Vijay Langer | Army Hospital Research and Referral, New Delhi, India (original) (raw)

Papers by Vijay Langer

Medical journal, Armed Forces India, Jul 1, 2012

Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instit... more Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instituted. They are prevalent all over the globe and pyogenic abscesses are predominant over amoebic. With better control of intra abdominal and systemic infections by a spectrum of antibiotics, aetiology of pyogenic abscesses are secondary to interventions and diseases in the biliary tree to a large extent today. The common organisms isolated are the Gram negative group. Amoebic abscesses continue to plague some regions of the world where hygiene and sanitation are questionable. Over the years, diagnosis, treatment and prognosis have evolved remarkably. Imaging modalities like ultrasonography and CT scan have become the cornerstone of diagnosis. The absence of ionizing radiation makes MRI an attractive alternative in patients who require multiple follow up scans. Serological testing in amoebic abscesses has become more reliable. Though antibiotics have remained the principal modality of management, percutaneous drainage of abscesses have vastly improved the chances of cure and bring down the morbidity drastically in pyogenic abscesses. Amoebic abscesses respond well to medical treatment with nitroimidazoles, and minimally invasive surgical drainage is an option in cases where open surgery is indicated.

Indian Journal of Plastic Surgery, Jul 1, 2005

Pectus carinatum is an uncommon congenital anomaly. Surgical correction for the deformity is infr... more Pectus carinatum is an uncommon congenital anomaly. Surgical correction for the deformity is infrequently sought but is usually very rewarding. There are three types of the deformity, viz. chondro gladiolar, chondro-manubrial and the lateral variety, of which the latter is the most rare. We present a fifteen year girl who had pectus carinatum of the lateral variety involving the left second to the eighth costo-chondral junctions. The indication for surgical intervention was purely aesthetic. Subperichondrial excision of the lateral halves of the affected costal cartilages and shaving of the adjacent ribs was done. The post-operative recovery was uneventful and the deformity was corrected satisfactorily.

Indian Dermatology Online Journal, 2014

Medical journal, Armed Forces India, Jul 1, 2011

Indian Journal of Plastic Surgery, 2011

Indian Dermatology Online Journal, 2014

539 therapy as well. The cells can be derived locally (e.g. fi broblasts, keratinocytes, melanocy... more 539 therapy as well. The cells can be derived locally (e.g. fi broblasts, keratinocytes, melanocytes, adipocytes, hair follicle cells, and skin progenitor cells) or systemically (e.g. cells in the bone marrow system). Studies indicate that progenitor cells produce more favorable outcome than differentiated keratinocytes in bioengineered skin. [9] The foregoing adjunctive measures may improve many aspects of wound healing in the patient with a leg ulcer. Excitingly, stem cells, especially adipose-derived stromal cells, may be of immense value in healing leg ulcers in the future. The world waits with bated breath for more trailblazing research on the subject and its diverse clinical applications.

Journal of Cleft Lip Palate and Craniofacial Anomalies, Jul 1, 2014

Wounds over the irradiated chest present as a tough challenge for coverage to the reconstructive ... more Wounds over the irradiated chest present as a tough challenge for coverage to the reconstructive surgeon. This is due to the adverse effects of radiation on local tissue. The best option in such patients is flap coverage. Split thickness skin graft, though a simpler alternative, does not take well or breaks down easily. Case report: A patient is presented in whom flap coverage was not sought and wound bed was prepared by negative pressure wound therapy to effectively take a skin graft. Conclusions: This simple technique may be of immense value in aiding closure of problematic wounds over the irradiated chest.

Medical journal, Armed Forces India, Oct 1, 2010

Traumatic injuries, especiaUy in the combat setting, stress the surgical team. that may be sited ... more Traumatic injuries, especiaUy in the combat setting, stress the surgical team. that may be sited in a remote forward area, battling against paucity of time, reIItlUI'eeI and infrastrueture. The lone surgeon may be faced with the arduous challenge of saving life. There is seldom thought given to reeonstruction in this high-presmre situation. If the patient survives, morbidity for want of reeonstruction can be severe and quality oflife can suffer IignifiQ1DtIy. lteooostruetion after 3 to 5 days is fraught with eomplicationJ and usually does compromise outcome in the post-operative phase. The reconstructive IIIII'geOD. should be involved early in the management as he can provide eoverage for large soft tiuue defeets after agg:reaive debridement with panaehe. H the patient is haem.odynamiea11y stable, he should be transferred ugently, preferrably by air, to a higher centre with multi-specialty care, espeeially being equipped with an orthopaedic: and trauma reeonstruetive IUrgeon. It has been proved beyond doubt that the healing improvea IIignifieantlJ aDd there is marked decrease in morbidity if coverage ofWODDdl!I is pnmded early, before colonized wounds get infected.

Indian Journal of Surgery, Aug 17, 2019

In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as... more In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as an age-old clinical tool utilised for soft tissue coverage. However, the scanty endorsement of return of protective tactile sensations in these split-thickness skin grafts seems mired between therapeutic subservience and clinical necessity. The objective of this study was to evaluate recovery of tactile protective sensations in split-thickness skin grafts. A total of 100 patients were recruited for the study. Prospective analysis of demographics, pre-and post-operative variables was done to evaluate the return of tactile sensations by two-point discrimination and cotton touch. Males represented 69% of the patients with a mean age of 49.04 (± 16.34) years. Early recovery of twopoint discrimination at the periphery of the split-thickness skin graft was observed in 1 week in 23.9% and cotton touch in 61.4% of patients. Over a follow-up period of 1 year, 60% patients had recovery of two-point discrimination and 92.8% for cotton touch. The return of sensation at the centre of the graft was delayed and at 1-year follow-up, 67% developed tactile sensations. The rate of change of two-point discrimination with respect to time was significant (F = 5.74, P = 0.018). Delayed recovery of sensations was observed in patients who developed graft bed oedema or had a scarred graft bed. The encouraging early return of tactile sensation furnishes the split-thickness skin graft with a protective capability against shear, often offered as a reason for graft loss in contemporary wisdom. The findings of a delayed return in a scarred and oedematous graft bed can be expressed as clinical underpinnings and these observations should expand the myriad uses a split thickness skin graft can be put to in soft tissue coverage.

Foot and Ankle Surgery, Mar 1, 2013

Medical journal, Armed Forces India, Oct 1, 2014

jo urn al ho mep age: www .e lsev ie r. co m/ lo cate/ mj afi m e d i c a l j o u r n a l a r m e... more jo urn al ho mep age: www .e lsev ie r. co m/ lo cate/ mj afi m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 (2 0 1 4) 3 9 4 e3 9 5

Medical journal, Armed Forces India, Jul 1, 2013

Journal of nursing & care, Oct 5, 2016

Indian Dermatology Online Journal, 2014

Medical journal, Armed Forces India, Apr 1, 2013

Introduction: Enzymatic debridement is a method by which burn wounds can be prepared for coverage... more Introduction: Enzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. Material and methods: A prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. Results: The age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. Conclusion: Debridace, a papaineurea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.

Indian journal of burns, 2022

Indian Dermatology Online Journal, 2014

International Surgery Journal, Jan 27, 2023

Chronic leg ulcers (CLU's) are one of the most challenging medical conditions, mostly resistant t... more Chronic leg ulcers (CLU's) are one of the most challenging medical conditions, mostly resistant to conventional therapy. Several treatment modalities are present but none have become standard of care. Autologous fat contains adipose derived stem cells (ADSC's) which is believed to have abundant growth factors (GF's) required for its regenerative and reparative properties. Our observational study was conducted to see the feasibility and efficacy of fat grafting in management of CLUs with complete wound healing as final outcome. 14 patients with CLUs (any etiology, >3 months and multiple ulcers were counted as individual cases if >3 cm apart) were included with coagulopathies, uncontrolled diabetes mellitus (Hba1c>9 mmol/mol) being the exclusions. Fat was harvested using standard Coleman's technique. Study was conducted from December 2015 to December 2017 in tertiary care hospital and patients were followed up for next 24 months. All cases were evaluated clinically. Average age of wounds before intervention was 33.34 months, average wound size 16.46 cm 2 and 4.9 cc of average fat was transferred underneath the ulcer. 11 out of 14 wounds healed completely within average 27.4 days and final outcome was not achieved in 3. Pain assessed using visual analogue scale (VAS) in immediate post operative period till 48 hours (telephonically). Patients were evaluated at 1 week, 1 month, 3 months and 6 months after procedure for pattern of wound healing and related complications. Fat grafting is easy, safe, effective and a minimally invasive OPD procedure with short recovery time for managing CLUs.

Medical journal, Armed Forces India, Jul 1, 2012

Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instit... more Hepatic abscesses are potentially lethal diseases if early diagnosis and treatment are not instituted. They are prevalent all over the globe and pyogenic abscesses are predominant over amoebic. With better control of intra abdominal and systemic infections by a spectrum of antibiotics, aetiology of pyogenic abscesses are secondary to interventions and diseases in the biliary tree to a large extent today. The common organisms isolated are the Gram negative group. Amoebic abscesses continue to plague some regions of the world where hygiene and sanitation are questionable. Over the years, diagnosis, treatment and prognosis have evolved remarkably. Imaging modalities like ultrasonography and CT scan have become the cornerstone of diagnosis. The absence of ionizing radiation makes MRI an attractive alternative in patients who require multiple follow up scans. Serological testing in amoebic abscesses has become more reliable. Though antibiotics have remained the principal modality of management, percutaneous drainage of abscesses have vastly improved the chances of cure and bring down the morbidity drastically in pyogenic abscesses. Amoebic abscesses respond well to medical treatment with nitroimidazoles, and minimally invasive surgical drainage is an option in cases where open surgery is indicated.

Indian Journal of Plastic Surgery, Jul 1, 2005

Pectus carinatum is an uncommon congenital anomaly. Surgical correction for the deformity is infr... more Pectus carinatum is an uncommon congenital anomaly. Surgical correction for the deformity is infrequently sought but is usually very rewarding. There are three types of the deformity, viz. chondro gladiolar, chondro-manubrial and the lateral variety, of which the latter is the most rare. We present a fifteen year girl who had pectus carinatum of the lateral variety involving the left second to the eighth costo-chondral junctions. The indication for surgical intervention was purely aesthetic. Subperichondrial excision of the lateral halves of the affected costal cartilages and shaving of the adjacent ribs was done. The post-operative recovery was uneventful and the deformity was corrected satisfactorily.

Indian Dermatology Online Journal, 2014

Medical journal, Armed Forces India, Jul 1, 2011

Indian Journal of Plastic Surgery, 2011

Indian Dermatology Online Journal, 2014

539 therapy as well. The cells can be derived locally (e.g. fi broblasts, keratinocytes, melanocy... more 539 therapy as well. The cells can be derived locally (e.g. fi broblasts, keratinocytes, melanocytes, adipocytes, hair follicle cells, and skin progenitor cells) or systemically (e.g. cells in the bone marrow system). Studies indicate that progenitor cells produce more favorable outcome than differentiated keratinocytes in bioengineered skin. [9] The foregoing adjunctive measures may improve many aspects of wound healing in the patient with a leg ulcer. Excitingly, stem cells, especially adipose-derived stromal cells, may be of immense value in healing leg ulcers in the future. The world waits with bated breath for more trailblazing research on the subject and its diverse clinical applications.

Journal of Cleft Lip Palate and Craniofacial Anomalies, Jul 1, 2014

Wounds over the irradiated chest present as a tough challenge for coverage to the reconstructive ... more Wounds over the irradiated chest present as a tough challenge for coverage to the reconstructive surgeon. This is due to the adverse effects of radiation on local tissue. The best option in such patients is flap coverage. Split thickness skin graft, though a simpler alternative, does not take well or breaks down easily. Case report: A patient is presented in whom flap coverage was not sought and wound bed was prepared by negative pressure wound therapy to effectively take a skin graft. Conclusions: This simple technique may be of immense value in aiding closure of problematic wounds over the irradiated chest.

Medical journal, Armed Forces India, Oct 1, 2010

Traumatic injuries, especiaUy in the combat setting, stress the surgical team. that may be sited ... more Traumatic injuries, especiaUy in the combat setting, stress the surgical team. that may be sited in a remote forward area, battling against paucity of time, reIItlUI'eeI and infrastrueture. The lone surgeon may be faced with the arduous challenge of saving life. There is seldom thought given to reeonstruction in this high-presmre situation. If the patient survives, morbidity for want of reeonstruction can be severe and quality oflife can suffer IignifiQ1DtIy. lteooostruetion after 3 to 5 days is fraught with eomplicationJ and usually does compromise outcome in the post-operative phase. The reconstructive IIIII'geOD. should be involved early in the management as he can provide eoverage for large soft tiuue defeets after agg:reaive debridement with panaehe. H the patient is haem.odynamiea11y stable, he should be transferred ugently, preferrably by air, to a higher centre with multi-specialty care, espeeially being equipped with an orthopaedic: and trauma reeonstruetive IUrgeon. It has been proved beyond doubt that the healing improvea IIignifieantlJ aDd there is marked decrease in morbidity if coverage ofWODDdl!I is pnmded early, before colonized wounds get infected.

Indian Journal of Surgery, Aug 17, 2019

In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as... more In the long evolution of world surgery, split-thickness skin grafting has distinguished itself as an age-old clinical tool utilised for soft tissue coverage. However, the scanty endorsement of return of protective tactile sensations in these split-thickness skin grafts seems mired between therapeutic subservience and clinical necessity. The objective of this study was to evaluate recovery of tactile protective sensations in split-thickness skin grafts. A total of 100 patients were recruited for the study. Prospective analysis of demographics, pre-and post-operative variables was done to evaluate the return of tactile sensations by two-point discrimination and cotton touch. Males represented 69% of the patients with a mean age of 49.04 (± 16.34) years. Early recovery of twopoint discrimination at the periphery of the split-thickness skin graft was observed in 1 week in 23.9% and cotton touch in 61.4% of patients. Over a follow-up period of 1 year, 60% patients had recovery of two-point discrimination and 92.8% for cotton touch. The return of sensation at the centre of the graft was delayed and at 1-year follow-up, 67% developed tactile sensations. The rate of change of two-point discrimination with respect to time was significant (F = 5.74, P = 0.018). Delayed recovery of sensations was observed in patients who developed graft bed oedema or had a scarred graft bed. The encouraging early return of tactile sensation furnishes the split-thickness skin graft with a protective capability against shear, often offered as a reason for graft loss in contemporary wisdom. The findings of a delayed return in a scarred and oedematous graft bed can be expressed as clinical underpinnings and these observations should expand the myriad uses a split thickness skin graft can be put to in soft tissue coverage.

Foot and Ankle Surgery, Mar 1, 2013

Medical journal, Armed Forces India, Oct 1, 2014

jo urn al ho mep age: www .e lsev ie r. co m/ lo cate/ mj afi m e d i c a l j o u r n a l a r m e... more jo urn al ho mep age: www .e lsev ie r. co m/ lo cate/ mj afi m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 0 (2 0 1 4) 3 9 4 e3 9 5

Medical journal, Armed Forces India, Jul 1, 2013

Journal of nursing & care, Oct 5, 2016

Indian Dermatology Online Journal, 2014

Medical journal, Armed Forces India, Apr 1, 2013

Introduction: Enzymatic debridement is a method by which burn wounds can be prepared for coverage... more Introduction: Enzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. Material and methods: A prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. Results: The age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. Conclusion: Debridace, a papaineurea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.

Indian journal of burns, 2022

Indian Dermatology Online Journal, 2014

International Surgery Journal, Jan 27, 2023

Chronic leg ulcers (CLU's) are one of the most challenging medical conditions, mostly resistant t... more Chronic leg ulcers (CLU's) are one of the most challenging medical conditions, mostly resistant to conventional therapy. Several treatment modalities are present but none have become standard of care. Autologous fat contains adipose derived stem cells (ADSC's) which is believed to have abundant growth factors (GF's) required for its regenerative and reparative properties. Our observational study was conducted to see the feasibility and efficacy of fat grafting in management of CLUs with complete wound healing as final outcome. 14 patients with CLUs (any etiology, >3 months and multiple ulcers were counted as individual cases if >3 cm apart) were included with coagulopathies, uncontrolled diabetes mellitus (Hba1c>9 mmol/mol) being the exclusions. Fat was harvested using standard Coleman's technique. Study was conducted from December 2015 to December 2017 in tertiary care hospital and patients were followed up for next 24 months. All cases were evaluated clinically. Average age of wounds before intervention was 33.34 months, average wound size 16.46 cm 2 and 4.9 cc of average fat was transferred underneath the ulcer. 11 out of 14 wounds healed completely within average 27.4 days and final outcome was not achieved in 3. Pain assessed using visual analogue scale (VAS) in immediate post operative period till 48 hours (telephonically). Patients were evaluated at 1 week, 1 month, 3 months and 6 months after procedure for pattern of wound healing and related complications. Fat grafting is easy, safe, effective and a minimally invasive OPD procedure with short recovery time for managing CLUs.