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Papers by Raja Tiwari
Journal of reconstructive microsurgery open, 2024
Microvascular reconstruction in the form of replantation has been life-changing. With refinements... more Microvascular reconstruction in the form of replantation has been life-changing. With refinements and the addition of newer techniques, the indications of replantation have been broadened. One such technique is ectopic tissue banking of amputated parts. 1 The indications are segmental injuries with extensively damaged or badly contaminated proximal parts, while the distal part is comparatively undamaged. Crush injury with loss of extensive soft tissues precludes replantation of the
Archives of Plastic Surgery, Feb 1, 2023
Indian Journal of Plastic Surgery, 2022
Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Pr... more Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 mo...
Journal of Plastic Surgery and Hand Surgery
Indian Journal of Surgery
BMJ Case Reports
Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cav... more Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cavity in order to abolish and avoid the complications associated with this dead space. Although effective in achieving this, the procedure is crippled by poor cosmetic appearance and functional outcome. We report a case of recalcitrant complex chest wall defect with a large cavity, marred by visible heart and poor availability of local muscles, that was successfully managed by a novel technique of thoracoplasty with acceptable postoperative appearance and function.
Heart Asia
ObjectiveExposure of implantable electrical devices may increase morbidity and mortality signific... more ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.MethodsThree patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infecti...
Oral and Maxillofacial Surgery Cases
Annals of Plastic Surgery
Journal of Plastic Reconstructive & Aesthetic Surgery
There is a consensus about the occurrence of otitis media in children with cleft palate before re... more There is a consensus about the occurrence of otitis media in children with cleft palate before repair. However, controversy continues regarding the recovery of Eustachian tube function and level of hearing loss in the patients after cleft palate repair. Levator sling palatoplasty is an important component of the cleft repair. Most surgeons would routinely transect the tensor tendon (tensor tenotomy) during the course of palatoplasty. However, this procedure may pose a risk to Eustachian tube function. Some authorities feel that addition of tensor tenopexy during palatoplasty would maintain the Eustachian tube in an open conformation, thereby improving middle ear ventilation. The present study assesses the effectiveness of tensor tenopexy in improving Eustachian tube function and preventing hearing loss in cleft palate patients treated with palatoplasty. A prospective randomised controlled trial was conducted in the Department of Plastic Surgery at a tertiary care institute in India....
Journal of reconstructive microsurgery open, 2024
Microvascular reconstruction in the form of replantation has been life-changing. With refinements... more Microvascular reconstruction in the form of replantation has been life-changing. With refinements and the addition of newer techniques, the indications of replantation have been broadened. One such technique is ectopic tissue banking of amputated parts. 1 The indications are segmental injuries with extensively damaged or badly contaminated proximal parts, while the distal part is comparatively undamaged. Crush injury with loss of extensive soft tissues precludes replantation of the
Archives of Plastic Surgery, Feb 1, 2023
Indian Journal of Plastic Surgery, 2022
Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Pr... more Separation of total vertical craniopagus with shared venous sinuses poses multiple challenges. Provision of soft-tissue cover to the exposed brains at the time of total separation is one of them, due to the large size of the defect and paucity of local tissues. Staged separation of twins is advised with partial venous and parenchymal disconnection in the first stage and total separation in the second stage. Tissue expanders are inserted in the first stage, and second stage planned to coincide with the period of adequate expansion. In the child being reported, emergency second stage was done due to the deteriorating general condition of the children. Left with inadequate expanded skin, the critical defect in a twin was managed with bilateral trapezius myocutaneous flaps. High ionotropic support of the postoperative period resulted in superficial necrosis of the flap, which was managed by debridement, allograft application and autograft later. Both twins had well-healed wounds by 3 mo...
Journal of Plastic Surgery and Hand Surgery
Indian Journal of Surgery
BMJ Case Reports
Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cav... more Thoracoplasty is a procedure to collapse the chest wall over a residual space in the thoracic cavity in order to abolish and avoid the complications associated with this dead space. Although effective in achieving this, the procedure is crippled by poor cosmetic appearance and functional outcome. We report a case of recalcitrant complex chest wall defect with a large cavity, marred by visible heart and poor availability of local muscles, that was successfully managed by a novel technique of thoracoplasty with acceptable postoperative appearance and function.
Heart Asia
ObjectiveExposure of implantable electrical devices may increase morbidity and mortality signific... more ObjectiveExposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.MethodsThree patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infecti...
Oral and Maxillofacial Surgery Cases
Annals of Plastic Surgery
Journal of Plastic Reconstructive & Aesthetic Surgery
There is a consensus about the occurrence of otitis media in children with cleft palate before re... more There is a consensus about the occurrence of otitis media in children with cleft palate before repair. However, controversy continues regarding the recovery of Eustachian tube function and level of hearing loss in the patients after cleft palate repair. Levator sling palatoplasty is an important component of the cleft repair. Most surgeons would routinely transect the tensor tendon (tensor tenotomy) during the course of palatoplasty. However, this procedure may pose a risk to Eustachian tube function. Some authorities feel that addition of tensor tenopexy during palatoplasty would maintain the Eustachian tube in an open conformation, thereby improving middle ear ventilation. The present study assesses the effectiveness of tensor tenopexy in improving Eustachian tube function and preventing hearing loss in cleft palate patients treated with palatoplasty. A prospective randomised controlled trial was conducted in the Department of Plastic Surgery at a tertiary care institute in India....