Vipul Nanda - Academia.edu (original) (raw)

Papers by Vipul Nanda

Acta Scientific Otolaryngology, 2021

Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration ... more Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration of nasal tip is technically challenging as every small manoeuvre may lead to dramatic outcomes. There is paucity of well-defined guidelines for sequence of steps to de-project nasal tip. We propose an incremental approach for deprojection of nasal tip. It emphasises on re assessment of tip after each manoeuvre to attain a final pleasing outcome. We analysed 60 patients of true over projected nasal tip over a period of eight years. In all patients sequence of surgical steps were the same as described. In the process, when desired tip de projection was achieved, further steps were not performed.

Introduction: Complex orofacial defects pose a difficult problem for reconstructive surgeon. Hist... more Introduction: Complex orofacial defects pose a difficult problem for reconstructive surgeon. History of previous surgery or radiation adds to the difficulty of reconstruction. In era of microsurgery, use of locoregional flaps, alone or in combination may prove to be the only practical solution in certain situations. Patients and Methods: Two cases of oral carcinoma were resected and the defects were reconstructed using the lateral forehead flap with the pectoralis myocutenous flap. In one of the cases 5th rib was harvested with PMMC flap for reconstruction of the mandibular defect. Result: In both the cases the donor defect was covered with split skin graft. All flaps survived and functional outcome was satisfactory. Aesthetic outcome of the donor defect was also acceptable. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in patients with previous history of radiation and surgery. Agarwal Avinash, Sharma Manik and Nanda Vipul* Department of Cosmetic a...

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.

Innovative Journal of Medical and Health Science, 2020

Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normalbone is repla... more Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normalbone is replaced by an abnormal fibro-osseous tissue. FD has various manifestationsand can present with significant cosmetic and functional disturbances, particularly inthe craniofacial skeleton. We present a craniofacial fibrous dysplasia (CFD) case in a 6year old child who presented with severely reduced mouth opening and some aestheticconcerns. The patient underwent left side coronoidectomy and contouring of the involvedfacial skeleton through bicoronal approach. There was significant improvementin mouth opening. The patient was very satisfied with the outcome. This case reporthighlights the importance of individualized treatment plan addressing the patient’sconcerns.Key words: Fibrous dysplasia–Craniofacial fibrous dysplasia–McCune-Albright syndrome

Acta Scientific Otolaryngology, 2020

Microtia is a congenital deformity of the external ear having an incidence of one in 7000 to 8000... more Microtia is a congenital deformity of the external ear having an incidence of one in 7000 to 8000 live birth [1]. The classical technique for treatment involves reconstruction of the ear framework with autologous costal cartilage. The use of synthetic materials to create a framework is increasing. Such materials are a suitable option in older individuals where the costal cartilages have already ossified and hence are unavailable for carving. Research continues to improve the quality of alloplastic materials and the surgical techniques are getting refined. However, despite all the improvements in the materials and the refinements, complications like infection, wound healing issues, exposure of the implant and fracture of the framework are known. Exposure of the implant often requires explantation resulting in failure of the entire surgical exercise. Implant exposure therefore is a challenging complication that requires urgent attention. The availability of local native tissue and the surgeon's ability to utilise it as a cover may turn out to be a lifeboat in this situation. We present a case of an exposed alloplastic ear implant (Medpor) which was salvaged successfully using the redundant native skin from the original deformed ear.

Indian Journal of Plastic Surgery, 2004

ABSTRACTWe describe the use of proximally based de-epithelialised fasciocutaneous flap for covera... more ABSTRACTWe describe the use of proximally based de-epithelialised fasciocutaneous flap for coverage of defects in the lower thigh and knee joint. These flaps are based on a number of perforators around the knee joint and can be based either posteriorly, posteromedially or posterolaterally depending upon the location of the defect. The whole of the flap including the bridge segment is de-epithelialised and turned over by 180 degrees and a split thickness graft is placed over the flap and the donor site. The flaps can be raised quickly, have minimum morbidity and are reliable even in the presence of extensive injuries. These flaps have remained stable and trouble free during a follow up period of 2-4 years.

The Journal of Bone and Joint Surgery-American Volume, 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.

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2005

Oman Medical journal, 2011

An amputation of the hand is a devastating injury. It adversely affects the victim's ability to e... 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, 2005

Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently... more Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. Viewpoints pertain to issues of general interest, even if they are not related to items previously published (such as unique techniques, brief technology updates, technical notes, and so on). Please note the following criteria for Letters and Viewpoints: • Text-maximum of 500 words (not including references) • References-maximum of five • Authors-no more than five • Figures/Tables-no more than two figures and/or one

Plastic and Reconstructive Surgery, 2004

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2005

Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently... more Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters and Viewpoints are published at the discretion of the Editor. Viewpoints pertain to issues of general interest, even if they are not related to items previously published (such as unique techniques, brief technology updates, technical notes, and so on). Please note the following criteria for Letters and Viewpoints: • Text-maximum of 500 words (not including references) • References-maximum of five • Authors-no more than five • Figures/Tables-no more than two figures and/or one

Plastic and Reconstructive Surgery, 2003

Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.

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 ...

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009

This study was conducted to evaluate any correlation between the measured width of cleft palates ... more This study was conducted to evaluate any correlation between the measured width of cleft palates and postoperative fistula formation. Prospective study design was used where 43 consecutive cases of patients with cleft lip and palate or isolated palate who underwent cleft palate repair in an institution were observed. A preoperative or peroperative dental impression of the upper jaw was taken for the measurement of various cleft parameters. Palatoplasty was done using the Von-Langenbeck procedure or modified Veau-Wardil-Kilner-type repair. Among these, only 31 patients could be followed up for at least 4 weeks after the surgery and were included in the study. The patients developing fistulas were evaluated with respect to size, site and initial cleft dimensions. Statistical evaluation of multiple variables was performed. It was found that the width of the cleft palate has a bearing on the occurrence of postoperative palatal fistula formation, with a width of 15 mm or more having a statistically significant risk of fistula formation. The strongest association was found for the ratio of cleft width to the sum of the palatal shelves width. As this ratio increases to 0.48 or more, the risk of fistula becomes statistically significant. The ratio of cleft width to the posterior arch width is also a strong predictor of fistula formation with the risk becoming higher if the ratio is more than 0.41. Thus, the concept of wide-cleft is not vague or irrelevant but has a bearing on postoperative fistula formation, as shown in this study.

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.

Acta Scientific Otolaryngology, 2021

Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration ... more Rhinoplasty is one of the most commonly performed aesthetic procedures worldwide. Any alteration of nasal tip is technically challenging as every small manoeuvre may lead to dramatic outcomes. There is paucity of well-defined guidelines for sequence of steps to de-project nasal tip. We propose an incremental approach for deprojection of nasal tip. It emphasises on re assessment of tip after each manoeuvre to attain a final pleasing outcome. We analysed 60 patients of true over projected nasal tip over a period of eight years. In all patients sequence of surgical steps were the same as described. In the process, when desired tip de projection was achieved, further steps were not performed.

Introduction: Complex orofacial defects pose a difficult problem for reconstructive surgeon. Hist... more Introduction: Complex orofacial defects pose a difficult problem for reconstructive surgeon. History of previous surgery or radiation adds to the difficulty of reconstruction. In era of microsurgery, use of locoregional flaps, alone or in combination may prove to be the only practical solution in certain situations. Patients and Methods: Two cases of oral carcinoma were resected and the defects were reconstructed using the lateral forehead flap with the pectoralis myocutenous flap. In one of the cases 5th rib was harvested with PMMC flap for reconstruction of the mandibular defect. Result: In both the cases the donor defect was covered with split skin graft. All flaps survived and functional outcome was satisfactory. Aesthetic outcome of the donor defect was also acceptable. Conclusion: Lateral forehead flap is a reliable flap with an acceptable outcome in patients with previous history of radiation and surgery. Agarwal Avinash, Sharma Manik and Nanda Vipul* Department of Cosmetic a...

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.

Innovative Journal of Medical and Health Science, 2020

Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normalbone is repla... more Fibrous dysplasia (FD) is a slowly progressive benign bone condition in which normalbone is replaced by an abnormal fibro-osseous tissue. FD has various manifestationsand can present with significant cosmetic and functional disturbances, particularly inthe craniofacial skeleton. We present a craniofacial fibrous dysplasia (CFD) case in a 6year old child who presented with severely reduced mouth opening and some aestheticconcerns. The patient underwent left side coronoidectomy and contouring of the involvedfacial skeleton through bicoronal approach. There was significant improvementin mouth opening. The patient was very satisfied with the outcome. This case reporthighlights the importance of individualized treatment plan addressing the patient’sconcerns.Key words: Fibrous dysplasia–Craniofacial fibrous dysplasia–McCune-Albright syndrome

Acta Scientific Otolaryngology, 2020

Microtia is a congenital deformity of the external ear having an incidence of one in 7000 to 8000... more Microtia is a congenital deformity of the external ear having an incidence of one in 7000 to 8000 live birth [1]. The classical technique for treatment involves reconstruction of the ear framework with autologous costal cartilage. The use of synthetic materials to create a framework is increasing. Such materials are a suitable option in older individuals where the costal cartilages have already ossified and hence are unavailable for carving. Research continues to improve the quality of alloplastic materials and the surgical techniques are getting refined. However, despite all the improvements in the materials and the refinements, complications like infection, wound healing issues, exposure of the implant and fracture of the framework are known. Exposure of the implant often requires explantation resulting in failure of the entire surgical exercise. Implant exposure therefore is a challenging complication that requires urgent attention. The availability of local native tissue and the surgeon's ability to utilise it as a cover may turn out to be a lifeboat in this situation. We present a case of an exposed alloplastic ear implant (Medpor) which was salvaged successfully using the redundant native skin from the original deformed ear.

Indian Journal of Plastic Surgery, 2004

ABSTRACTWe describe the use of proximally based de-epithelialised fasciocutaneous flap for covera... more ABSTRACTWe describe the use of proximally based de-epithelialised fasciocutaneous flap for coverage of defects in the lower thigh and knee joint. These flaps are based on a number of perforators around the knee joint and can be based either posteriorly, posteromedially or posterolaterally depending upon the location of the defect. The whole of the flap including the bridge segment is de-epithelialised and turned over by 180 degrees and a split thickness graft is placed over the flap and the donor site. The flaps can be raised quickly, have minimum morbidity and are reliable even in the presence of extensive injuries. These flaps have remained stable and trouble free during a follow up period of 2-4 years.

The Journal of Bone and Joint Surgery-American Volume, 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.

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2005

Oman Medical journal, 2011

An amputation of the hand is a devastating injury. It adversely affects the victim's ability to e... 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, 2005

Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently... more Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. Viewpoints pertain to issues of general interest, even if they are not related to items previously published (such as unique techniques, brief technology updates, technical notes, and so on). Please note the following criteria for Letters and Viewpoints: • Text-maximum of 500 words (not including references) • References-maximum of five • Authors-no more than five • Figures/Tables-no more than two figures and/or one

Plastic and Reconstructive Surgery, 2004

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2006

Plastic and Reconstructive Surgery, 2005

Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently... more Letters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters and Viewpoints are published at the discretion of the Editor. Viewpoints pertain to issues of general interest, even if they are not related to items previously published (such as unique techniques, brief technology updates, technical notes, and so on). Please note the following criteria for Letters and Viewpoints: • Text-maximum of 500 words (not including references) • References-maximum of five • Authors-no more than five • Figures/Tables-no more than two figures and/or one

Plastic and Reconstructive Surgery, 2003

Correspondence and brief communications are welcomed and need not concern only what has been publ... more Correspondence and brief communications are welcomed and need not concern only what has been published in this journal. We shall print items of interest to our readers, such as experimental, clinical, and philosophical observations; reports of work in progress; educational notes; and travel accounts relevant to plastic surgery. We reserve the right to edit communications to meet requirements of space and format. Any financial interest relevant to the content of the correspondence must be disclosed. Submission of a letter constitutes permission for the American Society of Plastic Surgeons and its licensees and assignees to publish it in the journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such letters.

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 ...

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009

This study was conducted to evaluate any correlation between the measured width of cleft palates ... more This study was conducted to evaluate any correlation between the measured width of cleft palates and postoperative fistula formation. Prospective study design was used where 43 consecutive cases of patients with cleft lip and palate or isolated palate who underwent cleft palate repair in an institution were observed. A preoperative or peroperative dental impression of the upper jaw was taken for the measurement of various cleft parameters. Palatoplasty was done using the Von-Langenbeck procedure or modified Veau-Wardil-Kilner-type repair. Among these, only 31 patients could be followed up for at least 4 weeks after the surgery and were included in the study. The patients developing fistulas were evaluated with respect to size, site and initial cleft dimensions. Statistical evaluation of multiple variables was performed. It was found that the width of the cleft palate has a bearing on the occurrence of postoperative palatal fistula formation, with a width of 15 mm or more having a statistically significant risk of fistula formation. The strongest association was found for the ratio of cleft width to the sum of the palatal shelves width. As this ratio increases to 0.48 or more, the risk of fistula becomes statistically significant. The ratio of cleft width to the posterior arch width is also a strong predictor of fistula formation with the risk becoming higher if the ratio is more than 0.41. Thus, the concept of wide-cleft is not vague or irrelevant but has a bearing on postoperative fistula formation, as shown in this study.

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.