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Khan A, Khan A, Mohan S, Panse N. Plastic Surgery Teaching to United Kingdom Undergraduate Medical Students: A Systematic Review. Indian J Plast Surg 2024; 57:9-15. [PMID: 38450015 PMCID: PMC10914533 DOI: 10.1055/s-0044-1779480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Background There are varying reports about United Kingdom medical students' exposure and teaching methods regarding plastic and reconstructive surgery. To date, no systematic review has been done looking at this topic. Methods Three databases (PubMed, Embase, and Medline) were searched from January 1, 2011 to July 20, 2023 for studies that assessed United Kingdom medical students' exposure to plastic surgery and suggested recommendations to improve teaching. Three authors performed data extraction and screening, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Fifteen studies were included. Medical students' average current exposure to plastic surgery was 29.44%, but this was highly variable across the studies. The most common method of currently teaching plastic surgery was through lectures (34% of studies), and the most common suggested method of teaching was through courses (40% of studies). Many of the studies (12/15) were deemed as being at high risk of bias. Conclusion More recent studies need to be performed to assess current levels of teaching of plastic surgery in the United Kingdom medical school curriculum. Greater exposure to plastic surgery through lectures and integrated clinical placements is needed to ensure equitable access for all medical students to plastic surgery as a profession.
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Affiliation(s)
- Ahmad Khan
- College of Life Sciences, Leicester Medical School, Leicester, United Kingdom
| | - Ahsan Khan
- College of Medical and Dental Sciences, Birmingham Medical School, Birmingham, United Kingdom
| | - Shaan Mohan
- College of Life Sciences, Leicester Medical School, Leicester, United Kingdom
| | - Nikhil Panse
- Department of Plastic Surgery at B.J Medical College & Sassoon Hospital, Pune, Maharashtra, India
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2
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Tang CQY, S. BS, Rugiero C, Heredia RBP, Kearns M, Huang TCT, Shaker MM, Glasbrenner J, Mehdizade T, Panse N, Santamaria E, Chen C, Jerome JTJ. International Residents' Perspectives on Education and Challenges in Microsurgery Training. J Hand Microsurg 2023; 15:295-298. [PMID: 37701315 PMCID: PMC10495202 DOI: 10.1055/s-0042-1744211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective Microsurgery remains an integral component of the surgical skillset and is essential for a diversity of reconstructive procedures. The apprenticeship also requires overcoming a steep learning curve, among many challenges. The method of microsurgical training differs depending on the countries' regions and resources of their health care system. Methods The Journal of Hand and Microsurgery leadership held an international webinar on June 19, 2021, consisting of a panel of residents from 10 countries and moderated by eminent panelists. This inaugural event aimed to share different experiences of microsurgery training on a global scale, identifying challenges to accessing and delivering training. Results Residents shared various structures and modes of microsurgical education worldwide. Areas of discussion also included microsurgical laboratory training, simulation training, knowledge sharing, burnout among trainees, and challenges for female residents in microsurgical training. Conclusion Microsurgical proficiency is attained through deliberate and continued practice, and there is a strong emphasis globally on training and guidance. However, much remains to be done to improve microsurgical training and start acting on the various challenges raised by residents. Level of Evidence Level V.
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Affiliation(s)
- Camelia Qian Ying Tang
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Benedicta Seeli S.
- Department of Plastic Surgery, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Clelia Rugiero
- Department of Hand Surgery, Victor Hugo Clinique, Paris, France
| | | | - Marie Kearns
- Department of Plastic Surgery, Canniesburn Plastic Surgery Unit, Glasgow, Scotland
| | - Tony C. T. Huang
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Turan Mehdizade
- Department of Plastic, Reconstructive, Aesthetic Surgery, Bezmialem Foundation University, Istanbul, Turkey
| | - Nikhil Panse
- Department of Plastic Surgery, B. J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Eric Santamaria
- Division of Microsurgery, Department of Plastic and Reconstructive Surgery, Hospital General “Manuel Gea González,” México City, México
| | - Charly Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinana, China
| | - J. Terrence Jose Jerome
- Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, Trichy, Tamil Nadu, India
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3
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Karanjkar A, Panse N, Panse S, Sahasrabudhe P. Indian Perspective of Burnout Among Plastic Surgeons. Indian J Plast Surg 2023; 56:153-158. [PMID: 37153331 PMCID: PMC10159714 DOI: 10.1055/s-0042-1759727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Abstract
Introduction Over the last decade, the term “Burnout” has become familiar term in all walks of life, particularly medicine. Emotional exhaustion, depersonalization, and a low sense of personal accomplishment make up the triad. At least a third of plastic surgeons are having burnout according to the western literature. Data on burnout in Indian plastic surgeons is lacking. We have made an attempt to analyze the incidence and factors responsible for burnout among plastic surgeons in India.
Materials and Methods An online survey was conducted in India to assess burnout among plastic surgeons from June to November 2019. Consent, demographic information, stress-related factors, the abbreviated Maslach Burnout Inventory (aMBI), and Satisfaction with Medicine were all included section wise in the survey. Both used scales were validated. Data were gathered using Google forms, then uploaded to an Excel file and analyzed. A multivariable and univariable analysis of factors associated with burnout was carried out.
Results Twenty-two percent of 330 plastic surgeons who responded were assessed to have moderate to high emotional exhaustion, 5% had moderate to high depersonalization, and 3% had low personal accomplishment. The overall burnout rate was 8.2%. Seventy-three percent of plastic surgeons enjoyed a good to very good quality of life. Great over-volume of work, mid-career practicing plastic surgeons and professional satisfaction with work were found to have a significant association with burnout on multivariate analysis.
Conclusions Plastic surgeons in India suffer an overall burnout rate of 8.2% with a multifactorial etiology. This occupational hazard is preventable and reversible. Plastic surgeons need to be vigilant about this and seek help whenever required.
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Affiliation(s)
- Ankur Karanjkar
- Department of Plastic & Reconstructive Surgery, BJ Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Nikhil Panse
- Department of Plastic & Reconstructive Surgery, BJ Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Smita Panse
- Department of Psychiatry, PCMC's Post Graduate Institute & YCM Hospital, Pimpri, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic & Reconstructive Surgery, BJ Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
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Pawar MD, Sahasrabudhe P, Panse N, Bindu AR, Phulwer RD. Management of Posttraumatic Posterior Elbow Defects by Nonmicrosurgical Reconstruction. Indian J Plast Surg 2022; 55:251-261. [PMID: 36325085 PMCID: PMC9622223 DOI: 10.1055/s-0042-1750372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction
Reconstruction of posterior defects is challenging due to the quality and uniqueness of the excess skin at the elbow that is durable, thick, pliable, and without much subcutaneous tissue. The goal of reconstruction is to cover the elbow defects with a durable skin cover that will facilitate full passive range of motion. In this era of microsurgery, free tissue transfer is feasible for almost any defect. However, in this article, we discuss various locoregional and pedicled flap options and the protocol followed at our institute to tackle posttraumatic posterior elbow defects.
Materials and Methods
This is a retrospective analysis of 48 patients with posttraumatic posterior elbow defects admitted from January 2012 to February 2020. Posterior elbow defects were assessed according to the size and location and managed with a nonmicrosurgical reconstruction.
Results
Of 48 patients, 32 were managed with nonmicrosurgical flaps. Eighteen patients had large defects and 14 had small defects. Reverse lateral forearm flap was the workhorse flap for defect coverage. Of 32 flaps, nine developed complications; however, no patient had total flap necrosis.
Conclusion
Posterior elbow defects are a difficult problem to tackle. To achieve optimal results, all patients with elbow trauma should be attended and managed by orthopaedic and plastic surgeons in collaboration for optimal results. We believe that most of these defects can be resurfaced by nonmicrosurgical reconstruction with proper planning and execution and their utility cannot be understated.
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Affiliation(s)
- Manoj Dinkar Pawar
- Department of Plastic & Reconstructive Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Parag Sahasrabudhe
- Department of Plastic & Reconstructive Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Nikhil Panse
- Department of Plastic & Reconstructive Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Ameya Rajan Bindu
- Department of Plastic & Reconstructive Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Rohit Dagadu Phulwer
- Department of Plastic & Reconstructive Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
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Abstract
A propeller flap is an islanded flap that reaches the recipient site through an axial rotation around its vascular axis. The degree of rotation varies from 90 degrees to 180 degrees. It is a highly reliable local reconstructive option. These flaps are simple, single-stage, easy to harvest, and not constrained by routine length-to-width ratios. Since their introduction, the technique has continued to evolve and more applications for the use of propeller flaps are being explored. In spite of their growing use in clinical practice in recent years, many reconstructive surgeons are unaware of their versatility, unsure of their safety, and apprehensive about using propeller flaps confidently. This article aims at understanding the nomenclature, key principles, biogeometry and planning, operative technical details, applications, and complications of propeller flaps.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India,Address for correspondence Nikhil Panse, MCh, DNB Department of Plastic and Reconstructive Surgery, B.J.G.M.C. and Sassoon General HospitalPune, Maharashtra 411001India
| | - Ankur Karanjkar
- Department of Plastic & Reconstructive Surgery, B. J. Government Medical, College and Sassoon Hospital, Pune, Maharashtra, India
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Sahasrabudhe PB, Pradhan MD, Panse N, Jagtap R. Post-CABG Deep Sternal Wound Infection: A Retrospective Comparative Analysis of Early versus Late Referral to a Plastic Surgery Unit in a Tertiary Care Center. Indian J Plast Surg 2021; 54:157-162. [PMID: 34239237 PMCID: PMC8257308 DOI: 10.1055/s-0041-1731256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Deep sternal wound infections (DSWI) following median sternotomy are initially treated by the cardiothoracic surgeons and are referred to a plastic surgical unit late in the course of time.
Methods
This is a retrospective review done in a tertiary care teaching institute from January 2005 to June 2018 and the data of 72 patients who had DSWI out of 4,214 patients who underwent median sternotomy for coronary artery bypass grafting (CABG) was collected with respect to the duration between CABG and presentation of DSWI as well as time of referral to a plastic surgery unit. We defined early referral as < or equal to 15 days from presentation and late referral as > 15 days. Both groups were compared with respect to multiple parameters as well as early and late postoperative course, postoperative complications, and mortality.
Results
The early group had 33 patients, while the late group had 39 patients. The number of procedures done by the cardiothoracic team before referral to the plastic surgery unit is significant (
p
= 0.002). The average duration from the presentation of DSWI to definitive surgery was found to be 16.58 days in the early group and 89.36 days in the late group. The rest of the variables that were compared in both the groups did not have significant differences.
Conclusion
There is no statistical difference between early and late referral to plastic surgery in terms of mortality and morbidity. Yet, early referrals could lead to highly significant reduction in total duration of hospital stay, wound healing, and costs. Early referral of post-CABG DSWIs to Plastic surgeons by the cardiothoracic surgeons is highly recommended.
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Affiliation(s)
- Parag B Sahasrabudhe
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India.,Department of Plastic Surgery, B.J. Medical Govt. College & Sassoon Hospitals, Pune, Maharashtra, India
| | - Mugdha D Pradhan
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Pune, Maharashtra, India
| | - Nikhil Panse
- Department of Plastic Surgery, B.J. Medical Govt. College & Sassoon Hospitals, Pune, Maharashtra, India
| | - Ranjit Jagtap
- Department of Cardiothoracic Surgery, Deenanath Mangeshkar Hospital & Research Centre, Maharashtra, India
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7
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Panse N, Narsimhan A, Dadhe P. Nasolabial island flap for management of post osteo-odonto-keratoprosthesis oroantral fistula. J Cleft Lip Palate Craniofac Anomal 2021. [DOI: 10.4103/jclpca.jclpca_39_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Panse N, Panse S, Ravi S, Mankar H, Karanjkar A, Sahasrabudhe P. Burnout among Plastic Surgery Residents in India: An Observational Study. Indian J Plast Surg 2020; 53:387-393. [PMID: 33402769 PMCID: PMC7775248 DOI: 10.1055/s-0040-1719238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introduction Burnout syndrome can be defined as emotional exhaustion, depersonalization, and perceived lack of personal accomplishment, all of which lead to decreased effectiveness at work. The Medscape burnout and depression report of 2018 suggests that the burnout range across various specialties ranges from 23 to 48%. There are no studies to assess the burnout among plastic surgery residents in India. This study is an attempt to assess the same. Materials and Methods An online survey was conducted in March and April 2019 for plastic surgery residents across India. Various parameters including those related to gender, year of the curriculum, hobbies, exercise, and marital status were assessed. There were multiple sections in the survey, which included the demographic details, stress-related variables, and the abbreviated Maslach Burnout Inventory. The abbreviated Maslach Burnout Inventory is a validated scale that has been used to assess the burnout among plastic surgery residents in India. The three subscales, emotional exhaustion, depersonalization, and personal accomplishment were measured on a Likert scale. Univariable and multivariable analysis of factors associated with burnout was performed. Results Of the 185 respondents, 48.4% experienced moderate-to-high burnout. Of these, 25% ( n = 46) were above the 75th centile of the overall burnout score, indicating severe burnout. Insufficient faculty involvement, insufficient time allotted for formalized teaching, conflict with colleagues, and lack of adequate support staff correlated with resident burnout on multivariate analysis. Residents who pursued their hobbies or performed physical activities for exercise had significantly lesser burnout. Conclusion The incidence of burnout in plastic surgery residents surveyed in our study was 48.4%. The faculty of the departments and the residents themselves, as well as the governing bodies, all have a role to play to address the issue of burnout among residents. Dedicated and persistent efforts toward improving physical and psychological well-being of plastic surgery residents will positively impact not only the well-being of the residents but also the quality of patient care.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Government Medical College & Sassoon Hospital, Pune, India
| | - Smita Panse
- Department of Psychiatry, PCMC's Post Graduate Institute & YCM Hospital, Pimpri, Pune, India
| | - Swaminathan Ravi
- Department of Plastic Surgery, B. J. Government Medical College & Sassoon Hospital, Pune, India
| | - Hemant Mankar
- Department of Plastic Surgery, B. J. Government Medical College & Sassoon Hospital, Pune, India
| | - Ankur Karanjkar
- Department of Plastic Surgery, B. J. Government Medical College & Sassoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B. J. Government Medical College & Sassoon Hospital, Pune, India
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9
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Abstract
The glabrous skin of the palm provides the best color and texture match for reconstruction of palmar aspect of fingers following the principle of reconstructing like with like. Few local axial and perforator flaps have been described of the palm for reconstruction of finger defects. This article reviews the various local flaps based on palmar vessels for digital reconstruction and shares the authors' experiences with similar flaps. Indications, clinical applications, surgical anatomy, and operative techniques of different flaps from palmar tissues are discussed. The authors suggest using these flaps for proximal and smaller defects on the palmar aspect of fingers.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Govt Medical College, Sassoon Hospital, Pune, Maharashtra, India.
| | - Ameya Bindu
- Department of Plastic Surgery, B.J. Govt Medical College, Sassoon Hospital, Pune, Maharashtra, India
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10
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Dighe T, Sahasrabudhe P, Ambekar N, Panse N, Deshpande S, Londhe S, Rathod J, Pradhan M, Vajed M. Study of efficacy and functionality of modified technique of proximal arteriovenous fistula as a vascular access for hemodialysis: A retrospective analysis of 171 cases. Med J DY Patil Vidyapeeth 2019. [DOI: 10.4103/mjdrdypu.mjdrdypu_89_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Abstract
BACKGROUND Gastrocnemius muscle and musculocutaneous flaps are very versatile and one of the commonly used flaps for lower extremity reconstruction. There is significant literature available on the use of these flaps. However, we feel that the potential of the gastrocnemius musculocutaneous (GMC) flaps has not yet been fully explored in terms of increasing their reach, viability and arc of rotation. An attempt is made to refine the technique of flap harvestation to optimize outcomes of this versatile flap. METHODS Six patients of complex lower limb defects were managed using the GMC flaps. Harvesting of the flap was always initiated from the posterior midline to include the proximal sural pedicle, sural nerve, short saphenous vein and the muscle belly of either the medial or the lateral gastrocnemius muscle along with the cutaneous paddle. All the flaps were islanded and denervated. The origin of the gastrocnemius muscle was detached in all cases to increase the reach of this flap. RESULTS The flap can reliably and comfortably cover defects from middle third-lower third junction of thigh and the entire posterior aspect of the thigh. Such a local option offers relatively simple but more cost-effective approach to complex clinical problem with tolerable impairment of the donor site. CONCLUSION The GMC flap can be considered as a worthwhile alternative to free-tissue transfer for limb salvage.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Rahul Bhadgale
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Ankur Karanjkar
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Rohit Phulwer
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
| | - Chaitanya Ramteke
- Department of Plastic Surgery, BJG Medical College and Sassoon Hospital, Pune, India
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12
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Karanjkar A, Panse N, Narasimhan A, Sahasrabudhe P, Phulwar R, Gharwade C, Bhadgale R. Managing Post-Hansen’s Muscular Wasting of the 1st web: Using spare part surgery. LEPROSY REV 2017. [DOI: 10.47276/lr.88.4.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Bhansali C, Gandhi G, Sahastrabudhe P, Panse N. Epidemiological study of burn injuries and its mortality risk factors in a tertiary care hospital. Indian J Burns 2017. [DOI: 10.4103/ijb.ijb_28_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Sahasrabudhe P, Jagtap R, Jadhav A, Panse N, Juvekar N, Patwardhan S. Audit of 37 cases of deep sternal wound infections (DSWIs) following 2418 coronary artery bypass graftings (CABGs). Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Panse N, Sahasrabudhe P, Khade S. The levels of evidence of articles published by Indian authors in Indian journal of plastic surgery. Indian J Plast Surg 2015; 48:218-20. [PMID: 26424995 PMCID: PMC4564515 DOI: 10.4103/0970-0358.163072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
| | - Sagar Khade
- Department of General Surgery, B.J. Government Medical College and Sassoon Hospital, Pune, Maharashtra, India
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16
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Sahasrabudhe P, Panse N, Baheti B, Jadhav A, Joshi N, Chandanwale A. Reconstruction of complex soft-tissue defects around the knee joint with distally based split vastus lateralis musculocutaneous flap: a new technique. J Plast Reconstr Aesthet Surg 2014; 68:35-9. [PMID: 25448368 DOI: 10.1016/j.bjps.2014.09.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
AIMS The aim of this study was to report our experience of using distally based spilt vastus lateralis musculocutaneous flaps for soft-tissue defects around the knee joint - a new technique. MATERIAL AND METHODS Cadaver dissection studies were conducted in three cadavers to demonstrate perforators entering the lower third of the vastus lateralis muscle arising from the superior lateral genicular artery. Its application in eight clinical cases for the reconstruction of soft-tissue defects around the knee joint is reported. RESULTS Seven out of eight flaps survived well without any flap loss. One flap with a skin island measuring 12 × 20 cm suffered a loss of 2 cm distally. This was later treated with skin grafting. Six out of eight donor sites were closed primarily. Six patients achieved full functional range of motion by 3 months. One patient had a 10° limitation of knee extension. One patient had foot drop due to primary injury and walks with a limping gait. CONCLUSIONS This flap is a new reconstructive option for knee defects. It can reach distally up to the tibial tuberosity and does not require an intraoperative change of position. The donor site can be closed primarily and is hidden inside the clothing. The function of the knee is not affected as the majority of the muscle is kept in continuity.
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Affiliation(s)
- P Sahasrabudhe
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India.
| | - N Panse
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - B Baheti
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - A Jadhav
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - N Joshi
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - A Chandanwale
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospitals, Pune, Maharashtra, India
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17
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Sahasrabudhe P, Dighe T, Panse N, Deshpande S, Jadhav A, Londhe S. Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature. Indian J Plast Surg 2014; 47:362-9. [PMID: 25593421 PMCID: PMC4292113 DOI: 10.4103/0970-0358.146592] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis. MATERIALS AND METHODS This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months. OBSERVATIONS AND RESULTS In this study of 505 cases of AVFs, primary patency rates by Kaplan - Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon. CONCLUSIONS Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. Flow rates in patients with vein diam. >2 mm were significantly higher as compared with patients with vein diam. <2 mm (P < 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P < 0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm.
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Affiliation(s)
- Parag Sahasrabudhe
- Department of Plastic Surgery, Nephrology Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Tushar Dighe
- Department of Nephrology Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Nikhil Panse
- Department of Plastic Surgery, Sassoon Hospitals, Pune, Maharashtra, India
| | - Shraddha Deshpande
- Department of Plastic Surgery, Nephrology Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Amit Jadhav
- Department of Plastic Surgery, Nephrology Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Sheetal Londhe
- Department of Plastic Surgery, Nephrology Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Panse N, Panse S, Jhingan M, Kulkarni P, Gandhi G, Kulkarni Y. Knowledge and awareness of skin donation in medical students: Overcoming the barriers. Indian J Plast Surg 2014; 47:141-3. [PMID: 24987221 PMCID: PMC4075204 DOI: 10.4103/0970-0358.129652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Govt Medical College and Sassoon Hospital, Pune, India
| | - Smita Panse
- Department of Psychiatry, B.J. Govt Medical College and Sassoon Hospital, Pune, India
| | - Mrida Jhingan
- Intern, Department of Plastic Surgery, B.J. Govt Medical College and Sassoon Hospital, Pune, India
| | - Priya Kulkarni
- Department of Preventive and Social Medicine, DY Patil Medical College, Pune, India
| | - Giriraj Gandhi
- Department of Plastic Surgery, B.J. Govt Medical College and Sassoon Hospital, Pune, India
| | - Yashwant Kulkarni
- Department of Anatomy, Indira Gandhi Medical College, Nagpur, Maharashtra, India
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Abstract
Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J.Government Medical College & Sassoon Hospital, Pune, Maharashtra, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B.J.Government Medical College & Sassoon Hospital, Pune, Maharashtra, India
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Panse N, Sahasrabudhe P. Ectropion in a case of collodion baby. World J Plast Surg 2014; 3:146-7. [PMID: 25489540 PMCID: PMC4236995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nikhil Panse
- Correspondence Author: Nikhil Panse, MD, Vimal Niwas, Sudarshan Society, Near Model Colony Post Office, Shivajinagar, Pune 16, India. Tel: +9422314809. E-mail:
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Parajuli NP, Shrestha D, Panse N. Distally based sural faciocutaneous and fascial (adipofascial) flap for reconstruction of distal leg, ankle and foot defects. Kathmandu Univ Med J (KUMJ) 2014; 12:126-31. [PMID: 25552218 DOI: 10.3126/kumj.v12i2.13659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Any soft tissue defect in distal leg, ankle and hind foot is still a challenging problem. There are various options for coverage of such defects, but the distally based sural neurocutaneous and neurofascial flap based on the sural nerve and superficial sural artery has been an important option. OBJECTIVE To evaluate the efficacy of distally based sural flap in reconstruction of the distal leg, ankle and hind foot soft tissue defects. METHOD Seventeen patients with soft tissue defects over distal leg, ankle and hind foot were included in this study. All patients were treated with distally based sural flap. Most of the cases were due to trauma (16 cases) which compromised tendon and bone. One case was of malignant melanoma of sole of hind foot which required wide excision and soft tissue reconstruction with sural flap. RESULT In all cases defects were successfully covered. Three showed venous congestion and partial necrosis. One developed secondary infection. One flap failed completely. Mean follow up of patients was 20 months (6-36 months). CONCLUSION Sural flap is a good option for reconstruction of distal leg, ankle and foot defects.
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Affiliation(s)
- N P Parajuli
- Department of Orthopedics and Trauma, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal
| | - D Shrestha
- Department of Orthopedics and Trauma, Dhulikhel Hospital- Kathmandu University Hospital, Kathmandu University School of medical Science, Dhulikhel, Kavre, Nepal
| | - N Panse
- Department of Plastic Surgery, B.J medical College and Sassoon Hospital, Pune India
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Panse N. Telemedicine and plastic surgery in India. World J Plast Surg 2014; 3:70-1. [PMID: 25489528 PMCID: PMC4236985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nikhil Panse
- Correspondence Author: Nikhil Panse, MCh, DNB; Assistant Professor of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Shivajionagar, Pune 411016, India. Tel: +91-94-22314809, Fax: +91-20-26128000, E-mail:
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Dhondge R, Panse N, Sahasrabudhe P. Raal ointment compared with 1% silver sulfadiazine cream for the treatment of second degree burns. Indian J Burns 2014. [DOI: 10.4103/0971-653x.146999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Panse N, Sahasrabudhe P, Joshi N. Face avulsion and degloving. World J Plast Surg 2014; 3:64-7. [PMID: 25489526 PMCID: PMC4236979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/04/2013] [Indexed: 11/10/2022] Open
Abstract
There have been sparse reports in literature of avulsion and degloving injuries of individual areas of face like the nose, eyelids, ear and even mandible. Hemi-facial degloving is extremely rare. We present a case of post-assault degloving of the nose, part of forehead with anterior wall of frontal sinus, entire upper and lower eyelids and the cheek. Proper planning and staging of the surgical procedures and use of local flaps, meticulous and proper alignment of tissues gave us good aesthetic and functional outcome with a satisfied patient.
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Affiliation(s)
- Nikhil Panse
- Correspondence Author: Nikhil Panse, MCh, DNB; Assistant Professor of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Shivajionagar, Pune 411016, India. Tel: +91-94-22314809, Fax: +91-20-26128000, E-mail:
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25
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Panse N, Sathe V, Sahasrabudhe P, Joshi N. Diet, wound healing and plastic surgery. Indian J Plast Surg 2013; 46:161-3. [PMID: 23960336 PMCID: PMC3745116 DOI: 10.4103/0970-0358.113748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospital, Pune, India
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Abstract
This report describes our experience of arteriovenous fistula (AVF) creation as vascular access for hemodialysis (HD). Study has been carried out in Deenanath Mangeshkar Hospital, Pune from January 2004 to December 2009. A total of 271 AVFs were created in 249 patients. Maximum follow up was 7 years and minimum was 1 year. In this study of 271 cases of AVFs, there were 196 (72.3%) successful cases and 75 (27.7%) failures. Basilic vein was used in 77 (28.4%) cases, cephalic vein in 186 (68.6%), and antecubital vein in 8 (3%) cases. End (vein) to side (artery) anastomosis was done in 170 (63%) cases. Side to side anastomosis was done in 100 (37%) cases. On table bruit was present in 244 (90%) and thrill in 232 (85.6%) cases. During dialysis, flow rate >250 ml/min was obtained in 136 (50.4%) cases. In complications, 16 (5.9%) patients developed distal edema, 32 (11.8%) developed steal phenomenon. Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. During proximal side to side fistula between antecubital/basilic vein and brachial artery, breaking of first valve toward wrist helps to develop distal veins in forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in arm.
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Affiliation(s)
- P. Sahasrabudhe
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
| | - T. Dighe
- Department of Nephrology, Deenanath Mangeshkar Hospital and Research Center, Erandwane,, Pune, Maharashtra, India
| | - N. Panse
- Department of Plastic Surgery, Sassoon Hospitals, Pune, Maharashtra, India
| | - S Patil
- Department of Plastic Surgery, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
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Panse N, Sahasrabudhe P, Chandanwale A, Joshi N. A rare case of horse shoe shaped lipoma of the upper extremity. World J Plast Surg 2013; 2:41-3. [PMID: 25489503 PMCID: PMC4238334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/22/2012] [Indexed: 10/25/2022] Open
Abstract
Horse shoe shaped lipoma of the upper extremity is a very rare entity. We present a case of 45 years old female who presented with painless progressive swelling over the distal forearm and tingling and numbness over the ulnar nerve territory. MRI and surgical exploration showed a horse shoe shaped multilobulated lipoma encasing the distal ulna. The mass was excised in toto, and the sensory alterations were completely relieved at three months follow up. We would like to highlight this rare occurrence of a horse shoe lipoma and present a detailed history of this case to increase awareness amongst clinicians regarding this condition.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJ Med- ical College and Sassoon Hospital, Pune, India;,Corresponding Author: Nikhil Panse, MD, Assistant Professor of Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Shivajinagar, Pune 16, India. Tel: +9422314809, E-mail:
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, BJ Med- ical College and Sassoon Hospital, Pune, India
| | - Ajay Chandanwale
- Department of Orthopaedics, BJ Medi- cal College and Sassoon Hospital, Pune, India
| | - Namrata Joshi
- Department of Surgery, BJ MedicalCollege and Sassoon Hospital, Pune, India
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Panse N, Sahasrabudhe P, Joshi N. Perforator relocation in free style local perforator flaps. World J Plast Surg 2013; 2:47-9. [PMID: 25489505 PMCID: PMC4238331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/29/2012] [Indexed: 11/23/2022] Open
Abstract
Local perforator flaps have evolved over the time to provide complete and stable coverage of soft tissue defects. Technical advances and experience with the perforator flaps have allowed the harvest of local perforator flaps in a free style manner by offering greater freedom in flap selection. We have proposed a technical modification in the harvest of a perforator flap by relocating the perforator to an anatomically favorable location. This has led to decreased traction over the perforator and provided some amount of added length to the perforator.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India
| | - Namrata Joshi
- Department of Surgery, BJ Medical College and Sassoon Hospital, Pune, India
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Abstract
There is considerable literature on the potential for a femoral blowout in case of fungating inguinal lymph nodes in a case of penile carcinoma. However, reported cases of actual femoral blowout are sparse in literature. We encountered one such case of femoral blowout because of fungating inguinal lymph nodes in a case of Ca.Penis. Emergency palliative resection of the fungating nodes, ligation of the femoral vein, and emergency flap cover in the form of a perforator-based anterolateral thigh flap was performed. We believe that patients with a potential of femoral blowout should undergo resection and suitable coverage to prevent fatal hemorrhage.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India
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30
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Sahasrabudhe P, Panse N, Waghmare C, Waykole P. V-y advancement flap technique in resurfacing postexcisional defect in cases with pilonidal sinus disease-study of 25 cases. Indian J Surg 2012; 74:364-70. [PMID: 24082587 PMCID: PMC3477405 DOI: 10.1007/s12262-011-0403-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022] Open
Abstract
We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21-30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan.
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Affiliation(s)
- Parag Sahasrabudhe
- Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, Maharashtra India
| | - Nikhil Panse
- Sassoon General Hospitals, Pune, Maharashtra India
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Sahasrabudhe P, Jagtap R, Waykole P, Panse N, Bhargava P, Patwardhan S. Our experience with pectoralis major flap for management of sternal dehiscence: A review of 25 cases. Indian J Plast Surg 2012; 44:405-13. [PMID: 22279272 PMCID: PMC3263267 DOI: 10.4103/0970-0358.90810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To report our experience of the pectoralis major flap as the treatment modality for post coronary artery bypass sternal wound dehiscence. Materials and Methods: A retrospective study of 25 open heart surgery cases, performed between January 2006 and December 2010 at Deenanath Mangeshkar Hospital, Pune, was carried out. Unilateral or bilateral pectoralis major muscle flap by the double breasting technique using rectus extension was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and post-surgery shoulder joint movements to evaluate donor site morbidity. The follow-up ranged from 5 months to 3.5 years. Results: Twenty-three (92%) patients were discharged with complete wound closure. One patient (4%) had wound dehiscence after flap surgery. One patient (4%) died in the hospital in the immediate postoperative period due to mediastinitis. No recurrent sternum infection has occurred till date in 24 patients (96%). For one patient (4%) who had wound dehiscence, daily dressing was done and wound healing was achieved with secondary intension. At follow-up, shoulder joint movements were normal in all the patients. Conclusions: The double breasting technique of the pectoralis major muscle flaps with rectus sheath extension is efficient in covering the entire length of the defect and can reduce the morbidity, without affecting the function of the shoulder joint.
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Affiliation(s)
- Parag Sahasrabudhe
- Department of Plastic and Cosmetic Surgery, Deenanath Mangeshkar Hospital, B. J. Medical College and Sassoon Hospitals, Pune, India
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Panse N, Sahasrabudhe P, Pande G, Chandanwale A, Dhongde R, Rajpal L. The split tibialis anterior muscle flap - A simple solution for longitudinal middle third tibial defects. Indian J Plast Surg 2012; 45:53-7. [PMID: 22754153 PMCID: PMC3385399 DOI: 10.4103/0970-0358.96585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The tibialis anterior flap is an underused flap, mainly because it is not an expendable muscle and is small in size. Aim: To study the use of the tibialis anterior muscle flap for longitudinal middle third tibial defects. Materials and Methods: We have analysed the use of tibialis anterior flap in five patients by the function preservation technique. Results and Conclusion: Function preservation techniques used in the harvesting of this flap will be able to cover narrow and linear defects on middle third of tibia comfortably. Size and pliability of the muscle must be assessed before initiation of harvesting of the flap. Flap harvesting is initiated by a saggital split incision to preserve maximum blood supply to the muscle. Transverse incisions may be employed to obtain the desired reach of the flap. This flap is a simple alternative for linear wounds with small transverse dimensions on middle third of the leg, where the tibialis anterior muscle is uninjured.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J Medical College and Sassoon Hospital, Pune, Maharashtra, India
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Affiliation(s)
- Nikhil Panse
- B.J Medical College and Sassoon hospital, Pune, India
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Abstract
Background: Cheek dimples are usually considered as an attractive feature of facial beauty. Unfortunately, not all beautiful girls have dimples. Literature on dimple creation surgery is sparse. Aims: We used a new and simple technique for dimple creation, passing a transcutaneous bolster stitch after scraping off the dermis of all mucomuscular attachments. Our aim was to analyse the positive and negative findings of this technique. Materials and Methods: We used this procedure in creation of 100 dimples under local anaesthesia as a daycare procedure and analysed the results. Results and Conclusion: This procedure is safe, reliable and easily reproducible. As no tissue is excised, chances of bleeding and haematoma formation are negligible. With this procedure, the patient satisfaction rate is very high, and patients seen long time after surgery continue to be pleased with their surgically created dimples.
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Affiliation(s)
- A R Lari
- Medical Director and Head, Lari Clinic, Kuwait
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35
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Panse N, Sahasrabudhe P, Dhondge R. Complex nasal and periorbital reconstruction using locoregional flaps: a case report. World J Plast Surg 2012; 1:116-20. [PMID: 25734054 PMCID: PMC4345426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Facial reconstruction is one of the most challenging problems faced by a reconstructive surgeon. We present a case of complex facial reconstruction with a composite trauma to the nose resulting in near total loss of skin and lining along with complete loss of left eyebrow with exposed frontal bone and partial loss of the left eyelid. We combined a temporoparietal fascial flap for reconstruction of the eyebrows and covering the exposed frontal bone and prefabricated forehead flap with skin graft for nasal reconstruction. Proper planning and staging of the surgical procedures and use of local flaps gave us good aesthetic and functional outcome with a satisfied patient.
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Affiliation(s)
- Nikhil Panse
- Corresponding Author: Nikhil Panse, MD, Assistant Professor in Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Near Model Colony Post Office, Shivajinagar, Pune 16, India, Tel: +9422314809,
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Panse N, Sahasrabudhe P, Joshi S, Telang R. Platysmal book flap for tracheostomy scars. Indian J Plast Surg 2012; 44:526-8. [PMID: 22279298 PMCID: PMC3263293 DOI: 10.4103/0970-0358.90857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J Medical College and Sassoon Hospital, Pune, India
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospital, Pune, India
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38
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Panse N, Sahasrabudhe P, Pande G. Successful correction of postburn mentosternal contracture and kyphosis of thoracic spine with thoracodorsal artery perforator flap: A case report and review of literature. Indian J Burns 2012. [DOI: 10.4103/0971-653x.111794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Panse N, Sahasrabudhe P, Bhatt Y. Use of local perforator flaps for post burn reconstruction. World J Plast Surg 2012; 1:22-9. [PMID: 25734040 PMCID: PMC4344962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mainstay of post-burn reconstruction is release and split skin grafting. Pedicle flaps are cumbersome to the patient, require multiple procedures and hospitalization. Free flaps are technically demanding and facilities are not universally available. Here we evaluated the local perforator flaps for post-burn reconstruction. METHODS We have used sixteen perforator propellar flaps for post-burn reconstruction for various areas of body. RESULTS All flaps did well without any recontracture and need of splintage. CONCLUSION Local perforator flaps should be considered as one of the primary treatment options for post burn reconstruction.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India,Corresponding Author: Nikhil Panse, M.Ch,DNB, Assistant Professor of Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Vimal Niwas, Sudarshan Society, Shivajinagar, Pune 411016, India. Tel: +91-20-25655451; +91-9422314809, Fax: +91-20-26128000, E-mail: ,
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, BJ Medical College and Sassoon Hospital, Pune, India
| | - Yogesh Bhatt
- Department of Plastic Surgery, Medical College and SSG Hospital, Baroda, India
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Panse N, Sahasrabudhe P. Hand injury prevention in India: Are we doing enough? Indian J Plast Surg 2011. [DOI: 10.1055/s-0039-1699533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B. J. Medical College and Sassoon Hospital, Pune, India
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Abstract
An ulnar digital artery perforator flap was used for little finger reconstruction. The flap has a reliable blood supply, being perfused by a constant sizeable perforator. This paper describes a study of a cadaveric dissection with methylene blue dye that was conducted to prove the rationality and reliability of the blood supply. The position of the perforator is confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger in three cases yielded positive results. To our knowledge, a digital artery perforator flap of this nature is unprecedented. We propose to call this flap the B.J. Flap after our institute.
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Medical College and Sasoon Hospital, Pune, India
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Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J Medical College and Sasoon Hospital, Pune, India
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Srivastava RK, Tandale MS, Panse N, Gupta A, Sahane P. Management of urethrocutaneous fistula after hypospadias surgery - An experience of thirty-five cases. Indian J Plast Surg 2011; 44:98-103. [PMID: 21713169 PMCID: PMC3111134 DOI: 10.4103/0970-0358.81456] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: The commonest complication following hypospadias repair is occurrence of urethrocutaneous fistula. The smaller fistulas (<2 mm) are easier to close with a simple closure whereas larger ones (>2 mm) with good vascular surrounding skin require a local skin flap closure for avoiding overlapping suture lines. For the recurrent/larger fistulas with impaired local surrounding skin - incidence of recurrence is significantly reduced by providing a waterproofing interposition layer. Aims: To study the effect of size, location, number of fistulas and surrounding tissues in selecting the procedure and its outcome. To identify various factors involved in the recurrence and to formulate a management in the cases where recurrence has occurred. Patients and Methods: This study of 35 cases of urethrocutaneous fistula repair was done from July 2006 to May 2009 to achieve better results in fistula management following hypospadias surgery. Statistical analysis used: X2 test and Fisher's exact test. Results: The overall success rate for fistula repair at first attempt was 89% with success rates for simple closure, layered closure and closure with waterproofing layer being 77%,89% and 100%, respectively. The second attempt success rate at fistula repair for simple closure and closure with waterproofing layer were 33% and 100%, respectively. At third attempt the two recurrent fistulas were managed by simple closure with a waterproofing interposition layer with no recurrence. All the waterproofing procedures in this study had a success rate of 100%. Conclusions: The treatment plan for a fistula must be individualized based on variables which has an effect on the outcome of repair and to an extent dictates the type of repair to be performed. The significantly improved success rates with the addition of a waterproofing layer suggests the use of this interposition layer should be done at the earliest available opportunity to prevent a reccurence rather than to reserve it for future options.
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Panse N, Sahasrabudhe P. The ulnar digital artery perforator flap. Indian J Plast Surg 2011; 44:162. [PMID: 21713210 PMCID: PMC3111115 DOI: 10.4103/0970-0358.81464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Medical College and Sasoon Hospital, Pune, India
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Panse N, Sahasrabudhe P. Anterolateral thigh flap for contralateral adductor canal defects. Indian J Plast Surg 2011; 43:225-7. [PMID: 21217990 PMCID: PMC3010792 DOI: 10.4103/0970-0358.73471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College and Sasoon Hospital, Pune, India
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Panse N, Sahasrabudhe P. Understanding the fibula by the candle model. Indian J Plast Surg 2011. [DOI: 10.1055/s-0039-1699496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J Medical College and Sasoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B.J Medical College and Sasoon Hospital, Pune, India
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Panse N, Sahasrabudhe P. The ulnar digital artery perforator flap. Indian J Plast Surg 2011. [DOI: 10.1055/s-0039-1699499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B.J. Medical College and Sasoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B.J. Medical College and Sasoon Hospital, Pune, India
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Panse N, Sahasrabudhe P, Date S, Balwantkar S. Splinting of penis after micro vascular reconstruction: A simple inexpensive method. Indian J Plast Surg 2010; 43:118-9. [PMID: 20924470 PMCID: PMC2938611 DOI: 10.4103/0970-0358.63945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College & Sasoon Hospital, Pune, India
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Panse N, Sahasrabudhe P, Date S, Balwantkar S. Splinting of penis after micro vascular reconstruction: A simple inexpensive method. Indian J Plast Surg 2010. [DOI: 10.1055/s-0039-1699422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Nikhil Panse
- Department of Plastic Surgery, B. J. Medical College & Sasoon Hospital, Pune, India
| | - Parag Sahasrabudhe
- Department of Plastic Surgery, B. J. Medical College & Sasoon Hospital, Pune, India
| | - Sanjay Date
- Department of Plastic Surgery, B. J. Medical College & Sasoon Hospital, Pune, India
| | - Sachin Balwantkar
- Department of Plastic Surgery, B. J. Medical College & Sasoon Hospital, Pune, India
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