Though limited in number, this case series demonstrates the value of limb salvage even for patients with posterior tibial nerve injury.

Indian Journal of Plastic Surgery, May 2, 2023

Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illn... more Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the selfamputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy, to achieve the optimum outcome possible in the replanted hand.

The Journal of Hand Surgery, Nov 1, 2022

Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and prox... more Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation. We discuss relevant technical considerations that indicate that, despite challenges, forequarter replantation can be achieved with success.

Indian Journal of Plastic Surgery, May 1, 2019

Indian Journal of Plastic Surgery, Sep 1, 2017

BMC Proceedings, May 19, 2015

Journal of Skin and Sexually Transmitted Diseases

There has been a paradigm shift in the management of lymphedema with a better understanding of th... more There has been a paradigm shift in the management of lymphedema with a better understanding of the functioning of lymphatics with the introduction of “lymphosome concept” and with the recent advances in super-microsurgical techniques. The most frequently used intraoperative imaging modality now is indo cyanine green lymphangiography. In endemic countries, any patient with lymphedema without prior history of trauma or, oncosurgical or radiotherapy interventions must undergo Alere filariasis test strip. Patients in early stages of disease can benefit from complex decongestive therapy and physiologic surgical procedures such as lymphovenous anastomosis or vascularized lymph node transfers. However, in advanced disease, excisions or debulking through radical reduction with preservation of perforators will be required. The localized adipose tissue deposits in lymphedema can be removed by liposuction. At present, there is still no cure for lymphedema, but emerging research in tissue engin...

Plastic and Reconstructive Surgery, 1999

Journal of hand surgery global online, Apr 1, 2023

BMC Proceedings, May 19, 2015

The Journal of Hand Surgery, Jul 1, 2021

Major upper-extremity degloving injuries with distal dysvascularity are rare and challenging surg... more Major upper-extremity degloving injuries with distal dysvascularity are rare and challenging surgical problems. When these degloving injuries occur over nonexpendable regions, such as the glabrous skin of the palm and digits, revascularization or replantation may be the treatment of choice. Because the degloved skin flap is often separated in the suprafascial plane, direct arterial repair may be impossible. We present a rare case of circumferential degloving of the hand and forearm with distal dysvascularity, treated successfully with revascularization with arterial anastomosis, venous anastomosis, and arteriovenous shunt creation. The patient required reoperation for partial flap loss and ligation of the arteriovenous fistula. At final follow-up 16 months after the injuries, she showed independence in activities, reported good functional use of the hand, and worked full-time at her original occupation.

Indian Journal of Plastic Surgery, 2019

Journal of Hand Surgery (European Volume), Oct 9, 2021

Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The mo... more Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The most important factor in salvage of a mutilated hand is involvement of a senior surgeon at the time of initial assessment and debridement. A regional block given on arrival helps through assessment and investigations in a pain-free state. Infection still remains the important negative determinant to outcome and is prevented by emergent radical debridement and early soft tissue cover. Radical debridement and secure skeletal stabilization must be achieved on day one in all situations. Dermal substitutes and negative pressure wound therapy are increasingly used but have not substituted regular soft tissue cover techniques. Ability to perform secondary procedures and the increased use of the reconstructed hand with time keeps reconstruction a better option than prosthesis fitting. Toe transfers and free functioning muscle transfers are the two major secondary procedures that have influenced outcomes.

Indian Journal of Orthopaedics, Aug 1, 2017

We describe a case of entrapment neuropathy of the infrapatellar branch of the saphenous nerve as... more We describe a case of entrapment neuropathy of the infrapatellar branch of the saphenous nerve as it pierces sartorius muscle. This is a rare cause of anteromedial knee pain that is easily overlooked and may be mistaken as arising from other anatomical structures in that region. The pain was successfully treated by partially dividing the sartorius muscle and translocating the nerve away from the site of entrapment. It is important to consider entrapment neuropathy of the infrapatellar branch of the saphenous nerve as a differential diagnosis when assessing a patient with anteromedial knee pain.

Plastic and Reconstructive Surgery, Oct 1, 1999

Jurnal Plastik Rekonstruksi, 2020

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a r... more Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 we...

2005 IEEE Aerospace Conference, 2005

An 1 easily-adopted 2 method of adding Prognostics/Health Management (PHM) to electronic systems ... more An 1 easily-adopted 2 method of adding Prognostics/Health Management (PHM) to electronic systems is described. As an example, a PWM-type switching power supply was chosen for analysis in this paper, due to the u biquitous nature of these Power Converters in Mil/Aero systems, and the criticality of their reliable performance. Switch mode power supplies (SMPS) provide significant advantages to users in terms of conversion efficiency, weight, and size. According to Industry Analysts, over $7.7 Billion of SMPS Power Systems were produced worldwide in 2002. However, SMPS's have unique reliability issues when used within a system due to size constraints, heat dissipation and varying load conditions.

Plastic and Reconstructive Surgery, Dec 1, 2015

BACKGROUND-Absence of plantar sensation is a critical factor considered in favor of amputation fo... more BACKGROUND-Absence of plantar sensation is a critical factor considered in favor of amputation for patients with lower limb-threatening injuries. This study aims to assess outcomes of limb salvage in a group of patients with severe lower extremity injuries associated with posterior tibial nerve transection. METHODS-We studied eight cases of limb salvage after traumatic injuries with documented tibial nerve laceration managed at Ganga Hospital, India. Functional and health-related quality of life outcomes were assessed. Outcomes from this case series were compared to outcomes of studies from a systematic literature review on salvage of the severely injured lower extremity. RESULTS-Patients in this case series reported mild pain (median score 20 on a 100 scale visual analog scale) with some return of plantar sensation in patients with tibial nerve repairs (median score 2/5). Patients demonstrated a decrease in ankle motion (27.5 degrees plantar flexion, 10 degrees extension) and muscle strength (median heel flexor score 3/5). All patients could ambulate independently. Quality of life and function measured by validated instruments revealed minimal disability. We identified 1,767 articles on lower extremity trauma and 14 articles were systematically reviewed. Relative to the case series, published articles reported similarly diminished ankle motion and muscle strength, with reports of mild pain in select studies. Patient reported outcome instruments found variations in the degree of physical disability based on time from the injury. CONCLUSIONS-Though limited in number, this case series demonstrates the value of limb salvage even for patients with posterior tibial nerve injury.

Indian Journal of Plastic Surgery, May 2, 2023

Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illn... more Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the selfamputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy, to achieve the optimum outcome possible in the replanted hand.

The Journal of Hand Surgery, Nov 1, 2022

Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and prox... more Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation. We discuss relevant technical considerations that indicate that, despite challenges, forequarter replantation can be achieved with success.

Indian Journal of Plastic Surgery, May 1, 2019

Indian Journal of Plastic Surgery, Sep 1, 2017