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Plastic & Reconstructive Surgery

We are engaged in providing Plastic & Reconstrotiv that are widely used for treating different types of diseases. During the treatment, we use latest technology and advanced instruments and tools for assuring effectiveness. All our treatments are widely appreciated by the customers due to their durability, reliability, cost-effectiveness and customization.

Maxillo Facial Surgery
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Maxillo Facial Surgery

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Entire face can be divided in three major part .Upper 1/3 that is forehead, part of cranium. middle 1/3 is nose, eyes and cheek. Lower 1/3 is lips and mandible. Face is composed of soft tissue (skin, muscle, vessels and nerves) and of hard part that is bone. Any trauma to face may lead to damage to soft tissue and or facial bones.

 

Injury to face -soft tissue: This may be most simple injury like abrasions or lacerated wounds or extensive trauma involving soft tissue and facial bones. Aim of treatment is To restore anatomical landmarks, facial symmetry, and dental occlusion. Basic management of management of facial wounds are:

 

  • Proper cleaning of wounds by saline and removal of all debris and foreign material.

  • Salvage of each milimeter of viable tissue.

  • Early repair of wounds taking all anatomical land marks in consideration.

  • Dressing using tropical ointment and if necessary systemic . Because of rich circulation facial wounds heels very well.

 

Facial bone fractures: Face consist of nasal bone, zygoma, maxilla and mandible. We can diagnose facial bone fractures by clinical examination a X-ray and CT Scan. The fractures are fix by using mini steel or titanium plates and screws. If large bone defects are present primary or secondary bone grafting may be needed.

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Cleft Lip and Palate Repair
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A cleft lip is an incomplete upper lip formation present at birth that appears as a separation on one or both sides. An incomplete formation of either the hard or soft parts of the upper palate inside the mouth is a cleft palate, also present at birth. These defects may cause impaired feeding, speech, dental development and hearing, and will require surgical treatment by a team of specialists.

 

Cleft lip repairs are initially performed when a child is at least 10 weeks of age and 10 pounds in weight and has a hemoglobin (or blood count) of at least 10. Cleft palate repairs are generally performed when a child is somewhat older, from 9 to 18 months of age.

 

Correction of a cleft lip or palate usually requires multiple procedures during a child's growth and development. Intervention is recommended early because of other medical problems that can be associated with clefting, particularly ear infections.

 

Management of Cleft Lip and Cleft Palate Patients: Both above defects are surgically correctable problems. Child becomes as good as normal after full course of treatment.

 

Cleft Lip Unilateral and Bilateral: Surgery is done at three Months and above. If surgery not had done in child hood it can be done at any age.

 

Prerequisite for surgery

 


  • Age 3 months and above
  • Weight of child 4.5 kg and above
  • Haemoglobin more then ten gm child should be in good health state and free from any infection
  • Pre operative investigation CBC, ( Hb.TLC,DLC, ESR,), BT,CT Pre operative consultation from Paediatrician for fitness of surgery
  • Surgery: Child is admitted one day before, are given and under standard general anaesthesia repair of cleft lip is done. I do modified Mellard's rotation advancement flap. Feeding is started on same day six hrs after surgery. Usually child is discharge on next day if every thing is ok. Suture removal is done after six days of surgery. No specific care is required after surgery. Parents should take care that child should not get injured or fall from bed.
  • Cleft palate: Defect in palate can be unilateral, bilateral or partial and only bifid uvula may be present.
  • Timing of surgery: Nine months to eighteen months. Preoperative investigations, Hb, TLC, DLC, ESR and BT, CT. Pre-operative paediatric consultation. Weight should be more then nine kg and child should be free from any active infection
  • Surgery: Child is admitted one day before surgery, preoperative are given. Child is operated under standard general anaesthesia. Standard palatoplasty is done using vicry suture. Child is kept nil orally for six hrs after surgery and then given clear fluid in full awake state very slowly .Patient is discharged after one or two days after surgery. There is no need to remove sutures
  • Feeding of Child With Cleft--- spoon feeding is better then bottle feeding. Multiple small feeds at short intervals should be given. During feeding child head (upper body part) should be kept above ( 45 degree angle ), and after feed allow him to do dakar. After feeding put child in lateral position rather then supine. We should take all precaution that child should not aspirate
  • Above two surgeries are basic surgeries for these patients. Child may need other surgeries to correct secondary deformities, and surgery for correction of speech is needed. Speech therapy, orthodontic treatment, rhinoplasty may be needed. These surgeries I will be covering further bulletin

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Scar Revision
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Scar Revision

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Healing is a natural process following any injury to skin is healed by nature . healing of body tissue always give scar. Scar is fibrous tissue bridging the normal tissue gap or skin. Colour and texture of scar may not match the near by skin, giving it a separate identity. These scars can be soft supple not ugly looking. Or scar can be..........

 

  • Hypertrophic: Thick rope like and do not grow in normal skin, Keloid-Thick, rope like growing to involve normal skin. All types of scar can be treated. Surgery is not indicated in Keloids

  • Keloid: Type of scar, thick, rope like, growing in nature and involving normal skin. patients complains of pain, tender on touch, itching and pricking sensation. Common site are sternum, shoulder and sometimes on external ear. Keliod develop after injury or after surgery. Keloids are usually not operated. After surgery they become more aggressive.

  • Hypertrophic scar: These scar are thick , itchy and develop after injury or after surgery. these do not grow in normal skin but grow in thickness. Tropical Steroid ointment, pressure garments, silicone sheet, Laser therapy can give good result. Surgical treatment is indicated in large resistant scars. Surgery is excision of scar . After excision if primary closure is not possible then grafting or skin flap are treatment of choice.

  • Contracture / contracting scar: Scar across joints contract, giving rise to contractures which reduces range of mobility of joints. Usually develop after burn injury. Multiple 'Z' plastie, or excision and skin grafting are treatments for contracting scars.

  • Post acne scars: Multiple depressed scars develop after acne. These scars can be treated with Laser, Chemical peeling, and dermabrasion depending on severity of scars

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Hand Surgery
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Hand Surgery

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a.) Tendon:

 

Tendons are long strong connective tissue structures which looks like strings. Tendon connects muscle to bone. When muscle contract, the tendons are stretched and bone moves. That's how tendons are very important structures for movements of joints. If these are cut or injured movement is lost. We can categorise tendons in two main group. One is flexor tendons ,these causes flexion of joint, another group is extensor tendons ,these produces extension of joints. Tendons if cut can be repaired directly. if there is shortening of length of tendon then tendon graft is needed to bridge the gap. After repair of tendon immobilisation of joint is done for 4 to 6 weeks.

 

b.) Softtissue injury:

 

Injury can lead to loss of skin and muscle and other structures of hand. This will lead to exposure of inner vital structures of hand .These vital structures are nerve, vessels and tendons. This requires various reconstructive procedures to cover them. These procedures are skin grafting and various types of flaps.

 

c.) Replant:

 

Re-attachment of amputed body part is called as re-plantation. Amputed body parts like fingers, hand or any part of hand, upper limb or lower limb amputed at any level, can be replanted. Ear, scalp and even can be replanted. Many times segmental crushed part of limb can be excised and limb can be replanted accepting the resulted shortening.

 

d.) Amputations and replantation:

 

Any body part which is completely detached from body is termed as amputation. Amputation of extremities may be because of industrial accidents, assault, Ganna (sugar cane) machines, wood cutting machines and thresher machines. Most of them are avoidable.

 

e.) Salvage hand:

 

Transport of amputed part:

 

Step I:

 

  • Clean the amputed part with saline or water and put it in Plastic beg and tie it.
  • Put this beg in a bucket/another plastic beg/or any container.
  • Now put lot of ice in this container.
  • Inform to doctor and shift to patient.
  • It is better to take instructions from doctor and explain him in detail about details of amputation.

 

  • Time - Ideally amputed part should reach within six hours to hospital. If amputed part is large like leg or upper limb try to reach earlier. If amputed part is small like fingers longer time can be accepted.
  • Risk - Under ideal circumstances risk is very less, but the risk factors are same as of any other surgical risk. If injuries are extensive risk increases.
  • Success of re plantation - Success depends on level and type of amputation and time delay (Ischemia time). Sharp amputation in young individual has better out come then crushed or avulsion amputation in elderly patient.
  • Blood transfusion - Major limb replant may need blood transfusions.
  • Return of functions - We can accept good functional results after re plantation. Patients may need multiple revision surgeries, tendon transfer etc. Long term extensive physiotherapy is import prerequisite for better functional result

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Lower limb Reconstruction
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Industrial accidents and high velocity trauma are most common cause leading to damage of lower extremity. Apart from neurovascular injury, soft tissue loss causing exposure of bone, joints and tendon .

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Diabetic Foot
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Patients with diabetes usually uncontrolled may develop ulcers in foot. These ulcers starts with very small boil, or redness in toes or foot. If these early signs are ignored and blood sugar is not controlled this may lead to extensive cellulites or an ulcer with purulent pus discharge. This may extend further and can cause gangrene of foot .So to avoid ulcers in foot it is mandatory to do care of foot. Proper periodic examination of foot should be done either by your regular physician or yourself care of diabetic foot

 

Examination of foot in diabetic patients:

 

  • Inspection-skin texture, colour (pale, red, blue, black),

  • Bony prominences, toe deformities, joint movements,

  • Fissures, sign and symptoms of infections, scars, dryness of skin, cracked nails, in-growing toe nails,

  • Palpation.. warmth, tenderness, calluses

  • Check movements at ankle and toes

  • Foot pulses------Peripheral pulses. Vein filling Capillary circulation

  • Neurological status: motor, sensory, sensation and movements of toes and foot.

 

The ten commandments of diabitic foot care:

 

  • Do not walk bare foot

  • Do not walk bearing weight on affected/ulcerated foot after surgery

  • Do not apply hot fomentation / cold compresses / electric heating pads / strong counter irritating ointments to leg and feet

  • Do not sit cross-legged for many ours

  • Do not remove foot wear during any travel & place your foot at any hot surface. This can cause burns

  • Do not cut corns / calluses with a blade or a knife. Home surgery is dangerous

  • Inspect the feet daily for blisters, wounds, bleeding, smell, increased temperature at pressure points of feet & oedema

  • Use correct footwear. Choose your footwear after consulting your doctor. Always wear footwear with socks with loose elastic

  • Cut the nails regularly, trimmed square

  • Clean the feet twice a day with soap & water. Wipe the web spaces dry & apply softening agent to feet. Do not use the Pumis Stone

  • Diabetes is neither an indication for amputation nor contraindication for reconstruction-even major. Timely control of infection, radical Debridment, multiple dressings, proper drainage of collection, control of blood and tissue glucose level, and reconstructive surgery are key instruments to salvage limb

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Nose Surgery
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Nose sits in central part of face, and projecting from facial plane. This makes nose more vulnerable to injury. Nose consists of hard part that is two symmetrical nasal bones, nasal septal cartilage, alar cartilages, and soft tissue is skin, nasal mucosa. Reconstruction of nose is a great challenge as it is one of most important aesthetic unit of face. Human injury is one of common form of nasal injury requiring reconstruction.

 

Most common flap use for nose reconstruction if skin from forehead as forehead flap or. Another source of skin is from cheek as nasolabial flap. Nasal bone defect is reconstructed by using autogenous bone graft.

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Lid and Ptosis
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Lid and Ptosis

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Abnormal drooping of upper eyelid or inability to lift up upper eye lid is known as ptosis. Normally Upper lid covers 1 to 2 mm of limbus of cornea. Upper lid is lifted up by normally innervated levator papabrae superioris muscle.

 

The ptosis may be due to congenital cause or acquired. Congenital ptosis is associated with myogenic dystrophic changes of levator muscle resulting in poor functioning of lid. Acquired ptosis is Neurogenic , Myogenic, Traumatic, Mechinal and Pseudosis.

 

Post traumatic, may be because of unrepaired levator muscle at the time of trauma to upper eyelid. Mechinal ptosis is due to a tumour or cyst, or enlarged lacrimal gland pushing the lid down. Preoperative detail history, careful examination, measure of supratarsal fold and symmetry, evaluation of lid contour, measure of ptosis in millimetre, difference of palpebral fissure, measure levator function ( lid excursion with brow static), visual acuity of eye, function of extraocular muscle, Bells phenomena, jaw winking. Also see for myasthenia gravis or Horner's syndrome.

Ptosis classification: Mild.1 to 2 mm, Moderate..3 mm, Severe...4+ mm, classification of levator function excellent 12 to 15 mm, Good 18 to 12 mm, Fair..5 to 7mm, Poor.2 to 4mm.

 

Management of ptosis Depends on grade of ptosis and levator function. Severe ptosis with poor levator function, then frontalis sling is procedure of choice. In this, tensor facia lata sling attaches frontalis muscle directly to lid margin, so as lid is lifted secondary to lifting of frontalis muscle. If levator function is good with minimal ptosis many types of levator muscle reconstructive procedures can be done. Basic of all of them is to improve levator excursion, either by muscle shortening or levator muscle / apponeurosis plication.

 

Postoperative Lid swelling is most common problem, which settles within a week. Second common may be inability to close eye completely. Patients should be explained about these in detail. Eye ointment in night should be advised. In cases of frontalis sling physiotherapy is started after 4 weeks of surgery. Patients should be examined at monthly interval at least for six months. Sometimes patient might need little adjustment of sling for final correction. This correction can be done under local anaesthesia as outdoor procedure.

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Micro Surgery

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Microsurgery takes advantage of using your own tissue, by using spare fat from your body instead of implants. Although a superior method to reconstruct after mastectomy, many plastic surgeons will not offer microsurgical reconstruction because they do not perform microsurgery or because they cannot perform it at the level that is needed to be successful with this type of surgery.

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Reach Us

Rejuvenate Hair Transplant CenterNo. 2 / 1, R. S. Bhandari Marg, Near Of Janjeerwala Chouraha, Opposite Nagar Nigam Shop, R S Bhandari Marg, Indore-452001, Madhya Pradesh, India

Rajkumar (Receptionist)

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