ABSTRACT
For management of nevus & various scars various methods are described like excision, skin grafting, dermabrasion, flap cover, dermatraction etc. but reconstruction of various scars by tissue expansion is a novel procedure. Aims & objectives: 1.Study of tissue expansion in the reconstruction of nevus & scars. 2. Advantage & disadvantages of tissue expansion. 3. Complications of tissue expansion. Methods: The study was conducted in SCB MCH, dept of Plastic surgery from October 2015 to April 2018. No. of patients in this study were 41 which includes post burn scars, post traumatic scars & nevus. Results: study includes age group from 11- 42 yrs with female predominance. It mainly includes post burn scars, facial scars. Neck was the most common site of expander used. Expander mostly used were rectangular type. Volume ranges from 50 to 540ml. Of total 46 expanders 5 cases two expanders used. Various complications of expanders included infection, blebs, hematoma, wound dehiscence etc of which extrusion of expanders were most common. Complications were more common in extremities. HTS & partial skin necrosis common scar related complication. Conclusion: Tissue expansion is an excellent technique to treat scars, pigmented lesions and alopetic patches. This provides the best tissue quality and matching as regards tissue characteristics. Flaps and skin grafts are inferior in treatment of these lesions when tissue expansion is possible. However this technique has its complications like infection, exposure and failure of expander. Therefore proper planning and selection of expander is extremely important.
ABSTRACT
Introduction: Salvage of complex limb injuries is not onlydependent on the skill, experience and attitude of the surgeonbut also on the ischemia time. If the revascularisation isnot possible within the golden period then the outcomeis unfavourable. There are very few reports of delayedreplantation. We are presenting a case series of replantationbeyond the golden hours i.e. 6 hours of warm ischemia byimmediate revascularisation before undertaking definitivereplantation. The definitive sequence of replantation is carriedout after the limb gets revascularised and the viscious cycle ofischemia is broken. Study aimed to salvage amputated limbs inthe borderline ischemia time by immediate revascularisation.Material and methods: A study was conducted between April2013 to March 2018 at SBM Plastic Surgery Hospital, cuttackand included all patients with limb amputations of 6-10 hoursduration. In this study the artery was anastomosed first to haltthe sequence of prolonged ischaemia. Temporary stability tothe repair was provided by taking deep bites to the proximaland distal muscle group with 2.0 vicryl sutures adjacent tothe anastomosis. After the limb was adequately revascularisedand proper hemostasis was achieved then the proper sequenceof replantation was started.Result: out of 31 patients presenting during this period, 9patients were excluded for poor preservation of the limb andpresenting after 10 hours of warm ischamia. Total no of casesincluded in the study were 22 patients who presented between4 to 9 hours of cold ischemia time. The break up accordingto the nature of injury was, 19 patients had avulsion injuries,two had assault with heavy sharp weapons and one hadcrush injury. Out of 22 cases of replantation 2 cases requiredamputation at a later date due to complications.Conclusion: In our country majority of patient come tohospital after 6-8 hrs of warm ischemia which is the upperlimit of ishaemia. If the ideal sequence of replantation willbe followed these limbs will undergo irreversible ischaemicdamage due to further delay. So the concept of immediatearterialisation gives the best opportunity for limb survival.