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Papers by Rajendra Nehete

Introduction Hand amputation at the wrist level is severely disabling, especially when bilateral.... more Introduction Hand amputation at the wrist level is severely disabling, especially when
bilateral. It is paramount to restore the hand function to the best possible level for the
patient’s daily living activities, as well as optimal social and occupational rehabilitation.
There are various options for restoration of function after amputation at wrist and
distal forearm levels including Krukenberg’s operation, variations of toe transfers, hand
allotransplantation, and prosthesis. Krukenberg’s procedure and the reconstruction
using toe transfer like Vilkki’s procedure or two-toe transfers, restore only the pinch.
Hand allotransplantation, although it gives excellent function, has limitations due to
the complications of immunosuppression. Functional hand prosthesis, though superior
in cosmetic appearance, have again limitations in function, and the cost is prohibitive
for most patients in our country.
Materials and Methods We present the unique case of a bilateral hand amputation at
the wrist level reconstructed with three toes and free anterolateral thigh (ALT) flap in a
single-stage surgery for each hand. In two stages, the patient had six toes transferred to
both hands.
Result All transferred toes and all three free (two ALT and one thoracodorsal artery
perforator) flaps survived completely. Three-finger grip (tripod pinch) was thus
restored in each hand. The hook grip was also restored well by the reconstructed
two fingers. Within 3 months after surgery, the patient could perform all activities of
daily living. He resumed his original job with some modification of his work within
6 months postinjury.
Conclusion Hand reconstruction using three toes and a free flap is an excellent option
for functional restoration for amputation at the wrist and distal forearm level. It allows
an early return to function and good social and professional integration of the patient.
This procedure is a potential alternative to expensive prosthesis and allotransplantation
for a bilateral hand amputation.

Indian Journal of Plastic Surgery, 2012

ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt sh... more ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

Hand Clinics, 2016

Poiseuille's law predicts the stationary flows of fluids between two solid surfaces. Here we use ... more Poiseuille's law predicts the stationary flows of fluids between two solid surfaces. Here we use an approximate treatment to predict the velocity fields at the flow front when a fluid is introduced to the space between solid surfaces. Our theory predicts that the velocity of fluids in the flowing direction decreases, while the velocity in the perpendicular direction increases, as one moves from the bulk to the free surface. This theory predicts an analytical expression of the traveling time, destination, and trajectory of fluid particles that flow through the flow front region and these may be accessible by quantitative measurements. Our theory may be useful to treat the dynamics of soft matters that fill the space between solid surfaces.

Journal of Reconstructive Microsurgery, 2014

Indian Journal of Plastic Surgery, 2012

ABSTRACTSoft tissue chondroma of palate is very rare. It has never been reported in a cleft palat... more ABSTRACTSoft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence after 2 years of follow-up.

Tropical Doctor, 2018

This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new mod... more This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck’s fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.

Plastic and Reconstructive Surgery, 1997

Introduction Hand amputation at the wrist level is severely disabling, especially when bilateral.... more Introduction Hand amputation at the wrist level is severely disabling, especially when
bilateral. It is paramount to restore the hand function to the best possible level for the
patient’s daily living activities, as well as optimal social and occupational rehabilitation.
There are various options for restoration of function after amputation at wrist and
distal forearm levels including Krukenberg’s operation, variations of toe transfers, hand
allotransplantation, and prosthesis. Krukenberg’s procedure and the reconstruction
using toe transfer like Vilkki’s procedure or two-toe transfers, restore only the pinch.
Hand allotransplantation, although it gives excellent function, has limitations due to
the complications of immunosuppression. Functional hand prosthesis, though superior
in cosmetic appearance, have again limitations in function, and the cost is prohibitive
for most patients in our country.
Materials and Methods We present the unique case of a bilateral hand amputation at
the wrist level reconstructed with three toes and free anterolateral thigh (ALT) flap in a
single-stage surgery for each hand. In two stages, the patient had six toes transferred to
both hands.
Result All transferred toes and all three free (two ALT and one thoracodorsal artery
perforator) flaps survived completely. Three-finger grip (tripod pinch) was thus
restored in each hand. The hook grip was also restored well by the reconstructed
two fingers. Within 3 months after surgery, the patient could perform all activities of
daily living. He resumed his original job with some modification of his work within
6 months postinjury.
Conclusion Hand reconstruction using three toes and a free flap is an excellent option
for functional restoration for amputation at the wrist and distal forearm level. It allows
an early return to function and good social and professional integration of the patient.
This procedure is a potential alternative to expensive prosthesis and allotransplantation
for a bilateral hand amputation.

Indian Journal of Plastic Surgery, 2012

ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt sh... more ABSTRACTIn bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

Hand Clinics, 2016

Poiseuille's law predicts the stationary flows of fluids between two solid surfaces. Here we use ... more Poiseuille's law predicts the stationary flows of fluids between two solid surfaces. Here we use an approximate treatment to predict the velocity fields at the flow front when a fluid is introduced to the space between solid surfaces. Our theory predicts that the velocity of fluids in the flowing direction decreases, while the velocity in the perpendicular direction increases, as one moves from the bulk to the free surface. This theory predicts an analytical expression of the traveling time, destination, and trajectory of fluid particles that flow through the flow front region and these may be accessible by quantitative measurements. Our theory may be useful to treat the dynamics of soft matters that fill the space between solid surfaces.

Journal of Reconstructive Microsurgery, 2014

Indian Journal of Plastic Surgery, 2012

ABSTRACTSoft tissue chondroma of palate is very rare. It has never been reported in a cleft palat... more ABSTRACTSoft tissue chondroma of palate is very rare. It has never been reported in a cleft palate patient. We report a case of 22-year-old male who came with asymptomatic swelling on the palate since birth, along with complete cleft of secondary palate. He had symptoms related to cleft palate only, i.e., nasal regurgitation and speech abnormalities. Swelling was excised and the cleft palate was repaired. Histopathological examination revealed chondroma of the palate. The patient had no recurrence after 2 years of follow-up.

Tropical Doctor, 2018

This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new mod... more This case series of 51 patients (age range = 11–17 years; 30-month follow-up) describes a new modified approach to treatment of distal and mid-penile hypospadias that has fewer complications. The meatal locations were sub-coronal (51%), coronal (45%) and mid-penile (4%). Forty patients had chordee. Urethra with the corpus spongiosum was dissected off the corpus cavernosum up to the peno-scrotal junction. The distal 5 mm stenotic and avascular part of the urethral tube was excised. The elastic urethra was then stretched and sutured to form a neo-meatus. The urethra was anchored to the Buck’s fascia at the glandular, sub-coronal and mid-penile levels. Meatal regression in one patient (2%), subcutaneous hematomas in two patients (4%) and wound dehiscence in two patients (4%) were the complications in the immediate postoperative period. None developed fistula, meatal stenosis or residual chordee in the 30-month follow-up.

Plastic and Reconstructive Surgery, 1997