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Papers by Ramasamy Kalimuthu

Research paper thumbnail of Abstract

Plastic and Reconstructive Surgery - Global Open, 2016

Research paper thumbnail of Joint Flaps for Nasal Tip and Alar Reconstruction: P39

Plast Reconstr Surg, 2005

Research paper thumbnail of A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions

Plastic and Reconstructive Surgery, Feb 1, 2010

Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in soph... more Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in sophistication to become the procedure of choice for many reconstructive surgeons treating postmastectomy patients. The modification of the immediate two-stage reconstruction using AlloDerm (Lifecell, Branchburg, N.J.) to create complete coverage of the tissue expander further enhanced this already reliable and effective approach. When used in this fashion, AlloDerm provides inferior pole coverage of a subpectorally placed tissue expander, allows higher initial fill volume, improves definition of inframammary fold, and results in less postoperative pain.1 AlloDerm has also been used in nipple reconstruction to tackle the challenge of projection loss over time. Although experience on nipple reconstruction with AlloDerm is limited, preliminary results are encouraging.2,3 The cost of AlloDerm can be prohibitive, especially when it is used in both breast and nipple reconstruction. For breast reconstruction, it costs 2100to2100 to 2100to3400 per breast, depending on the size selected. For nipple reconstruction, an additional 480to480 to 480to1500 is needed. Despite the Women’s Health and Cancer Rights Act of 1998, U.S. health insurance companies do not provide consistent coverage for the cost of AlloDerm in breast reconstruction, and at the time of writing of this article, none covers the cost of AlloDerm in nipple reconstruction. We describe a novel cost-saving approach that obviates the cost of AlloDerm in nipple reconstruction when the AlloDerm has already been used in the breast reconstruction.

Research paper thumbnail of Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature

HAND, 2006

Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, t... more Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including “pocket procedures” to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful “arterialization” of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple,...

Research paper thumbnail of Single-Stage Immediate Breast Reconstruction after Skin-Sparing Mastectomy

Plastic and Reconstructive Surgery, 2008

Research paper thumbnail of Anatomy of the Breast, Axilla, and Chest Wall

Research paper thumbnail of Joint Flaps for Nasal Tip and Alar Reconstruction

Plastic and Reconstructive Surgery, 2005

Research paper thumbnail of Posterior Rectal Hernia after Vacuum-Assisted Closure Treatment of Sacral Pressure Ulcer

Plastic and Reconstructive Surgery, 2008

Research paper thumbnail of Salvaging Exposed Left Ventricular Assist Devices

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Medial Thigh Fasciocutaneous Flaps for Reconstruction of the Scrotum following Fournier Gangrene

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Salvaging Difficult Chest and Epigastric Defects with the Intercostal Artery Perforator Flap

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Lip replantation: A viable option for lower lip reconstruction after human bites, a literature review and proposed management algorithm

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012

Research paper thumbnail of Mantle Design

Journal of Craniofacial Surgery, 2012

We present a unique case of orbital floor and wall reconstruction after complete destruction by a... more We present a unique case of orbital floor and wall reconstruction after complete destruction by a self-inflicted gunshot wound. The complex comminuted fracture was repaired using a composite construct design (the mantle design) that was fixed in place using mini plates and screws. The designed composite graft was shaped exactly to fit the area of the orbital floor and maxilla to create stability and support for the globe.The orbital floor and maxilla were repaired using this special design, which was created based on the basic physical principles of mantle constructs that have been known for many years to be strong, durable, and stable. After surgery, radiologic evaluation revealed excellent placement of our construct. This particular reconstruction method may be used in patients with severe orbital bony destruction with no surrounding stable bony support elements, which are required to reconstruct the orbital floor in patients with trauma using either an autologous or a biologic implant.

Research paper thumbnail of A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach

British journal of plastic …, 1985

Research paper thumbnail of A Novel Cost-Saving Approach to the Use of Acellular Dermal Matrix (AlloDerm) in Postmastectomy Breast and Nipple Reconstructions

Plastic and Reconstructive Surgery, 2010

Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in soph... more Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in sophistication to become the procedure of choice for many reconstructive surgeons treating postmastectomy patients. The modification of the immediate two-stage reconstruction using AlloDerm (Lifecell, Branchburg, N.J.) to create complete coverage of the tissue expander further enhanced this already reliable and effective approach. When used in this fashion, AlloDerm provides inferior pole coverage of a subpectorally placed tissue expander, allows higher initial fill volume, improves definition of inframammary fold, and results in less postoperative pain.1 AlloDerm has also been used in nipple reconstruction to tackle the challenge of projection loss over time. Although experience on nipple reconstruction with AlloDerm is limited, preliminary results are encouraging.2,3 The cost of AlloDerm can be prohibitive, especially when it is used in both breast and nipple reconstruction. For breast reconstruction, it costs 2100to2100 to 2100to3400 per breast, depending on the size selected. For nipple reconstruction, an additional 480to480 to 480to1500 is needed. Despite the Women’s Health and Cancer Rights Act of 1998, U.S. health insurance companies do not provide consistent coverage for the cost of AlloDerm in breast reconstruction, and at the time of writing of this article, none covers the cost of AlloDerm in nipple reconstruction. We describe a novel cost-saving approach that obviates the cost of AlloDerm in nipple reconstruction when the AlloDerm has already been used in the breast reconstruction.

Research paper thumbnail of Earlobe repair: a new technique

Plastic and reconstructive …, 1984

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... An abstract is unavailable. This article is ...

Research paper thumbnail of Microsurgical replantation of the lip: a multi-institutional experience

Plastic and …, 1998

Traumatic amputation of the lip is a rare yet devastating event affecting both form and function.... more Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective review of 13 lip replantations performed in 12 institutions utilizing a form database and clinical and photographic analysis. Lip replantation was successful in all 13 patients; partial flap loss occurred in one patient owing to iatrogenic injury. Follow-up averaged 3.1 years. Average patient age at the time of injury was 21.1 years. There were six male and seven female patients. Injuries in two patients were the result of a human bite, the remaining injuries resulted from dog bites. One patient had significant associated injuries. Average length of hospital stay was 11.9 days. Ten patients suffered amputations of the upper lip, and three suffered amputations of the lower lip. Average defect size was 10.6 cm2. Operative time averaged 5.7 hours (range 2.5 to 12 hours). Warm ischemia time averaged 2.9 hours, and cold ischemia time averaged 2.7 hours. Donor and recipient veins were often scarce; all patients had at least one arterial anastomosis, whereas no vein was available in 7 of 13 patients; vein grafts were required in one patient. Leech therapy was employed in 11 of 13 patients. Anticoagulant therapy was administered in the majority of patients. Systemic heparin was utilized in 10 of 13 patients, low molecular weight dextran was used in 7 of 13 patients, and aspirin was given to 7 of 13 patients. One bleeding complication was incurred. An average of 6.2 units of packed red blood cells was administered to 12 of 13 patients (adjusted to 250 cc/unit). Antispasmodic therapy was employed in six of eight patients intraoperatively and in two of eight patients postoperatively. Intraoperative complications included difficulty identifying veins in 7 of 13 patients, arterial spasm in 1 of 13 patients, and vessel diameter < 0.5 mm in 4 patients. Postoperatively, one patient suffered vein thrombosis requiring anastomotic revision. Broad spectrum antibiotics were administered to all patients, and there were no infections. Nearly one-third (4 of 13) patients suffered prolonged edema lasting > 4 months. Color match of the replanted lip segment was rated excellent in all cases. Hypertrophic scarring occurred in 6 of 13 patients. A total of 12 revision procedures was performed in six patients. Interestingly, leech therapy resulted in permanent visible scarring as a result of the leech bite in 6 of 11 patients treated. Ten patients demonstrated active orbicularis muscle contraction in the replanted lip segment. Stomal continence was present in all lips. Sensibility return in the replanted lip segment was quite good with 12 of 13 patients demonstrating at least protective moving two-point sensibility (> or = 10 mm). Partial replant necrosis in one patient resulted in significant scar and contraction that compromised the aesthetic appearance. Overall, however, all patients were uniformly pleased with their final results. This clinical study is one of the largest of its kind on lip replantation. Although this represents a multi-institutional experience, the data are remarkably consistent. Re-establishment of venous outflow seems to be the most problematic technical challenge. By incorporating the adjuncts of anticoagulation, leech therapy, and antispasmodics, a successful outcome can be expected despite the paucity of vessels and small vessel size. The risks of blood transfusion, lengthy operative time, and hospital stay must be weighed against the functional benefits.

Research paper thumbnail of Sternomastalis

Annals of Plastic Surgery, 2006

Research paper thumbnail of Abstract

Plastic and Reconstructive Surgery - Global Open, 2016

Research paper thumbnail of Joint Flaps for Nasal Tip and Alar Reconstruction: P39

Plast Reconstr Surg, 2005

Research paper thumbnail of A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions

Plastic and Reconstructive Surgery, Feb 1, 2010

Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in soph... more Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in sophistication to become the procedure of choice for many reconstructive surgeons treating postmastectomy patients. The modification of the immediate two-stage reconstruction using AlloDerm (Lifecell, Branchburg, N.J.) to create complete coverage of the tissue expander further enhanced this already reliable and effective approach. When used in this fashion, AlloDerm provides inferior pole coverage of a subpectorally placed tissue expander, allows higher initial fill volume, improves definition of inframammary fold, and results in less postoperative pain.1 AlloDerm has also been used in nipple reconstruction to tackle the challenge of projection loss over time. Although experience on nipple reconstruction with AlloDerm is limited, preliminary results are encouraging.2,3 The cost of AlloDerm can be prohibitive, especially when it is used in both breast and nipple reconstruction. For breast reconstruction, it costs 2100to2100 to 2100to3400 per breast, depending on the size selected. For nipple reconstruction, an additional 480to480 to 480to1500 is needed. Despite the Women’s Health and Cancer Rights Act of 1998, U.S. health insurance companies do not provide consistent coverage for the cost of AlloDerm in breast reconstruction, and at the time of writing of this article, none covers the cost of AlloDerm in nipple reconstruction. We describe a novel cost-saving approach that obviates the cost of AlloDerm in nipple reconstruction when the AlloDerm has already been used in the breast reconstruction.

Research paper thumbnail of Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature

HAND, 2006

Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, t... more Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including “pocket procedures” to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful “arterialization” of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple,...

Research paper thumbnail of Single-Stage Immediate Breast Reconstruction after Skin-Sparing Mastectomy

Plastic and Reconstructive Surgery, 2008

Research paper thumbnail of Anatomy of the Breast, Axilla, and Chest Wall

Research paper thumbnail of Joint Flaps for Nasal Tip and Alar Reconstruction

Plastic and Reconstructive Surgery, 2005

Research paper thumbnail of Posterior Rectal Hernia after Vacuum-Assisted Closure Treatment of Sacral Pressure Ulcer

Plastic and Reconstructive Surgery, 2008

Research paper thumbnail of Salvaging Exposed Left Ventricular Assist Devices

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Medial Thigh Fasciocutaneous Flaps for Reconstruction of the Scrotum following Fournier Gangrene

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Salvaging Difficult Chest and Epigastric Defects with the Intercostal Artery Perforator Flap

Plastic and Reconstructive Surgery, 2010

Research paper thumbnail of Lip replantation: A viable option for lower lip reconstruction after human bites, a literature review and proposed management algorithm

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2012

Research paper thumbnail of Mantle Design

Journal of Craniofacial Surgery, 2012

We present a unique case of orbital floor and wall reconstruction after complete destruction by a... more We present a unique case of orbital floor and wall reconstruction after complete destruction by a self-inflicted gunshot wound. The complex comminuted fracture was repaired using a composite construct design (the mantle design) that was fixed in place using mini plates and screws. The designed composite graft was shaped exactly to fit the area of the orbital floor and maxilla to create stability and support for the globe.The orbital floor and maxilla were repaired using this special design, which was created based on the basic physical principles of mantle constructs that have been known for many years to be strong, durable, and stable. After surgery, radiologic evaluation revealed excellent placement of our construct. This particular reconstruction method may be used in patients with severe orbital bony destruction with no surrounding stable bony support elements, which are required to reconstruct the orbital floor in patients with trauma using either an autologous or a biologic implant.

Research paper thumbnail of A retrospective study of treatment of orbital floor fractures with the maxillary sinus approach

British journal of plastic …, 1985

Research paper thumbnail of A Novel Cost-Saving Approach to the Use of Acellular Dermal Matrix (AlloDerm) in Postmastectomy Breast and Nipple Reconstructions

Plastic and Reconstructive Surgery, 2010

Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in soph... more Immediate two-stage breast reconstruction using a tissue expander and implant has evolved in sophistication to become the procedure of choice for many reconstructive surgeons treating postmastectomy patients. The modification of the immediate two-stage reconstruction using AlloDerm (Lifecell, Branchburg, N.J.) to create complete coverage of the tissue expander further enhanced this already reliable and effective approach. When used in this fashion, AlloDerm provides inferior pole coverage of a subpectorally placed tissue expander, allows higher initial fill volume, improves definition of inframammary fold, and results in less postoperative pain.1 AlloDerm has also been used in nipple reconstruction to tackle the challenge of projection loss over time. Although experience on nipple reconstruction with AlloDerm is limited, preliminary results are encouraging.2,3 The cost of AlloDerm can be prohibitive, especially when it is used in both breast and nipple reconstruction. For breast reconstruction, it costs 2100to2100 to 2100to3400 per breast, depending on the size selected. For nipple reconstruction, an additional 480to480 to 480to1500 is needed. Despite the Women’s Health and Cancer Rights Act of 1998, U.S. health insurance companies do not provide consistent coverage for the cost of AlloDerm in breast reconstruction, and at the time of writing of this article, none covers the cost of AlloDerm in nipple reconstruction. We describe a novel cost-saving approach that obviates the cost of AlloDerm in nipple reconstruction when the AlloDerm has already been used in the breast reconstruction.

Research paper thumbnail of Earlobe repair: a new technique

Plastic and reconstructive …, 1984

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... An abstract is unavailable. This article is ...

Research paper thumbnail of Microsurgical replantation of the lip: a multi-institutional experience

Plastic and …, 1998

Traumatic amputation of the lip is a rare yet devastating event affecting both form and function.... more Traumatic amputation of the lip is a rare yet devastating event affecting both form and function. Considering the available methods for reconstruction, replantation may offer a reasonable solution. We sought to characterize the variables associated with lip replantation and to assess the outcome in a retrospective review of 13 lip replantations performed in 12 institutions utilizing a form database and clinical and photographic analysis. Lip replantation was successful in all 13 patients; partial flap loss occurred in one patient owing to iatrogenic injury. Follow-up averaged 3.1 years. Average patient age at the time of injury was 21.1 years. There were six male and seven female patients. Injuries in two patients were the result of a human bite, the remaining injuries resulted from dog bites. One patient had significant associated injuries. Average length of hospital stay was 11.9 days. Ten patients suffered amputations of the upper lip, and three suffered amputations of the lower lip. Average defect size was 10.6 cm2. Operative time averaged 5.7 hours (range 2.5 to 12 hours). Warm ischemia time averaged 2.9 hours, and cold ischemia time averaged 2.7 hours. Donor and recipient veins were often scarce; all patients had at least one arterial anastomosis, whereas no vein was available in 7 of 13 patients; vein grafts were required in one patient. Leech therapy was employed in 11 of 13 patients. Anticoagulant therapy was administered in the majority of patients. Systemic heparin was utilized in 10 of 13 patients, low molecular weight dextran was used in 7 of 13 patients, and aspirin was given to 7 of 13 patients. One bleeding complication was incurred. An average of 6.2 units of packed red blood cells was administered to 12 of 13 patients (adjusted to 250 cc/unit). Antispasmodic therapy was employed in six of eight patients intraoperatively and in two of eight patients postoperatively. Intraoperative complications included difficulty identifying veins in 7 of 13 patients, arterial spasm in 1 of 13 patients, and vessel diameter < 0.5 mm in 4 patients. Postoperatively, one patient suffered vein thrombosis requiring anastomotic revision. Broad spectrum antibiotics were administered to all patients, and there were no infections. Nearly one-third (4 of 13) patients suffered prolonged edema lasting > 4 months. Color match of the replanted lip segment was rated excellent in all cases. Hypertrophic scarring occurred in 6 of 13 patients. A total of 12 revision procedures was performed in six patients. Interestingly, leech therapy resulted in permanent visible scarring as a result of the leech bite in 6 of 11 patients treated. Ten patients demonstrated active orbicularis muscle contraction in the replanted lip segment. Stomal continence was present in all lips. Sensibility return in the replanted lip segment was quite good with 12 of 13 patients demonstrating at least protective moving two-point sensibility (> or = 10 mm). Partial replant necrosis in one patient resulted in significant scar and contraction that compromised the aesthetic appearance. Overall, however, all patients were uniformly pleased with their final results. This clinical study is one of the largest of its kind on lip replantation. Although this represents a multi-institutional experience, the data are remarkably consistent. Re-establishment of venous outflow seems to be the most problematic technical challenge. By incorporating the adjuncts of anticoagulation, leech therapy, and antispasmodics, a successful outcome can be expected despite the paucity of vessels and small vessel size. The risks of blood transfusion, lengthy operative time, and hospital stay must be weighed against the functional benefits.

Research paper thumbnail of Sternomastalis

Annals of Plastic Surgery, 2006