Vipul Nanda - Academia.edu (original) (raw)
Papers by Vipul Nanda
The Journal of Bone and Joint Surgery American Volume, May 1, 2000
Recent interest in reconstruction of the upper limb following brachial plexus injuries has focuse... more Recent interest in reconstruction of the upper limb following brachial plexus injuries has focused on the restoration of prehension following complete avulsion of the brachial plexus. Double free muscle transfer was performed in patients who had complete avulsion of the brachial plexus. After initial exploration of the brachial plexus and (if possible) repair of the fifth cervical nerve root, the first free muscle, used to restore elbow flexion and finger extension, is transferred and reinnervated by the spinal accessory nerve. The second free muscle, transferred to restore finger flexion, is reinnervated by the fifth and sixth intercostal nerves. The motor branch of the triceps brachii is reinnervated by the third and fourth intercostal nerves to restore elbow extension. Hand sensibility is restored by suturing of the sensory rami of the intercostal nerves to the median nerve or the ulnar nerve component of the medial cord. Secondary reconstructive procedures, such as arthrodesis of the carpometacarpal joint of the thumb, shoulder arthrodesis, and tenolysis of the transferred muscle and the distal tendons, may be required to improve the functional outcome. The early results were evaluated in thirty-two patients who had had reconstruction with use of the double free muscle procedure. Twenty-six of these patients were followed for at least twenty-four months (mean duration, thirty-nine months) after the second free muscle transfer, and they were assessed with regard to the long-term outcome as well. Satisfactory (excellent or good) elbow flexion was restored in twenty-five (96 percent) of the twenty-six patients and satisfactory prehension (more than 30 degrees of total active motion of the fingers), in seventeen (65 percent). Fourteen patients (54 percent) could position the hand in space, negating simultaneous flexion of the elbow, while moving the fingers at least 30 degrees and could use the reconstructed hand for activities requiring the use of two hands, such as holding a bottle while opening a cap and lifting a heavy object. The results were analyzed to identify factors affecting the outcome. The double free muscle procedure can provide reliable and useful prehensile function for patients with complete avulsion of the brachial plexus.
Aesthetic Plastic Surgery, 2004
Rhinophyma is the advanced stage of acne rosacea and a source of embarrassment for the patient. S... more Rhinophyma is the advanced stage of acne rosacea and a source of embarrassment for the patient. Secondary localized cutaneous amyloidosis complicating rhinophyma is not reported in the literature. A patient with rhinophyma was treated by excision and primary closure. The histologic examination showed amyloidosis.
Aesthetic Plastic Surgery, 2006
The development of linear hypopigmentation after intralesional or intraarticular injection of tri... more The development of linear hypopigmentation after intralesional or intraarticular injection of triamcinolone acetonide has been reported in the literature as a very rare side effect. This case report describes a patient with linear hypopigmentation and discusses the possible pathophysiology. Clinicians involved in the care of hypertrophic scars and keloids need to be aware of this rare side effect so that they can guide their patients appropriately. They need to understand the pathogenesis of this complication better so that it may become avoidable.
Plastic and Reconstructive Surgery, 2006
Oman medical journal, 2009
Severe crush injuries to the upper limb may require a formal amputation with devastating conseque... more Severe crush injuries to the upper limb may require a formal amputation with devastating consequences to the patient. We report a patient with a near total amputation at the level of mid-forearm who underwent revascularization and salvage of his hand. The operative details of this case are described. It is the first time that such a patient has been treated successfully by plastic surgeons and orthopedic surgeons at the Sultan Qaboos Hospital, Salalah. Awareness of the possibility of salvage should be spread among health care personnel as well as the need for immediate attention by a multispeciality team. Literature related to the operative technique, contraindications and long term results is reviewed.
Oman Medical journal, 2011
An amputation of the hand is a devastating injury. It adversely affects the victim&am... more An amputation of the hand is a devastating injury. It adversely affects the victim's ability to earn a livelihood, support a family, and carry out daily activities. It has a great psychological impact. We report a middle aged male with an amputation at the level of the distal forearm who underwent replantation. The operative details of this case are described. Awareness of the possibility of salvage should be spread among healthcare personnel and the need for immediate attention by a multispeciality team is advocated. This report reviews the literature related to the operative technique, contraindications and long term results.
Surgery Today, 1999
Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India ... more Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India of chronic arterial occlusion of the limbs. The current modalities of therapy do not provide adequate relief to a large number of these patients. An omentum autotransplantation to the lower limbs was performed in three patients as a limb salvage procedure. The initial results with up to a year of follow-up are so far encouraging.
Plastic and Reconstructive Surgery, 2006
Plastic and Reconstructive Surgery, 2003
Plastic and Reconstructive Surgery, 2004
The chunni, a long scarf-like garment worn around the neck, is a traditional form of Indian attir... more The chunni, a long scarf-like garment worn around the neck, is a traditional form of Indian attire worn by women along with a loose long shirt and pants (the salwar kameez). It is a 2.25-meter-long and 1.25-meter-wide free cloth usually made of polyester or cotton. Until ...
The Journal of Hand Surgery, 2000
We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft con... more We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft consisted of periosteum, full-thickness cortex, and the underlying cancellous bone and was harvested from the supracondylar region of the femur. The graft was nourished by the articular branch of the descending geniculate artery and vein. Unlike the currently used vascularized bone grafts, this graft can be easily harvested and shaped to accommodate the bone defect of the scaphoid without disturbing its vascularity and can then be transferred with microvascular anastomosis of the nutrient vessels to the radial artery and its venae commitantes. Ten patients with longstanding nonunion of the scaphoid secondary to avascular necrosis, confirmed by radiologic and intraoperative findings, were treated with this vascularized bone graft. Union was achieved in all 10 patients at an average of 12 weeks after surgery. The average follow-up period for all fractures was 3.5 years. The scores for overall outcome, according to the Mayo wrist scoring system, were excellent in 4 patients, good in 4, and fair in 2. Two unsatisfied patients had preoperative signs of early periscaphoid osteoarthrosis. This free vascularized small bone graft from the supracondylar region of the femur is an attractive alternative to the conventional vascularized bone grafting procedures.
The Cleft Palate-Craniofacial Journal, 2005
To study the audiological profile in the cleft population comprising older children and adolescen... more To study the audiological profile in the cleft population comprising older children and adolescents with unrepaired cleft palate and to arrive at a consensus regarding management of otitis media with effusion in this unique group. Tertiary care institute in Chandigarh, Punjab, India. Prospective study based on all patients older than 7 years with unrepaired cleft palate, attending the plastic surgery outpatient department, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India, from January 2001 to December 2002. Patients with submucous cleft were excluded from the study. General characteristics, otoscopic findings, pure tone audiometry, and impedence audiometry of all patients were recorded. Patients' ages ranged from 8 to 18 years, with a mean of 10.5 years. Regarding otological complaints, 86.7% were asymptomatic. Otoscopic findings revealed mild retraction as the most common finding in 50% of the ears. Type B curve was the most common tympanometric finding. The highest and lowest hearing thresholds recorded were 45 db and 15 db, respectively, with a mean of 27.11 db. The audiological profile of this unique group, which neither had undergone palatoplasty nor had received treatment for the ear condition, demonstrates a mild to moderate hearing impairment. This definitely requires treatment, but owing to the lack of a prospective control group, it is difficult to conclude whether these patients are benefited by conservative treatment alone or by an early aggressive surgical treatment for otitis media with effusion (OME).
Anesthesia & Analgesia, 2006
To the Editor: A 23-yr-old female was sched-uled for Le Fort I osteotomy ad-vancement, calvaria b... more To the Editor: A 23-yr-old female was sched-uled for Le Fort I osteotomy ad-vancement, calvaria bone grafting, and rhinoplasty to repair a Class II malocclusion and persistent na-sal deformity. She had undergone maxillo-mandibular fixation 5 yr previously for bilateral Le ...
Aesthet Plast Surg, 1999
Contemporary options for the improvement of depressed scars include scar revision with an ellipti... more Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon's resources when treating scars.
Aesthetic Plastic Surgery, 1999
Contemporary options for the improvement of depressed scars include scar revision with an ellipti... more Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon's resources when treating scars.
Plastic and Reconstructive Surgery, 2005
Primary palatoplasty seeks to restore normal speech with minimum interference in midface growth. ... more Primary palatoplasty seeks to restore normal speech with minimum interference in midface growth. Surgery is often complicated, however, by the occurrence of palatal fistulas or velopharyngeal incompetence. Both result in similar speech disorders but demand different treatment ...
The Journal of Bone and Joint Surgery American Volume, May 1, 2000
Recent interest in reconstruction of the upper limb following brachial plexus injuries has focuse... more Recent interest in reconstruction of the upper limb following brachial plexus injuries has focused on the restoration of prehension following complete avulsion of the brachial plexus. Double free muscle transfer was performed in patients who had complete avulsion of the brachial plexus. After initial exploration of the brachial plexus and (if possible) repair of the fifth cervical nerve root, the first free muscle, used to restore elbow flexion and finger extension, is transferred and reinnervated by the spinal accessory nerve. The second free muscle, transferred to restore finger flexion, is reinnervated by the fifth and sixth intercostal nerves. The motor branch of the triceps brachii is reinnervated by the third and fourth intercostal nerves to restore elbow extension. Hand sensibility is restored by suturing of the sensory rami of the intercostal nerves to the median nerve or the ulnar nerve component of the medial cord. Secondary reconstructive procedures, such as arthrodesis of the carpometacarpal joint of the thumb, shoulder arthrodesis, and tenolysis of the transferred muscle and the distal tendons, may be required to improve the functional outcome. The early results were evaluated in thirty-two patients who had had reconstruction with use of the double free muscle procedure. Twenty-six of these patients were followed for at least twenty-four months (mean duration, thirty-nine months) after the second free muscle transfer, and they were assessed with regard to the long-term outcome as well. Satisfactory (excellent or good) elbow flexion was restored in twenty-five (96 percent) of the twenty-six patients and satisfactory prehension (more than 30 degrees of total active motion of the fingers), in seventeen (65 percent). Fourteen patients (54 percent) could position the hand in space, negating simultaneous flexion of the elbow, while moving the fingers at least 30 degrees and could use the reconstructed hand for activities requiring the use of two hands, such as holding a bottle while opening a cap and lifting a heavy object. The results were analyzed to identify factors affecting the outcome. The double free muscle procedure can provide reliable and useful prehensile function for patients with complete avulsion of the brachial plexus.
Aesthetic Plastic Surgery, 2004
Rhinophyma is the advanced stage of acne rosacea and a source of embarrassment for the patient. S... more Rhinophyma is the advanced stage of acne rosacea and a source of embarrassment for the patient. Secondary localized cutaneous amyloidosis complicating rhinophyma is not reported in the literature. A patient with rhinophyma was treated by excision and primary closure. The histologic examination showed amyloidosis.
Aesthetic Plastic Surgery, 2006
The development of linear hypopigmentation after intralesional or intraarticular injection of tri... more The development of linear hypopigmentation after intralesional or intraarticular injection of triamcinolone acetonide has been reported in the literature as a very rare side effect. This case report describes a patient with linear hypopigmentation and discusses the possible pathophysiology. Clinicians involved in the care of hypertrophic scars and keloids need to be aware of this rare side effect so that they can guide their patients appropriately. They need to understand the pathogenesis of this complication better so that it may become avoidable.
Plastic and Reconstructive Surgery, 2006
Oman medical journal, 2009
Severe crush injuries to the upper limb may require a formal amputation with devastating conseque... more Severe crush injuries to the upper limb may require a formal amputation with devastating consequences to the patient. We report a patient with a near total amputation at the level of mid-forearm who underwent revascularization and salvage of his hand. The operative details of this case are described. It is the first time that such a patient has been treated successfully by plastic surgeons and orthopedic surgeons at the Sultan Qaboos Hospital, Salalah. Awareness of the possibility of salvage should be spread among health care personnel as well as the need for immediate attention by a multispeciality team. Literature related to the operative technique, contraindications and long term results is reviewed.
Oman Medical journal, 2011
An amputation of the hand is a devastating injury. It adversely affects the victim&am... more An amputation of the hand is a devastating injury. It adversely affects the victim's ability to earn a livelihood, support a family, and carry out daily activities. It has a great psychological impact. We report a middle aged male with an amputation at the level of the distal forearm who underwent replantation. The operative details of this case are described. Awareness of the possibility of salvage should be spread among healthcare personnel and the need for immediate attention by a multispeciality team is advocated. This report reviews the literature related to the operative technique, contraindications and long term results.
Surgery Today, 1999
Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India ... more Thomboangiitis obliterans (TAO), also known as Buerger's disease, is an important cause in India of chronic arterial occlusion of the limbs. The current modalities of therapy do not provide adequate relief to a large number of these patients. An omentum autotransplantation to the lower limbs was performed in three patients as a limb salvage procedure. The initial results with up to a year of follow-up are so far encouraging.
Plastic and Reconstructive Surgery, 2006
Plastic and Reconstructive Surgery, 2003
Plastic and Reconstructive Surgery, 2004
The chunni, a long scarf-like garment worn around the neck, is a traditional form of Indian attir... more The chunni, a long scarf-like garment worn around the neck, is a traditional form of Indian attire worn by women along with a loose long shirt and pants (the salwar kameez). It is a 2.25-meter-long and 1.25-meter-wide free cloth usually made of polyester or cotton. Until ...
The Journal of Hand Surgery, 2000
We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft con... more We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft consisted of periosteum, full-thickness cortex, and the underlying cancellous bone and was harvested from the supracondylar region of the femur. The graft was nourished by the articular branch of the descending geniculate artery and vein. Unlike the currently used vascularized bone grafts, this graft can be easily harvested and shaped to accommodate the bone defect of the scaphoid without disturbing its vascularity and can then be transferred with microvascular anastomosis of the nutrient vessels to the radial artery and its venae commitantes. Ten patients with longstanding nonunion of the scaphoid secondary to avascular necrosis, confirmed by radiologic and intraoperative findings, were treated with this vascularized bone graft. Union was achieved in all 10 patients at an average of 12 weeks after surgery. The average follow-up period for all fractures was 3.5 years. The scores for overall outcome, according to the Mayo wrist scoring system, were excellent in 4 patients, good in 4, and fair in 2. Two unsatisfied patients had preoperative signs of early periscaphoid osteoarthrosis. This free vascularized small bone graft from the supracondylar region of the femur is an attractive alternative to the conventional vascularized bone grafting procedures.
The Cleft Palate-Craniofacial Journal, 2005
To study the audiological profile in the cleft population comprising older children and adolescen... more To study the audiological profile in the cleft population comprising older children and adolescents with unrepaired cleft palate and to arrive at a consensus regarding management of otitis media with effusion in this unique group. Tertiary care institute in Chandigarh, Punjab, India. Prospective study based on all patients older than 7 years with unrepaired cleft palate, attending the plastic surgery outpatient department, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India, from January 2001 to December 2002. Patients with submucous cleft were excluded from the study. General characteristics, otoscopic findings, pure tone audiometry, and impedence audiometry of all patients were recorded. Patients' ages ranged from 8 to 18 years, with a mean of 10.5 years. Regarding otological complaints, 86.7% were asymptomatic. Otoscopic findings revealed mild retraction as the most common finding in 50% of the ears. Type B curve was the most common tympanometric finding. The highest and lowest hearing thresholds recorded were 45 db and 15 db, respectively, with a mean of 27.11 db. The audiological profile of this unique group, which neither had undergone palatoplasty nor had received treatment for the ear condition, demonstrates a mild to moderate hearing impairment. This definitely requires treatment, but owing to the lack of a prospective control group, it is difficult to conclude whether these patients are benefited by conservative treatment alone or by an early aggressive surgical treatment for otitis media with effusion (OME).
Anesthesia & Analgesia, 2006
To the Editor: A 23-yr-old female was sched-uled for Le Fort I osteotomy ad-vancement, calvaria b... more To the Editor: A 23-yr-old female was sched-uled for Le Fort I osteotomy ad-vancement, calvaria bone grafting, and rhinoplasty to repair a Class II malocclusion and persistent na-sal deformity. She had undergone maxillo-mandibular fixation 5 yr previously for bilateral Le ...
Aesthet Plast Surg, 1999
Contemporary options for the improvement of depressed scars include scar revision with an ellipti... more Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon's resources when treating scars.
Aesthetic Plastic Surgery, 1999
Contemporary options for the improvement of depressed scars include scar revision with an ellipti... more Contemporary options for the improvement of depressed scars include scar revision with an elliptical excision, z-plasty, w-plasty, and geometric broken-line closure. Dermabrasion and laser treatment has been used to obtain a uniform skin surface. When scars are hypertrophic, intralesional steroids and silicone pressure therapy may be useful. Occasionally, scars may be adherent to the underlying fascia. The resulting depression along the length of the scar worsens the aesthetic deformity. Fat injection is an established method for treating depressions and contour deformities. We report encouraging results with the use of this fat injection technique into a pocket made with a sharp cannula in treating 30 patients with postsurgical scars that were depressed and adherent to the underlying fascia. This technique is a useful addition to the surgeon's resources when treating scars.
Plastic and Reconstructive Surgery, 2005
Primary palatoplasty seeks to restore normal speech with minimum interference in midface growth. ... more Primary palatoplasty seeks to restore normal speech with minimum interference in midface growth. Surgery is often complicated, however, by the occurrence of palatal fistulas or velopharyngeal incompetence. Both result in similar speech disorders but demand different treatment ...