Naveen Narayan - Academia.edu (original) (raw)

Papers by Naveen Narayan

International Surgery Journal, 2022

Background: Appendicitis being the one the most common cause of right iliac fossa pain that leads... more Background: Appendicitis being the one the most common cause of right iliac fossa pain that leads to emergency abdominal surgery. The existence of non-perforating or non-acute forms of appendicitis is doubted to this day despite clinical, intraoperative, radiological and histo-pathological findings. Appendectomy though being curative, yet the decision on its timing is still controversial especially in non-acute variants of appendicitis.Methods: A retrospective observational study on 200 consecutive cases of suspected appendicitis who underwent appendectomy in department of General surgery, Adichunchangiri Hospital and Research Centre during a period between January 2020 and January 2021. The data was accrued from patient data base retrospectively and analysed.Results: We found in our study that the ultrasonographic findings had a sensitivity of 100% and a specificity of 44.44% as compared to the clinical diagnosis of appendicitis. The histopathological studies revealed chronic infla...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Though there are regional and distant approaches for acquired scalp defect reconstruction, use of... more Though there are regional and distant approaches for acquired scalp defect reconstruction, use of local flaps always have the advantage of retaining the topography of scalp. As in treatment of any other defect the choice of a local flap in scalp wound coverage is dictated by the location, size, and depth of the defect and by the availability of adjacent tissue for reconstruction. The versatile and adaptable triangular hatchet flap with a partial skin and subcutaneous bridged pedicle has great versatility. When used singularly or in pair to cover small and medium sized defects, utilising both rotation and advancement components for its movement, has the benefit of maintaining cosmetic appearance. Double hatchet flaps are used commonly in an opposing manner so as to convert a circular wound to a ‘S’ shaped suture line. In the current case series, with a description of four representative cases, authors have presented a modification of this double hatchet flap in unopposing configurati...

Prune Belly Syndrome (PBS) or Eagle-Barrett Syndrome is a congenital disorder that typically asso... more Prune Belly Syndrome (PBS) or Eagle-Barrett Syndrome is a congenital disorder that typically associates aplasia or hypoplasia of the anterior wall muscles of the abdomen, urinary malformations, and bilateral cryptorchidism. Other malformations such as pulmonary, skeletal, cardiac and gastrointestinal malformations may also be associated. Antenatal diagnosis can be done by echography. We report the case of a 32-year-old patient, referred in our formation at the CHU Hassan II of Fez at 24SA for a severe oligoamnios. Obstetrical ultrasound showed a bilaterally uretral pyelocaliciel dilatation associated with mega-bladder and dilatation of the ureter in a male fetus. An abnormality of the anterior abdominal wall was suspected with an ultrasound appearance suggestive of agenesis of the right muscles of the abdomen. The plum belly syndrome has been suspected. The patient presented a premature delivery at 32SA. Examination of the new born finds a thin, flaccid, wrinkled skin appearance, with empty purses. NN died from respiratory distress 2 hours after delivery. We discussed through this observation the various malformations found in Belly Prune Syndrome, the prenatal and postnatal ultrasound diagnosis, the fate of these children and their therapeutic management.

Vitiligo is a hypopigmentation causing malady of skin occurring in blotches. It is impossible to ... more Vitiligo is a hypopigmentation causing malady of skin occurring in blotches. It is impossible to envisage the extent of skin that can be affected. It has no age, sex or ethnic discrimination, but most develop by the age of 20 and more noticeable in dark skin people. Some acquire sparing white dots while others have white patches affecting larger areas of the skin. It may also affect hair, the inside of the mouth and even the eyes. Most widely accepted to be of autoimmune in nature but is of multifactorial origin. It is commonly associated with other autoimmune disorders affecting thyroid, adrenals and pancreas. Many variants are described depending on the pattern and extent of the skin involved. It is clinically diagnosed sometimes requiring biopsy to differentiate from other hypopigmentation disorders. Currently available treatment options for vitiligo include sunscreens for photosensitive skin, cosmetic cover-up, restoration of normal skin color with use of medical options like PUVA or surgically by autografting, tattooing and depigmentation of normal skin to make an even color. Results of these are not constant with only partial recovery. But the most commonly neglected imperative factor in the treatment of vitiligo is the psychological trauma and fear of social disgrace sustained by the patient. In this case report, we state a rare pattern of vitiligo involving only half of the body and the importance and effect of psychological treatment.

Ovarian cancer accounts for 5% of all cancers among women and causes more deaths than any other f... more Ovarian cancer accounts for 5% of all cancers among women and causes more deaths than any other female genital tract cancer. The majority (85-90%) of ovarian cancers is epithelial in origin and arises typically in postmenopausal patients. An ovarian serous cystadenocarcinoma forms the malignant end of ovarian serous tumours. It is the most common malignant ovarian tumor and is derived from glandular epithelium, in which cystic accumulations of retained secretions are formed. Early diagnosis is often a matter of maintaining high clinical suspicion. Management consists initially of optimal surgical cytoreduction with or without chemotherapy. Appendicitis is a polymicrobial infection of the appendix. Appendectomy for appendicitis is the most commonly performed emergency operation in the world. Elderly patients with appendicitis often pose a more difficult diagnostic problem because of the atypical presentation and expanded differential diagnosis such as a twisted ovarian tumor may erroneously be diagnosed as appendicitis in females. In this paper, we present a case of a 58 yr old female, who presented with features suggestive of acute appendicitis. On examination an abdomino-pelvic mass was revealed. On further investigation, a left ovarian serous cystadenocarcinoma in stage 1 was diagnosed. Laparotomy was done with removal of the left ovarian tumor, contralateral ovary, bilateral fallopian tubes and uterus.

The cystic swellings of scrotum are one among the common surgical problem in all age group. Objec... more The cystic swellings of scrotum are one among the common surgical problem in all age group. Objective of this study is to identify the cause, mode of presentation, various modalities of management and outcome of these with least complications. A total of 50 cases of cystic swellings of scrotum fulfilling the methodology criteria were subjected to preformatted study. Final diagnosis was made with clinical examination and ultrasound. All 50 cases were treated surgically. Most of the patients were in age group of 31-40 years (28%), common presenting feature being scrotal swelling in 60% of cases, majority of them were right sided(64%), most of them presented within a year of development of symptoms. Primary vaginal hydrocele was the commonest cystic swelling (60%), followed by epididymal cyst, sebaceous cyst, haematocoele, pyocoele. Most of the patients were discharged around 8th Post-operative day. All of the cystic swellings were treated surgically with good results.

Journal of Medical Sciences and Health

Context: Nipple areola complex (NAC) is an essential part of breast reconstruction. It functions ... more Context: Nipple areola complex (NAC) is an essential part of breast reconstruction. It functions as an imperative aesthetic unit for the breast. Numerous surgical techniques to the gamut of NAC reconstruction such as skate flap, star flap, Swiss Roll flap, C-V flap, silicone rods, spiral flap made of residual scar tissue and tissue engineering and many others have been added. Despite the availability of surfeit of techniques, a simple reliable method to maintain nipple projection remains obscure. The purpose of this study was to demonstrate the advantages of Skate flap and tattooing in NAC reconstruction. Methods and Material: The NAC reconstruction Skate flap technique involved marking of the flap design on the patient's breast in afore tattooed scar tissue. Dermal flaps were raised with subcutaneous pedicle and closed with inverted dermal absorbable sutures followed by simple interrupted non-absorbable sutures. After this, full thickness skin graft was used to cover the adjacent donor defect to recreate the areola. The newly constructed nipple was guarded using a syringe barrel. This was done to avert compression on the anew nipple. This was left in place for up to 6 weeks. Surgical outcome was evaluated by recording post-operative complications, nipple projection at intervals and surgical revisions, if needed. Callipers were used to record projection of the nipple at the time of surgery and at 1, 3 and 6 months post-operatively. Results: A total of 26 NAC reconstructions in 19 post burn breast patients were performed over duration of 18 months employing Skate flap and tattooing. Mean nipple projection at time of surgery was 6.77 mm and 4.66 mm at end of 6 months follow up. There was a mean net projection loss of 31% at the end of 6 months post-operatively. Overall patient satisfaction on the outcome of reconstruction was generally favourable. No post-operative complications were noted. Conclusion: The study shows that the use of a Skate flap is a safe, easily performed, reliable and reproducible technique for maintaining projection in reconstructed nipples for a long period. Using the burnt scarred tissue helps in achieving excellent projection since contracture is somewhat lessened and also a more aesthetically pleasing nipple reconstruction is achieved matching the surrounding topography.

International Journal of Surgery and Medicine

Highlights on Medicine and Medical Science Vol. 16, 2021

Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genital... more Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genitalia and perineal tissues that can be fatal. Young men are the most typically affected, however it can also affect women and children. The use of broad spectrum antibiotics and surgical intervention with serial wound debridement is the main stay of treatment and critical determinant of prognosis. It's a difficult undertaking to rebuild a soft tissue defect after it's been debrided. The goal of this studyis to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene. Methods: This prospective study included all patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender presenting to our hospital. Age, gender, aetiology, predisposing variables, clinical characteristics, defect location, type of bacterial flora, reconstructive treatment performed, length of hospital stay, post-operative pain, patient ...

Background: Lymphedema is a chronic lymphatic system condition characterised by reduced lymphatic... more Background: Lymphedema is a chronic lymphatic system condition characterised by reduced lymphatic return and swelling of the affected area. Despite the fact that it is a significant cause of morbidity, little is known about the epidemiology and impact of this illness on patients or health systems. Management of lymphedema primarily aims at reducing or halting progression of swelling and to prevent associated infection. The condition is treated with a combination of moisturisers and emollients, compression bandages, isotonic exercise, and regular massage. The idea of stimulating lymphatic drainage with external physical means has a good physiological basis. However, given the lack of proof on relative effectiveness of approaches now available, relying on a single strategy alone is improbable. Objective: The aim of the study was to study lymphedema clinically and institute treatment accordingly and study the outcome of same. Methods: The study comprised 33 patients who presented with ...

International Surgery Journal, 2021

Background: Pancreatitis has been recognized since antiquity. Acute pancreatitis is an acute infl... more Background: Pancreatitis has been recognized since antiquity. Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other tissues or remote organ systems, presenting with variable clinical and systemic manifestations, presenting with mild self-limiting disease to severe life-threatening multi-organ failure.Methods: This was a prospective study of 60 patients, who were admitted with the diagnosis of acute pancreatitis (AP) during the period from December 2017 to June 2019. The data was collected from the all the patients who met the inclusion criteria, and recorded in the proforma prepared for the study.Results: Out of 60 patients 86.7% were male and 13.3% were female. The highest incidence was noted in 40-51 years age group (35%). Alcohol was the most common cause (75% patients). Abdominal pain was the most common mode of presentation (100%), and epigastric tenderness was the most common sign (100%). More than 3-fold elevation of serum amyl...

International Surgery Journal

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consi... more Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (re...

International Surgery Journal

Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physica... more Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physical as well as psychosocial scarring for the patient. It often results in loss of functionality which is usually out of proportion to the percentage of burns. Hence, these burns are classified as major burns. Direct injury to the genitalia can lead to sexual dysfunction. In such circumstances, the treatment plan should comprehensively look into even psychosocial aspects of the patient. Both functional and cosmetic appearance should be the primary concern. With scarcely available burns unit and dedicated hospitals in India to treat burns, patients often develop severe contractures without proper post burns care. Most of the burn patients end up being treated by staff without special training in burn care. A variety of surgical procedures in post burn contractures of groin and perineum have been described all aimed to achieve satisfactory functional and cosmetic outcome. However, advantages ...

International Journal of Surgery and Medicine

International Surgery Journal

Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft ti... more Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft tissue and oral mucosa. Though many opine that with the coming on of free flap surgery, the pedicled flap is an outdated surgical option, the latter still has its uses. Free flaps are criticized as being medically risky, expensive, and time-consuming. Combining both these flaps in a single surgery would bring in the baggage of all negatives along with the benefits of these flaps.Methods: Over a period of 3 years, 13 patients with expected large composite oral defects after ablative surgery for malignancy were included in the study requiring both skin cover and mucosal lining. A one-stage reconstructive procedure employing combination of free and pedicled flaps was used. Data was abstracted pertaining to cancer demography and surgical outcome.Results: The free fibula osteocutaneous flap (FFOCF)- deltopectoral fasciocutaneous flap (DPF) combination was most commonly used (n=5), secondly by f...

International Surgery Journal

Background: Open fractures of leg classified under type IIIB, those requiring free flap cover cou... more Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while...

International Journal of Research in Medical Sciences, 2016

Journal of Health Sciences & Research, 2015

Reconstruction of the post-burn contracture is a complex task in plastic surgery. A burn patient ... more Reconstruction of the post-burn contracture is a complex task in plastic surgery. A burn patient treated traditionally only by dressings develops scar with contracture involving the burned region. The lip is a part of the face that is frequently affected by burn injury. Post-burn scar sequelae in this area often result in cosmetic disfigurement and psychological upset in patients. Microstomia poses difficulty in airway intubation during anesthesia and contracture of the neck if present confounds difficulty. Reconstruction of post-burn oral commissure aims to restore both symmetry of the lips (esthetic) and full oral competence (functional). Frequently treated in our department, we present a case series of post-burn contracture of neck with microstomia whose neck extension and mouth opening both were restricted giving less option but more challenge for both anesthesiologists and plastic surgeons.

The Journal of Medical Sciences, 2015

Breast hypertrophy and sagging of the breast are two different benign disorders of breast that ca... more Breast hypertrophy and sagging of the breast are two different benign disorders of breast that can occur during various stages of women's life from adolescence to menopause. A woman can seek a plastic surgeon for breast reduction for reasons both physical and psychological. Breast reduction surgery or reduction mammoplasty is a plastic surgical procedure by which the sizes of large breasts are reduced. During this procedure, excess skin, fat and breast tissue are removed. The procedure recreates a breast with the desired appearance, contour and volume. Breast lift operation/mastopexy is a procedure where only skin is removed with repositioning of the nipple higher on the chest wall and is the procedure of choice in small but sagging breast. We present a series of five cases, two presenting with virginal hypertrophy, one with gestational hypertrophy and other two with postmenopausal sagging and hypertrophy. Four patients underwent reduction mammoplasty and one patient underwent m...

International Surgery Journal, 2022

Background: Appendicitis being the one the most common cause of right iliac fossa pain that leads... more Background: Appendicitis being the one the most common cause of right iliac fossa pain that leads to emergency abdominal surgery. The existence of non-perforating or non-acute forms of appendicitis is doubted to this day despite clinical, intraoperative, radiological and histo-pathological findings. Appendectomy though being curative, yet the decision on its timing is still controversial especially in non-acute variants of appendicitis.Methods: A retrospective observational study on 200 consecutive cases of suspected appendicitis who underwent appendectomy in department of General surgery, Adichunchangiri Hospital and Research Centre during a period between January 2020 and January 2021. The data was accrued from patient data base retrospectively and analysed.Results: We found in our study that the ultrasonographic findings had a sensitivity of 100% and a specificity of 44.44% as compared to the clinical diagnosis of appendicitis. The histopathological studies revealed chronic infla...

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2021

Though there are regional and distant approaches for acquired scalp defect reconstruction, use of... more Though there are regional and distant approaches for acquired scalp defect reconstruction, use of local flaps always have the advantage of retaining the topography of scalp. As in treatment of any other defect the choice of a local flap in scalp wound coverage is dictated by the location, size, and depth of the defect and by the availability of adjacent tissue for reconstruction. The versatile and adaptable triangular hatchet flap with a partial skin and subcutaneous bridged pedicle has great versatility. When used singularly or in pair to cover small and medium sized defects, utilising both rotation and advancement components for its movement, has the benefit of maintaining cosmetic appearance. Double hatchet flaps are used commonly in an opposing manner so as to convert a circular wound to a ‘S’ shaped suture line. In the current case series, with a description of four representative cases, authors have presented a modification of this double hatchet flap in unopposing configurati...

Prune Belly Syndrome (PBS) or Eagle-Barrett Syndrome is a congenital disorder that typically asso... more Prune Belly Syndrome (PBS) or Eagle-Barrett Syndrome is a congenital disorder that typically associates aplasia or hypoplasia of the anterior wall muscles of the abdomen, urinary malformations, and bilateral cryptorchidism. Other malformations such as pulmonary, skeletal, cardiac and gastrointestinal malformations may also be associated. Antenatal diagnosis can be done by echography. We report the case of a 32-year-old patient, referred in our formation at the CHU Hassan II of Fez at 24SA for a severe oligoamnios. Obstetrical ultrasound showed a bilaterally uretral pyelocaliciel dilatation associated with mega-bladder and dilatation of the ureter in a male fetus. An abnormality of the anterior abdominal wall was suspected with an ultrasound appearance suggestive of agenesis of the right muscles of the abdomen. The plum belly syndrome has been suspected. The patient presented a premature delivery at 32SA. Examination of the new born finds a thin, flaccid, wrinkled skin appearance, with empty purses. NN died from respiratory distress 2 hours after delivery. We discussed through this observation the various malformations found in Belly Prune Syndrome, the prenatal and postnatal ultrasound diagnosis, the fate of these children and their therapeutic management.

Vitiligo is a hypopigmentation causing malady of skin occurring in blotches. It is impossible to ... more Vitiligo is a hypopigmentation causing malady of skin occurring in blotches. It is impossible to envisage the extent of skin that can be affected. It has no age, sex or ethnic discrimination, but most develop by the age of 20 and more noticeable in dark skin people. Some acquire sparing white dots while others have white patches affecting larger areas of the skin. It may also affect hair, the inside of the mouth and even the eyes. Most widely accepted to be of autoimmune in nature but is of multifactorial origin. It is commonly associated with other autoimmune disorders affecting thyroid, adrenals and pancreas. Many variants are described depending on the pattern and extent of the skin involved. It is clinically diagnosed sometimes requiring biopsy to differentiate from other hypopigmentation disorders. Currently available treatment options for vitiligo include sunscreens for photosensitive skin, cosmetic cover-up, restoration of normal skin color with use of medical options like PUVA or surgically by autografting, tattooing and depigmentation of normal skin to make an even color. Results of these are not constant with only partial recovery. But the most commonly neglected imperative factor in the treatment of vitiligo is the psychological trauma and fear of social disgrace sustained by the patient. In this case report, we state a rare pattern of vitiligo involving only half of the body and the importance and effect of psychological treatment.

Ovarian cancer accounts for 5% of all cancers among women and causes more deaths than any other f... more Ovarian cancer accounts for 5% of all cancers among women and causes more deaths than any other female genital tract cancer. The majority (85-90%) of ovarian cancers is epithelial in origin and arises typically in postmenopausal patients. An ovarian serous cystadenocarcinoma forms the malignant end of ovarian serous tumours. It is the most common malignant ovarian tumor and is derived from glandular epithelium, in which cystic accumulations of retained secretions are formed. Early diagnosis is often a matter of maintaining high clinical suspicion. Management consists initially of optimal surgical cytoreduction with or without chemotherapy. Appendicitis is a polymicrobial infection of the appendix. Appendectomy for appendicitis is the most commonly performed emergency operation in the world. Elderly patients with appendicitis often pose a more difficult diagnostic problem because of the atypical presentation and expanded differential diagnosis such as a twisted ovarian tumor may erroneously be diagnosed as appendicitis in females. In this paper, we present a case of a 58 yr old female, who presented with features suggestive of acute appendicitis. On examination an abdomino-pelvic mass was revealed. On further investigation, a left ovarian serous cystadenocarcinoma in stage 1 was diagnosed. Laparotomy was done with removal of the left ovarian tumor, contralateral ovary, bilateral fallopian tubes and uterus.

The cystic swellings of scrotum are one among the common surgical problem in all age group. Objec... more The cystic swellings of scrotum are one among the common surgical problem in all age group. Objective of this study is to identify the cause, mode of presentation, various modalities of management and outcome of these with least complications. A total of 50 cases of cystic swellings of scrotum fulfilling the methodology criteria were subjected to preformatted study. Final diagnosis was made with clinical examination and ultrasound. All 50 cases were treated surgically. Most of the patients were in age group of 31-40 years (28%), common presenting feature being scrotal swelling in 60% of cases, majority of them were right sided(64%), most of them presented within a year of development of symptoms. Primary vaginal hydrocele was the commonest cystic swelling (60%), followed by epididymal cyst, sebaceous cyst, haematocoele, pyocoele. Most of the patients were discharged around 8th Post-operative day. All of the cystic swellings were treated surgically with good results.

Journal of Medical Sciences and Health

Context: Nipple areola complex (NAC) is an essential part of breast reconstruction. It functions ... more Context: Nipple areola complex (NAC) is an essential part of breast reconstruction. It functions as an imperative aesthetic unit for the breast. Numerous surgical techniques to the gamut of NAC reconstruction such as skate flap, star flap, Swiss Roll flap, C-V flap, silicone rods, spiral flap made of residual scar tissue and tissue engineering and many others have been added. Despite the availability of surfeit of techniques, a simple reliable method to maintain nipple projection remains obscure. The purpose of this study was to demonstrate the advantages of Skate flap and tattooing in NAC reconstruction. Methods and Material: The NAC reconstruction Skate flap technique involved marking of the flap design on the patient's breast in afore tattooed scar tissue. Dermal flaps were raised with subcutaneous pedicle and closed with inverted dermal absorbable sutures followed by simple interrupted non-absorbable sutures. After this, full thickness skin graft was used to cover the adjacent donor defect to recreate the areola. The newly constructed nipple was guarded using a syringe barrel. This was done to avert compression on the anew nipple. This was left in place for up to 6 weeks. Surgical outcome was evaluated by recording post-operative complications, nipple projection at intervals and surgical revisions, if needed. Callipers were used to record projection of the nipple at the time of surgery and at 1, 3 and 6 months post-operatively. Results: A total of 26 NAC reconstructions in 19 post burn breast patients were performed over duration of 18 months employing Skate flap and tattooing. Mean nipple projection at time of surgery was 6.77 mm and 4.66 mm at end of 6 months follow up. There was a mean net projection loss of 31% at the end of 6 months post-operatively. Overall patient satisfaction on the outcome of reconstruction was generally favourable. No post-operative complications were noted. Conclusion: The study shows that the use of a Skate flap is a safe, easily performed, reliable and reproducible technique for maintaining projection in reconstructed nipples for a long period. Using the burnt scarred tissue helps in achieving excellent projection since contracture is somewhat lessened and also a more aesthetically pleasing nipple reconstruction is achieved matching the surrounding topography.

International Journal of Surgery and Medicine

Highlights on Medicine and Medical Science Vol. 16, 2021

Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genital... more Background: Fournier's gangrene is a synergistic necrotizing fascitis of the external genitalia and perineal tissues that can be fatal. Young men are the most typically affected, however it can also affect women and children. The use of broad spectrum antibiotics and surgical intervention with serial wound debridement is the main stay of treatment and critical determinant of prognosis. It's a difficult undertaking to rebuild a soft tissue defect after it's been debrided. The goal of this studyis to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene. Methods: This prospective study included all patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender presenting to our hospital. Age, gender, aetiology, predisposing variables, clinical characteristics, defect location, type of bacterial flora, reconstructive treatment performed, length of hospital stay, post-operative pain, patient ...

Background: Lymphedema is a chronic lymphatic system condition characterised by reduced lymphatic... more Background: Lymphedema is a chronic lymphatic system condition characterised by reduced lymphatic return and swelling of the affected area. Despite the fact that it is a significant cause of morbidity, little is known about the epidemiology and impact of this illness on patients or health systems. Management of lymphedema primarily aims at reducing or halting progression of swelling and to prevent associated infection. The condition is treated with a combination of moisturisers and emollients, compression bandages, isotonic exercise, and regular massage. The idea of stimulating lymphatic drainage with external physical means has a good physiological basis. However, given the lack of proof on relative effectiveness of approaches now available, relying on a single strategy alone is improbable. Objective: The aim of the study was to study lymphedema clinically and institute treatment accordingly and study the outcome of same. Methods: The study comprised 33 patients who presented with ...

International Surgery Journal, 2021

Background: Pancreatitis has been recognized since antiquity. Acute pancreatitis is an acute infl... more Background: Pancreatitis has been recognized since antiquity. Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other tissues or remote organ systems, presenting with variable clinical and systemic manifestations, presenting with mild self-limiting disease to severe life-threatening multi-organ failure.Methods: This was a prospective study of 60 patients, who were admitted with the diagnosis of acute pancreatitis (AP) during the period from December 2017 to June 2019. The data was collected from the all the patients who met the inclusion criteria, and recorded in the proforma prepared for the study.Results: Out of 60 patients 86.7% were male and 13.3% were female. The highest incidence was noted in 40-51 years age group (35%). Alcohol was the most common cause (75% patients). Abdominal pain was the most common mode of presentation (100%), and epigastric tenderness was the most common sign (100%). More than 3-fold elevation of serum amyl...

International Surgery Journal

Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consi... more Background: Appendectomy is the most common abdominal surgery performed today. Appendicitis consists of vast spectrum ranging from acute to chronic to recurrent forms however existence of recurrent and chronic appendicitis is still doubted by many. In spite of various scoring systems and appendectomy being the ultimate treatment, its timing remains still controversial especially in chronic and recurrent variants of appendicitis.Methods: A total of 100 consecutive cases of suspected appendicitis who were admitted investigated and treated at our centre were taken up for this observational study. Data pertaining to clinical, operative and histopathological findings were collected and tabulated. Mean and SD were used for continuous data and for categorical data, frequency and percentages were calculated. A chi-square test was used for categorical data to find statistical significance.Results: Per operatively the appendix appeared non-inflamed in 57% of patients suggestive of chronic (re...

International Surgery Journal

Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physica... more Similar to burns of the face, hands, and feet, groin and perineal burn injuries result in physical as well as psychosocial scarring for the patient. It often results in loss of functionality which is usually out of proportion to the percentage of burns. Hence, these burns are classified as major burns. Direct injury to the genitalia can lead to sexual dysfunction. In such circumstances, the treatment plan should comprehensively look into even psychosocial aspects of the patient. Both functional and cosmetic appearance should be the primary concern. With scarcely available burns unit and dedicated hospitals in India to treat burns, patients often develop severe contractures without proper post burns care. Most of the burn patients end up being treated by staff without special training in burn care. A variety of surgical procedures in post burn contractures of groin and perineum have been described all aimed to achieve satisfactory functional and cosmetic outcome. However, advantages ...

International Journal of Surgery and Medicine

International Surgery Journal

Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft ti... more Background: Extensive composite defects of the oromandibular site involve skin, mandible, soft tissue and oral mucosa. Though many opine that with the coming on of free flap surgery, the pedicled flap is an outdated surgical option, the latter still has its uses. Free flaps are criticized as being medically risky, expensive, and time-consuming. Combining both these flaps in a single surgery would bring in the baggage of all negatives along with the benefits of these flaps.Methods: Over a period of 3 years, 13 patients with expected large composite oral defects after ablative surgery for malignancy were included in the study requiring both skin cover and mucosal lining. A one-stage reconstructive procedure employing combination of free and pedicled flaps was used. Data was abstracted pertaining to cancer demography and surgical outcome.Results: The free fibula osteocutaneous flap (FFOCF)- deltopectoral fasciocutaneous flap (DPF) combination was most commonly used (n=5), secondly by f...

International Surgery Journal

Background: Open fractures of leg classified under type IIIB, those requiring free flap cover cou... more Background: Open fractures of leg classified under type IIIB, those requiring free flap cover could be done as emergency procedure. The ideal timing has still remained controversial. Although it appears imperative to operate early and reduce length of hospital stay, costs, disability adjusted life years and put the patient back on his feet, our study was necessitated in the context of differing views regarding ideal timing of free flap.Methods: The prospective observational study was conducted for duration of 4 years between October 2015 to September 2019. Patients were taken up for free flap cover after optimization for the major surgery. Details of flap complications and the procedures for salvage were noted. At the end of one year following the injury, patient quality of life (PQOL) was tabulated for all patients.Results: Most common mode of injury was road traffic accidents. Early flaps were done in 28 and primary flaps in 22 patients. One patient had partial flap necrosis while...

International Journal of Research in Medical Sciences, 2016

Journal of Health Sciences & Research, 2015

Reconstruction of the post-burn contracture is a complex task in plastic surgery. A burn patient ... more Reconstruction of the post-burn contracture is a complex task in plastic surgery. A burn patient treated traditionally only by dressings develops scar with contracture involving the burned region. The lip is a part of the face that is frequently affected by burn injury. Post-burn scar sequelae in this area often result in cosmetic disfigurement and psychological upset in patients. Microstomia poses difficulty in airway intubation during anesthesia and contracture of the neck if present confounds difficulty. Reconstruction of post-burn oral commissure aims to restore both symmetry of the lips (esthetic) and full oral competence (functional). Frequently treated in our department, we present a case series of post-burn contracture of neck with microstomia whose neck extension and mouth opening both were restricted giving less option but more challenge for both anesthesiologists and plastic surgeons.

The Journal of Medical Sciences, 2015

Breast hypertrophy and sagging of the breast are two different benign disorders of breast that ca... more Breast hypertrophy and sagging of the breast are two different benign disorders of breast that can occur during various stages of women's life from adolescence to menopause. A woman can seek a plastic surgeon for breast reduction for reasons both physical and psychological. Breast reduction surgery or reduction mammoplasty is a plastic surgical procedure by which the sizes of large breasts are reduced. During this procedure, excess skin, fat and breast tissue are removed. The procedure recreates a breast with the desired appearance, contour and volume. Breast lift operation/mastopexy is a procedure where only skin is removed with repositioning of the nipple higher on the chest wall and is the procedure of choice in small but sagging breast. We present a series of five cases, two presenting with virginal hypertrophy, one with gestational hypertrophy and other two with postmenopausal sagging and hypertrophy. Four patients underwent reduction mammoplasty and one patient underwent m...