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Periasamy M, Muthukumar V, Venkatramani H, Sabapathy SR. Reconstruction of plantar forefoot in diabetic foot ulcers with microvascular tissue transfer using tunneled pedicle with dorsal anastomosis. J Plast Reconstr Aesthet Surg 2024; 91:3-5. [PMID: 38401275 DOI: 10.1016/j.bjps.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Madhu Periasamy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, Tamil Nadu, India.
| | - Vamseedharan Muthukumar
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, Tamil Nadu, India.
| | - Hari Venkatramani
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, Tamil Nadu, India.
| | - Shanmuganathan Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore 641043, Tamil Nadu, India.
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Periasamy M, Muthukumar V, Venkatramani H, Sabapathy SR. Recipient Vessel Dissection Technique in Diabetic Foot Patients with Perivascular Fibrosis. Indian J Plast Surg 2023; 56:526-527. [PMID: 38105884 PMCID: PMC10721359 DOI: 10.1055/s-0043-1775870] [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: 12/19/2023] Open
Abstract
Diabetic foot ulcers are becoming more prevalent, and microsurgical free flaps are gaining popularity in salvaging the foot after postdebridement. The perivascular fibrosis around the recipient vessels often makes the dissection of vessels difficult. In this article, we describe a technique of dissection in such situations where fibrosis and dissection of vessels are fraught with danger. In the period from November 2020 to May 2023, 72 free flap reconstructions of the diabetic foot were done at our institute using this technique, with a success rate of 95.8%.
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Affiliation(s)
- Madhu Periasamy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Vamseedharan Muthukumar
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Jatin B, Karki D, Ahluwalia C, Muthukumar V, Karki D. Lipofilling-A Regenerative Alternate for Remodeling Burn Scars: A Clinico-Immunohistopathological Study. Indian J Plast Surg 2023; 56:357-366. [PMID: 37705812 PMCID: PMC10497342 DOI: 10.1055/s-0043-1771515] [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: 09/15/2023] Open
Abstract
Introduction Any injury involving the dermis will lead to scarring. Scar tissue can cause functional limitations, cosmetic impairments, pain, and itch. Adipose-derived stem cells have also been shown to play a role in scar modulation. This study evaluates changes in lipofilled scar over the period of time and compares it with non-lipofilled scar tissue. Materials and Methods A prospective case-control study with intraindividual follow-up was performed on 30 adult patients with post-burn scars from November 2016 to May 2019. Clinical, histopathological, and immunohistochemical parameters were assessed among the case and control regions of the scar. Results Mean age of the study population was 30.6 years. The duration of the scar included in this study ranged from 1 to 28 years, with a mean duration of 5.91 years. There was a significant reduction in pain, itch, stiffness, and an increase in the pliability of the scar, and a substantial improvement in the modified Vancouver Scar Score in the lipofilled group. In histopathological analysis, the case group showed organized parallel collagen fibers, a significant reduction in melanocytes, improvement in vascularity, and a significantly increased amount of collagen fibers at the reticular dermis. Immunohistochemical analysis indicated new cell synthesis in the scar tissue and reduced melanocytes. Conclusion The remodeling effect of adipocyte-derived stem cells is long-lasting, and there is a gradual improvement in most of the parameters. Lipofilling has regenerative capacity, which leads to the improved overall appearance of scar and improvement at the cellular level.
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Affiliation(s)
- Bhojani Jatin
- Department of Plastic, Burns & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
| | - Durga Karki
- Department of Plastic, Burns & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
| | | | - Vamseedharan Muthukumar
- Department of Plastic, Burns & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
| | - Divyanjali Karki
- School of Biosciences, Engineering and Technology, VIT Bhopal, Madhya Pradesh, India
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Periasamy M, Muthukumar V, Mali Reddy R, Asokan K, Sabapathy SR. Outcomes of Keller Gap Arthroplasty for Plantar Hallux Interphalangeal Joint Ulcers in Patients With Diabetes Mellitus. Foot Ankle Int 2023; 44:192-199. [PMID: 36760022 DOI: 10.1177/10711007231152883] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Hallux ulcers are known for their recurrence and associated risk for future amputations. Traditional nonsurgical external offloading methods have poor compliance rates, and the data is sparse on surgical offloading of hallux ulcers. We performed this study to analyze the outcomes of Keller excision gap arthroplasty of the first metatarsophalangeal joint in patients with a neuropathic plantar hallux interphalangeal joint (IPJ) ulcer in patients with diabetes mellitus. METHODS A retrospective study of 105 diabetic patients with a plantar hallux IPJ ulcer who underwent a Keller excision gap arthroplasty between December 2014 and June 2020 was done. A total of 122 great toes had been operated upon for hallux IPJ ulcers. We studied the long-term wound healing rates from patient records and then did a prospective survey of the postreview period. RESULTS All the hallux IPJ ulcers healed well in the immediate postoperative period. Six patients reported a recurrence of the ulcer at the original site during a mean follow-up period of 30 months. For these 6 patients, the mean time to recurrence of ulcer after operation was 2.5 years. CONCLUSION At an average of 30 months, we found the Keller gap arthroplasty for treatment of noninfected and nonischemic diabetic foot hallux IPJ ulcers was associated with an ulcer recurrence rate of 5%. LEVEL OF EVIDENCE
Level IV, cohort study.
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Affiliation(s)
- Madhu Periasamy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, TN, India
| | - Vamseedharan Muthukumar
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, TN, India
| | - Radhika Mali Reddy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, TN, India
| | - Kumanan Asokan
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, TN, India
| | - S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, TN, India
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Periasamy M, Muthukumar V, Ahamed Pi F, Ahammed V A, Venkatramani H, Sabapathy SR. Single-stage Flexor Hallucis Longus transfer and Gracilis free flap cover for failed Achilles tendon repair with soft tissue defect. J Plast Reconstr Aesthet Surg 2023; 77:236-243. [PMID: 36587479 DOI: 10.1016/j.bjps.2022.11.028] [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] [Received: 08/13/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Reconstruction of failed Achilles tendon repair, with infection and loss of overlying skin, is a surgical challenge. This paper aims to deal with the technical considerations and study the outcome of reconstructing such defects by radical debridement and reconstruction with combined Flexor hallucis longus (FHL) transfer and free Gracilis flap cover. MATERIALS AND METHODS A retrospective study of six patients with failed Achilles tendon repair with overlying skin and soft tissue loss reconstructed by FHL transfer and free Gracilis flap cover performed between January 2017 and August 2020 was conducted. Postoperatively, they were assessed with the Mean Functional Gait Assessment score(MFGA), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, the Achilles tendon Total Rupture Score (ATRS), and Modified Vancouver scar scale score (mVSS). RESULTS All six patients reported a good gait at nine months of follow-up. The MFGA score at six months was 24.8. The mean ankle plantar flexion at nine months follow up was 39.1° . The mean nine-month postoperative AOFAS and ATRS scores were 86.33 ± 2.654 and 88.5 ± 5.54, respectively. At nine months, all the patients could perform a single-leg heel raise on the operated foot. The overall mean mVSS score was 1.41. In about 12 months, the peak forefoot to hindfoot ratio matched the uninjured opposite foot. CONCLUSION Simultaneous reconstruction of the Achilles tendon with FHL transfer with free Gracilis flap for the coverage of overlying soft tissue loss is a good management option for failed Achilles tendon repair with overlying skin loss.
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Affiliation(s)
- Madhu Periasamy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043
| | - Vamseedharan Muthukumar
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043
| | - Febin Ahamed Pi
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043
| | - Ajeer Ahammed V
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043
| | - Hari Venkatramani
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043
| | - S Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, India, 641043.
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Sabapathy SR, Shanmugakrishnan RR, Ramkumar S, Muthukumar V, Senthilkumaran M, Bharathi RR. Postburn Reconstruction of the Face and Neck. Plast Reconstr Surg 2022; 150:1326e-1339e. [DOI: 10.1097/prs.0000000000009690] [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: 11/30/2022]
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Periasamy M, Asokan K, Mohan M, Muthukumar V, Venkatramani H, Sabapathy SR. Parachute Method: A Novel Method to Retrieve a Stuck Degloved Finger. Indian J Plast Surg 2022; 55:307-310. [PMID: 36325091 PMCID: PMC9622326 DOI: 10.1055/s-0042-1744455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/07/2022] Open
Abstract
An entrapped finger is a relatively uncommon domestic injury. When the finger gets stuck proximal to the proximal interphalangeal joint, the resultant distal edema and inappropriate attempts at retrieval can result in circumferential degloving of the skin and injury to the neurovascular structures. We report a technique that can be used in such circumstances. Strategically placed skin sutures are used to get the skin through the constricting ring, and retrieval is aided by a cut finger glove that wraps the finger and can be lubricated. This non-cutting technique is named as the parachute technique since the withdrawn skin sutures look like the strings of the parachute. This technique is valuable when the finger gets stuck in an idli plate, a common South Indian kitchen utensil, where there is difficulty of access to cutting equipment and where inappropriate attempts at retrieval can result in skin injury making further attempts more difficult.
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Affiliation(s)
- Madhu Periasamy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Kumanan Asokan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Vamseedharan Muthukumar
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India,Address for correspondence S. Raja Sabapathy, MS, MCh, DNB, FRCS (Edin), Hon. FRCS (Glasgow), Hon. FACS Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043India
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Venkatramani H, Patel SK, Mohan M, Muthukumar V, Sabapathy SR. Emergency Foot Fillet Free Flap Based on Posterior Tibial Vessels for Reconstruction of Contralateral Heel and Sole: A Unique Spare Part Surgery. J Hand Microsurg 2022. [DOI: 10.1055/s-0042-1749443] [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: 10/17/2022] Open
Abstract
Abstract
Introduction Reconstruction of the sole is an extremely challenging problem for a reconstructive microsurgeon. The specialized nature of its skin and subcutaneous tissue makes reconstruction arduous. When posed with complex bilateral lower extremity trauma where one limb was nonsalvageable, we harvested the uninjured foot fillet flap for free flap cover to reconstruct the contralateral sole. We report two such cases with follow-up assessment.
Patients and Methods Two cases of sole reconstruction with emergency foot fillet free flap scavenged from the amputated contralateral limb were retrospectively analyzed. In both the patients, foot fillet free flap based on the posterior tibial neurovascular bundle was used. The follow-up assessment data collected included flap status, presence of any complications and prosthesis use, and functional status of the limbs at final follow-up.
Results Both the free flaps survived. Postoperative period was uneventful. No complications such as wound infection, delayed healing, flap necrosis, or scar breakdown were noted. The plantar flaps had recovery of protective sensation. Both the patients are ambulant; the first man with a fitted prosthesis and the second woman with the aid of a walker.
Conclusion The opportunity to utilize spare tissue from the amputated limb should be seized. Loss of the plantar aspect of foot poses a real challenge. The plantar foot fillet free flap is a durable flap with preservation of plantar sensations. It is probably the best choice as it replaces “like with like.” Prerequisites for utilizing the “spare part surgery” concept are meticulous initial debridement as well as emergency free tissue transfer, which require senior input and excellent infrastructure.
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Affiliation(s)
- Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Smitkumar K. Patel
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Monusha Mohan
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - Vamseedharan Muthukumar
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Centre and Hospital, Coimbatore, India
| | - S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Medical Centre and Hospital, Coimbatore, India
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Karki D, Dawson L, Muthukumar V, Aggarwal N. Blood Indices In Adult Acute Burn: A Window Into Milieu Interieur - The Future Biomarkers? Ann Burns Fire Disasters 2022; 35:46-54. [PMID: 35582086 PMCID: PMC9020846] [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] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 06/15/2023]
Abstract
Optimal treatment of sepsis in burned patients depends on early diagnosis and includes prompt administration of antimicrobials as well as management of hemodynamic alterations and other organ dysfunctions. The role of red blood cell distribution width (RDW) and platelet indices in prognosticating and identifying sepsis in acute burn patients is studied. This study was done as a prospective study over 18 months, including patients in the age group >18 or <60 years, with burns >20% and <70% TBSA, burn time to resuscitation time 24 hours or less and with thermal and scald burns. Data of 157 patients were analyzed and the following observations were made. The mean age of the study population was 31.36 years (18-59 years). RDW values were higher in the non-survivor group. Platelet count and plateletcrit were higher in the survivor group and the no sepsis group. Positive rising trends of platelet count and plateletcrit were seen in the survivor group. Day 1, 3, 7 values of RDW, platelet count and plateletcrit were significant in determining the outcome of the patient on mortality and sepsis related morbidity of the patient. RDW, platelet count and plateletcrit in combination can predict mortality and sepsis as early as the third day, thus giving a clinical advantage of initiating targeted treatment to the at-risk burn population before sepsis is detected clinically. This could better the outcomes in treatment of burn patients.
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Affiliation(s)
- D Karki
- Dr. Durga Karki MS, MCh, DNB, MNAMS, FACS
Dept. of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung HospitalDelhi 110029India+91 1126122903; +91 9910649386
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Venkatramani H, Periasamy M, Muthukumar V, Sabapathy SR. Neglected Infected Post-traumatic Pseudoaneurysms of Anterior Tibial Artery: A Case Report and the Lessons Learnt. Indian J Plast Surg 2022; 55:124-125. [PMID: 35444746 PMCID: PMC9015822 DOI: 10.1055/s-0041-1740525] [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: 11/29/2022] Open
Affiliation(s)
- Hari Venkatramani
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Madhu Periasamy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Vamseedharan Muthukumar
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Division of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Dash S, Arumugam PK, Muthukumar V, Kumath M, Sharma S. Study of clinical pattern of limb loss in electrical burn injuries. Injury 2021; 52:1925-1933. [PMID: 33902868 DOI: 10.1016/j.injury.2021.04.028] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Electrical burn injuries are devastating and cause not only loss of life but also severe disabilities in the form of limb loss. Increase in urbanization, industrialization and overcrowding has led to an increase in electric injuries. MATERIAL AND METHODS The study was prospective in nature evaluating electric burns and studied the pattern of limb loss for a duration of 18 months from October 2016 to March 2018. Parameters recorded were demographic data, clinical data regarding the electrical injuries, complications, and outcomes. RESULTS Male patients made up 85.3% of cases. Mean TBSA was 24.76 ± 19.18%. Mean age was 27.59 ± 13.73 years. Pediatric patients made up 17%. High voltage burns constituted 68.2 %. Electric contact burn was the most common type making up 49.5% of cases. The most common cause was occupational (38.9%). A fasciotomy was required in 22% of cases with an amputation rate of 38% (209 out of 550). There were 190 major amputations and 106 minor amputations. Overall, the right upper limb amputations were twice as common as the left. The ratio of upper limb: lower limb amputation was 4:1. Fifty patients (23.9%) required revision amputation. The age group 11 to 30 years made up 55.5% of amputations. There was no statistical difference in amputation rates between males (31.31%) and females (41.97%). In patients with TBSA less than 25% amputation rate was 47.77% as compared to patients with more than 25% TBSA, 19.47% (p<0.001). Most amputations occurred due to electric contact burns (74.16%). In the high voltage group, 46.1% underwent amputation vs low voltage group -20.6% (p<0.001). Overall mortality rate was 12.7%. Three hundred patients (55%) had low level of awareness regarding consequences of electric injury. Thirty one percent had medium level of awareness and only 14 % had high level of awareness. There was a significant correlation between education level and awareness in adult patients (p<0.001). Seventy percent of persons with occupational injuries used only footwear and no other protective equipment. CONCLUSION Increasing public awareness, safety measures at workplaces are measures that will help reducing electrical burns which reduce limb and life loss.
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Affiliation(s)
- Suvashis Dash
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Praveen Kumar Arumugam
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi.
| | - Manish Kumath
- Dept. of Forensic Medicine, V.M. Medical College & Safdarjung Hospital, New Delhi, 110029, India.
| | - Shardendu Sharma
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, New Delhi
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Abstract
Fasciotomy is indicated to relieve compartment syndrome caused by electric burns. Many techniques are available to close the fasciotomy wounds including vacuum-assisted closure, skin grafting, and healing by secondary intention. This study assessed the shoelace technique in fasciotomy wound closure in patients with electric burns. The study included 19 fasciotomy wounds that were treated by shoelace technique (Group ST, n = 10 fasciotomy wounds) or by skin grafting/healing by secondary intention (Group C, n = 9 fasciotomy wounds). Data were collected for wound surface area, time to intervention, time to wound closure, rate of decrease in wound surface area after application of shoelace technique and associated complications. The mean time to intervention after fasciotomy was significantly lower in Group ST-7.6 ± 3.8 days as compared to 15.8 ± 5.3 days in Group C (P = .004). The median time to closure was also significantly lower in Group ST-7 days (range 6-10) as compared to Group C-20 days (range 12-48) (P < .001). Primary closure was achieved in 80% cases in the group ST and no complications were recorded. The shoelace technique is an economical, fast, and effective method of fasciotomy wound closure in electric burns, especially in high volume centers and resource-limited areas.
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Affiliation(s)
- Praveen Kumar Arumugam
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Rahul Bamal
- Department of Burns, Plastic and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India.,School of Medicine, Griffith University, Gold Coast, Australia
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Muthukumar V, Arumugam P, Narasimhan A, Kumar S, Sharma U, Sharma S, Kain R. Blood Lactate And Lactate Clearance: Refined Biomarker And Prognostic Marker In Burn Resuscitation. Ann Burns Fire Disasters 2020; 33:293-298. [PMID: 33708018 PMCID: PMC7894842] [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] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 06/12/2023]
Abstract
Adequate resuscitation of acute burn patients is important to ensure end organ perfusion and oxygenation. The ideal marker to the endpoint of burn resuscitation is still not established. We aimed to evaluate the role of blood lactate and lactate clearance in burn resuscitation and their association with mortality and sepsis in burn patients. The retrospective study included patients (18-50 years) with thermal and scald burns with total body surface area of 30% to 60% over a period of 9 months who had achieved target urine output of at least 0.5ml/kg/hr within 24 hours of resuscitation. Patients were divided based on their admission blood lactate levels (Group A < 2 mmol/L and Group B > 2 mmol/L). Group B was further subdivided into Group B1 in whom blood lactate levels reached less than 2 mmol/L within 24 hours of burn resuscitation and Group B2 in whom it did not. Total patients included were 203. Mortality (M) and sepsis (S) rates in subgroup B2 were higher (M=57.9%; S=43.5%) and rates in subgroup B1 (M=25.8%; S=27.4%) were comparable to Group A (M=27.8%; S=26.4%). Persistent lactic acidosis at 24 hours was independently associated with significantly increased mortality and sepsis. Our data suggests a correlation of blood lactate levels and lactate clearance within 24 hours of admission with mortality and sepsis related to burn injury.
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Affiliation(s)
| | | | | | - S. Kumar
- Dr. Shalabh Kumar MCh (Plastic Surgery), Professor and Head Dept. of Plastic, Burns & Maxillofacial Surgery
V.M. Medical College & Safdarjung HospitalDelhi - 110029India+91 9818710366
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Dash S, Muthukumar V, Rajkumar R, Karki D. Cryogenic Refrigerant Burns: A Rare Occupational Hazard. Workplace Health Saf 2020; 69:109-114. [PMID: 33357039 DOI: 10.1177/2165079920965539] [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: 11/15/2022]
Abstract
BACKGROUND Cryogenic burns induced by coolant gases used in refrigerators and air conditioners are rarely encountered, despite the wide use of these gases. To date, only a few cases have been reported in the literature. This study examined the occupational circumstances leading to such injuries, relevant injury sites, types of chemicals involved, and treatment measures. METHODS This study was conducted in a tertiary burn center in India between March 2015 and March 2019. The demographic details, chemicals involved, and burn regions and characteristics were analyzed. FINDINGS There were 15 burn cases all involving injury to the hand. All injuries were managed initially with dressings and nonoperative management. One patient required anti-edema therapy with limb elevation and fingertip debridement, while another patient required skin grafting. All patients had satisfactory hand function after treatment. CONCLUSIONS/APPLICATION TO PRACTICE Cryogenic burn injuries caused by refrigerants are rare, and their etiology varies considerably. Exposure time is the primary factor that determines burn depth and severity; hence, reducing exposure time is important in first aid. Our findings suggest that after exposure, the patient should be treated in a specialized burn center. Adequate knowledge regarding the pathophysiology of these types of burn injuries and their management is necessary; otherwise, misjudgments in the treatment plan can lead to adverse consequences.
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Affiliation(s)
- Suvashis Dash
- Vardhman Mahavir Medical College & Safdarjung Hospital
| | | | - R Rajkumar
- Vardhman Mahavir Medical College & Safdarjung Hospital
| | - Durga Karki
- Vardhman Mahavir Medical College & Safdarjung Hospital
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Karki D, Muthukumar V, Dash S, Singh AK. Trapezius Transfer to Restore Shoulder Function in Traumatic Brachial Plexus Injury: Revisited and Modified. J Hand Surg Asian Pac Vol 2020; 25:143-152. [PMID: 32312206 DOI: 10.1142/s2424835520500150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Abstract
Background: Trapezius transfer has shown promise to restore shoulder movements and has stood through the passage of time. We here in describe a modification of trapezius transfer technique and review the current literature available. Methods: The modified trapezius transfer in which the trapezius muscle is extended with folded tensor fascia lata graft and attached as distally possible to the deltoid insertion was done in twelve patients at tertiary health care centre in India. Post-operative splinting and staged physiotherapy were given. Results: Results were described in the form of improvement in degree of shoulder abduction and Disabilities of the Arm, Shoulder and Hand (DASH) score. Six months post-surgery there were improvement in shoulder abduction and DASH score with mean 116 degrees (10-180 degree) and 38 (23-58) respectively. One patient showed poor results due to poor compliance in post-operative period. There were no major complications observed. Conclusions: The modified technique of trapezius transfer described here is a feasible option with good biomechanical outcomes. The technique is simple and can be adopted easily by emerging brachial plexus surgeon as a technique for secondary reconstruction of shoulder joint.
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Affiliation(s)
- Durga Karki
- Department of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung Hospital, Delhi, India
| | - Suvashis Dash
- Department of Plastic, Burns & Maxillofacial Surgery, V.M. Medical College & Safdarjung Hospital, Delhi, India
| | - Arun K Singh
- Department of Plastic and Reconstructive Surgery, King George Medical University, Uttar Pradesh, India
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Karki D, Muthukumar V. Postburn Nasal Reconstruction With Distally Based Radial Artery Perforator Flap: A Novel Technique. J Burn Care Res 2020; 41:731-733. [PMID: 32020199 DOI: 10.1093/jbcr/iraa022] [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: 11/14/2022]
Abstract
Postburn total nasal reconstruction associated with face burns is challenge to all reconstructive surgeons. The local tissue flaps for reconstruction is virtually out of options, forcing surgeons to opt for distant tissues for nasal reconstruction. Here in, we have described the use of distally based radial artery perforator flap for total postburn nasal reconstruction which has not been described for nasal reconstruction. The anatomy and technique of the flap and case series is presented in this report. Two cases of total nasal reconstruction using the distally based radial artery perforator flap are presented, one case post thermal burn and another post chemical burn. Radial artery distal perforator-based pedicled flap is a versatile option for nasal reconstruction especially when there is a paucity of unscarred skin in loco regional options.
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Affiliation(s)
- Durga Karki
- Department of Plastic, Burns and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Plastic, Burns and Maxillofacial Surgery, V.M. Medical College and Safdarjung Hospital, Delhi, India
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Dash S, Muthukumar V, Sharma S. Superstition, Misconceptions, and Magical Beliefs in Burns Patients-A Cross-Sectional Study of 100 Patients. J Burn Care Res 2020; 41:652-656. [PMID: 31996923 DOI: 10.1093/jbcr/iraa018] [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: 11/13/2022]
Abstract
Superstitious beliefs have been frequently encountered in our day-to-day practices among patients and caretakers. Though this is a common phenomenon, there is a paucity of data pertaining to these beliefs due to various reasons. Many of these beliefs are deep engraved into the culture and mindsets of the population. This is an observational study performed in Tertiary burn care center in India during period October 1, 2018 to January 31, 2019. Data from 100 patient units were collected through a set of questionnaires given to each of patient and their caregivers/family members and responses were collected and analyzed. In the food category of superstitions, there was a thought that white colored foods had to be avoided to avoid pus discharge and wound healing in 60% of the response; eating pomegranate or drinking the juice of pomegranate improves the hemoglobin in 80% of the response. Wearing various colored strings in various parts of the body seemed to be a dominant practice in 85% of the responses, wearing the hair with origin from human, donkeys, horses, and various animals was practiced in 45% of people and wearing peacock feathers was seen in 40% of patients. About 95% of the patients thought adversely to the idea of bathing or even contact of the water with the wounds. This study is an attempt to analyze the different parameters of superstition, misconception, and magical beliefs.
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Affiliation(s)
- Suvashis Dash
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
| | - Shardendu Sharma
- Department of Burns, Plastic & Maxillofacial Surgery, VM Medical College & Safdarjung Hospital, Delhi, India
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Abstract
Synovial sarcoma is one of the common soft-tissue tumors of the body and is usually found on the lower extremity, head-and-neck regions. Reports of monophasic variant of synovial sarcoma in the palm are a rare entity. It can present as a challenge for the surgeons mimicking other conditions. Very few cases of this malignancy are reported in the palm. Painful palmar mass is an unusual presentation for this variant of sarcoma. Preoperative suspicion and planned surgical approach pave the way for the proper management. Neoplasm of the hand is very challenging, as it needs surgical resection balancing with resection margin and functionality of the hand. These cases are notorious for late recurrences and metastasis. Long-term follow-up is of utmost importance. We are reporting a case of palmar monophasic synovial sarcoma with its management and follow-up.
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Affiliation(s)
- Durga Karki
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
| | - Suvashis Dash
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
| | - Vamseedharan Muthukumar
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
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Abstract
Background The trinity of hypothermia, acidosis and coagulopathy, the lethal triad in trauma setting is a well-known risk factor associated with high risk of death. Burn is also a pathological situation where inflammatory response, endothelial injury, hypovolemia, reduced end-organ perfusion, cellular hypoxia, and myocardial depression are frequently encountered. This study aimed to study the occurrence and outcome of patients presenting with the ‘triad of death’ in burn population. Methods The study population included patients between 18 years and 60 years presenting to the department with thermal and scald burns with total body surface area involving 50–70%. The study was conducted for a period of 180 days and patients were followed up for 30 days. A p value <0.05 was considered statistically significant. Results One hundred and ninety-six patients were admitted during study period. Fifty patients out of them were eligible and were included in the study. The average abbreviated burns score index was 11 in lethal triad subgroup when compared to eight in the subgroup without the lethal triad. The mortality in the subgroup with lethal triad was higher (68.8% vs 17.6%, p = 0.0009). The “on admission” acidosis, hypothermia, and coagulopathy were independently associated with significantly increased mortality. The overall relative risk of mortality in the presence of lethal triad was 3.896. Conclusion This study reiterates the fact that the lethal triad is seen in burn patient. Burn associated with on admission lethal triad has significantly higher mortality rates. There are only countable studies addressing this issue in burn setting. How to cite this article Muthukumar V, Karki D, Jatin B. Concept of Lethal Triad in Critical Care of Severe Burn Injury. Indian J Crit Care Med 2019;23(5):206-209.
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Affiliation(s)
- Vamseedharan Muthukumar
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
| | - Durga Karki
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
| | - Bhojani Jatin
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
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Muthukumar V, Venugopal S, Subramaniam SK. Report of a Case and Review of Literature of Internal Hernia through Peritoneal Defect in Pouch of Douglas: A Rare Occurrence. Int J Appl Basic Med Res 2017; 7:196-198. [PMID: 28904922 PMCID: PMC5590385 DOI: 10.4103/ijabmr.ijabmr_297_16] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intestinal obstruction attributable to internal hernia as a cause is a rare phenomenon with a reported incidence of 0.6%–5.8%. Internal hernias ensuing as a result of defect in the pouch of Douglas is extremely rare with only six such cases reported so far in the literature. We present a case of 74-year-old posthysterectomy status female who presented with features of intestinal obstruction. Intraoperatively, the site of obstruction was found to be a rent in the peritoneum of the pouch of Douglas through which a loop of ileum was found herniating. The viability of the bowel was confirmed, and the defect was closed. The postoperative course was uneventful. This report presents an extremely rare type of internal hernia caused by defect in the pouch of Douglas and review of the literature so far available.
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Affiliation(s)
| | - Sarveswaran Venugopal
- Department of General Surgery, Sri Ramakrishna Hospital, Coimbatore, Tamil Nadu, India
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Menon PS, Mishra NK, Muthukumar V. Precocious puberty, gelastic seizures and hypothalamic hamartoma. Indian Pediatr 1993; 30:924-7. [PMID: 8132289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- P S Menon
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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