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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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Ramkumar S, Periasamy M, Bhardwaj P, Bharathi RR, Mohan M, Sabapathy SR. Diabetic Hand Infections: Factors at Presentation Influencing Amputation and Number of Surgical Procedures. Indian J Plast Surg 2021; 54:289-296. [PMID: 34667513 PMCID: PMC8515347 DOI: 10.1055/s-0041-1735421] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Background Diabetic hand infections are associated with significant morbidity and disability. Amputations cause permanent disability, and multiple surgical procedures lead to morbidity. Diabetic foot infections have been well-studied but literature on hand infections is limited. We undertook a retrospective study of patients with diabetic hand infections operated at our center to study the factors at presentation with significant association with amputation and number of surgical procedures. Patients and Methods Demographic data of 51 patients was collected. The six parameters, namely, duration of diabetes, "onset of symptoms to presentation" interval, presence of comorbidities, HbA1c level, random blood sugar (RBS) levels at admission, and culture characteristics were selected for statistical analysis to find a relationship with the two outcome variables: number of procedures done and need for amputation. Results On bivariate analysis, Gram-negative infection was found to have a significant relationship with the need for multiple of procedures ( p = 0 . 014). The mean difference between the "onset of symptoms to presentation" interval between the amputation/non-amputation groups (2.9 days, p = 0 . 04) and the multiple procedures/non-multiple procedure groups (4.4 days, p = 0 . 02) was found to be statistically significant. Presence of comorbidities, long duration of diabetes, HbA1c, and RBS levels at admission did not show any statistically significant association with the two outcome variables studied. Conclusion In the present study, we found that infection with Gram-negative organisms is significantly related to the need for multiple surgical procedures. A delay in presentation can influence the risk of amputation as well as multiple procedures. Institution of early appropriate care is important to get a good outcome.
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Affiliation(s)
- Sanjai Ramkumar
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Madhu Periasamy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Praveen Bhardwaj
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - R Ravindra Bharathi
- 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
| | - S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Patnaik JSS, Balaraman K, Ramani V, Bhat K, Thomas D, Bharathi RR, Sabapathy SR. Incidence and outcome of repair of canalicular lacerations: A case series. J Craniomaxillofac Surg 2020; 49:135-139. [PMID: 33446397 DOI: 10.1016/j.jcms.2020.12.009] [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] [Received: 05/20/2020] [Revised: 09/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- J Sai Santosh Patnaik
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India.
| | - Kannan Balaraman
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Vimalambiga Ramani
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Keerthana Bhat
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Devdutt Thomas
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - R Ravindra Bharathi
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
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Balaraman K, Patnaik JSS, Ramani V, Bhat K, Thomas D, Bharathi RR, Sabapathy SR. Management of White-Eyed Blowout Fracture in the Pediatric Population. J Maxillofac Oral Surg 2020; 20:37-41. [PMID: 33584039 DOI: 10.1007/s12663-020-01393-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/08/2020] [Indexed: 11/28/2022] Open
Abstract
Aims and objectives Diplopia in children is uncommon. However a small group of patients present with diplopia and severe restriction of upward globe movement which requires early diagnosis and prompt intervention. This study aims to evaluate the timing of intervention and functional outcome in the management of white-eyed blowout fractures. Methodology The study was conducted in a tertiary level trauma center. There were a total of 46 orbital floor injuries over a period of 2 years out of which 4 patients with white-eyed blowout fractures were identified. Details of each case were entered on a standard data base and analysed with respect to age, mode of injury, extent of limitation of gaze, timing of intervention, pre and post-operative diplopia. Minimum follow up period for every case was 1year. Results All of them had sports related injuries. Three of the four patients had complete recovery from diplopia with full range of eye movements. However one child with delayed presentation didn't recover fully and had persistence of symptoms within the functional range. Conclusion White-eyed orbital blowout fracture in kids though uncommon need prompt diagnosis and management for complete recovery. The initial clinical presentation mimics that of head injury and hence can be missed, leading to a delay in diagnosis resulting in incomplete recovery.
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Affiliation(s)
- Kannan Balaraman
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - J Sai Santosh Patnaik
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Vimalambiga Ramani
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Keerthana Bhat
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - Devdutt Thomas
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - R Ravindra Bharathi
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
| | - S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery, Facio Maxillary Surgery, Aesthetic Surgery, Oncoplastic Breast Surgery and Burns, Ganga Hospital, Coimbatore, India
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Sankaran A, Bharathi RR, Sabapathy SR. Complex dorsal dislocation of the distal interphalangeal joint: Perspectives on management. Indian J Plast Surg 2016; 49:403-405. [PMID: 28216823 PMCID: PMC5288918 DOI: 10.4103/0970-0358.197251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Distal interphalangeal joint dislocations are only rarely complex and irreducible. We present a case and illustrate our approach to management of this problem. Open reduction is necessary, and preferred approach is volar. It is imperative to identify the injured soft tissue and repair them as is feasible.
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Affiliation(s)
- Ajeesh Sankaran
- Department of Plastic, Hand, Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - R. Ravindra Bharathi
- Department of Plastic, Hand, Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Department of Plastic, Hand, Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Balaraman K, Shanmugakrishnan RR, Bharathi RR, Sabapathy SR. Mandibular distraction in a 75-day-old child with severe Pierre Robin sequence. Indian J Plast Surg 2013; 46:154-6. [PMID: 23960331 PMCID: PMC3745111 DOI: 10.4103/0970-0358.113743] [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: 11/12/2022] Open
Affiliation(s)
- Kannan Balaraman
- Department of Plastic, Hand and Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Abstract
Anatomical features of the lower third of the leg like subcutaneous bone surrounded by tendons with no muscles, vessels in isolated compartments with little intercommunication between them make the coverage of the wounds in the region a challenging problem. Free flaps continue to be the gold standard for the coverage of lower third leg wounds because of their ability to cover large defects with high success rates and feasibility of using it in acute situations by choosing distant recipient vessels. Reverse flow flaps are more useful for the coverage of the ankle and foot defects than lower third leg defects. The perforators in the lower third leg on which these flaps are based are often damaged during the injury. In medium-sized defects of less than 50 cm(2) size, local transposition flaps, perforator flaps, or propeller flaps can be used. Preoperative identification by the Doppler is essential before embarking on these flaps. Of the muscle flaps, the peroneus brevis flap can be used in selected cases with small defects. In spite of all recent developments, cross-leg flaps continue to remain as a useful technique. In rare occasions when other flaps are not possible or when other options fail it can be a life boat. In the author's practice free flaps continue to be the first choice for coverage of wounds in the lower third leg with gracilis muscle flap for small and medium defects, latissimus dorsi muscle flap for large defects and anterolateral thigh flap when a skin flap is preferred.
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Affiliation(s)
- Babu Bajantri
- Department of Plastic, Hand and Reconstructive Microsurgery and Burns, Ganga Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, India
| | - R. Ravindra Bharathi
- Department of Plastic, Hand and Reconstructive Microsurgery and Burns, Ganga Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, India
| | - S. Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery and Burns, Ganga Hospital, Mettupalayam Road, Coimbatore, Tamil Nadu, India
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Abstract
Nail bed injuries are common and management of these requires good knowledge of the nail bed anatomy. Proper management of these injuries will ensure good healing and prevent late deformities. When loss occurs it is challenging to reconstruct which can be done by grafts or microsurgical reconstruction to restore aesthetic appearance of fingers.
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Affiliation(s)
- R Ravindra Bharathi
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, India
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Abstract
The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns. Reconstructive procedures can greatly improve the function of the hands. Appropriate choice of procedures and timing of surgery followed by supervised physiotherapy can be a boon for a burns survivor.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand, Reconstructive Microsurgery and Burns Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, India
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Abstract
The current concepts of replantation surgery, a procedure that has been practiced for half a century, can be discussed in terms of patients' demands and expectations, present indications for the procedure, available evidence that influences decision making, and technical refinements practiced to produce better outcomes.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand, and Reconstructive Microsurgery, Ganga Hospital, Tamil Nadu, India.
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Abstract
UNLABELLED Toe-tip injury presents a challenging problem. There are few techniques that provide cover for distal toe defects, and most injuries are usually treated with terminalization or a skin graft. In patients with toe-tip injuries where there is preservation of the plantar toe pulp, V-Y flap advancement is a therapeutic option. In this article, we describe the surgical technique used and present the results of 10 patients with dorsal oblique or transverse toe injuries that underwent V-Y flap advancement for defect coverage. Eight patients had distal great toe injuries, 1 had a dorsal oblique amputation of the third toe, and 1 had a transverse amputation at the metatarsophalangeal joint level. Mean follow-up was 5 months, at which time all patients had returned to their previous activity level, and showed acceptable levels of scarring. The V-Y advancement flap, commonly used in fingertip injuries, when indicated and carefully performed gives excellent contour and padding, maintains toe length, and provides good cosmesis for treatment of toe amputations. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- R Ravindra Bharathi
- Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, Coimbatore 641 043, India
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Sabapathy SR, Venkatramani H, Bharathi RR, Dheenadhayalan J, Bhat VR, Rajasekaran S. Technical considerations and functional outcome of 22 major replantations (The BSSH Douglas Lamb Lecture, 2005). J Hand Surg Eur Vol 2007; 32:488-501. [PMID: 17950208 DOI: 10.1016/j.jhse.2007.06.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 06/05/2007] [Accepted: 06/13/2007] [Indexed: 02/03/2023]
Abstract
Twenty-two consecutive major replantations carried out over a 5-year period were assessed with a minimum follow-up of 2 years. Only two patients suffered guillotine amputations. The remainders were either crush, or crush avulsion amputation. Replantation was successful in 20 cases. When analysed by Chen's criteria, there were three Grade I, nine Grade II, six Grade III and two Grade IV results. Most patients with successful replants put the hand to greater use with time and replantation greatly added to the overall well-being of the patient. We consider major replantation as a worthwhile procedure. Radical debridement, bone shortening and well laid out protocols to reduce the ischaemia time are important for success. The technical details which we believe to be important for success are outlined. With decreasing numbers of such injuries in most countries, this paper may help surgeons faced with an occasional patient with a major amputation to make the right decisions.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641043, India.
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Jamie McKenzie RW, Maclean G, Ravindra Bharathi R, Raja Sabapathy S. Tube pedicle flap in the management of a Grade III C lower limb injury. J Plast Reconstr Aesthet Surg 2006; 59:1420-3. [PMID: 17113533 DOI: 10.1016/j.bjps.2005.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 10/17/2005] [Accepted: 12/06/2005] [Indexed: 11/23/2022]
Abstract
Salvage of a Grade III C lower limb injury is a challenging problem. Apart from microsurgical revascularisation, they frequently need soft tissue coverage procedures. Due to the magnitude of the injury, local flaps from adjacent tissues may not be available and microsurgical free flaps are the flaps of choice. We present an instance where the defect in the middle third of a revascularised leg was covered by a tube pedicle flap raised from the groin and transferred, with the wrist as the carrier. This was chosen because of the below knee amputation on the opposite side combined with long segment circumferential loss of skin in the affected extremity and paucity of vein graft sources. Thus the reconstruction of a limb which was saved by microsurgery was completed by tube pedicle flap. In exceptional circumstances 'old' techniques are still useful.
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Affiliation(s)
- R W Jamie McKenzie
- Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ganga Hospital, 2, Swarnambika Lay Out, Coimbatore--641009, India
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Abstract
Total scalp avulsions are devastating injuries and replantation is the best form of reconstruction. We present our experience of replantation of six totally avulsed scalps done between 1996 and 2004. All were technically successful, but one was lost in the post-operative period due to accidental shearing of the scalp during nursing care. A single team performed the surgery in all cases and the average operating time was 6 h. No vein grafts were used. Hair growth was satisfactory in all cases. None underwent formal nerve repair but there was adequate sensory recovery in all of them by 6-9 months. A small area of skin necrosis in the occipital area (three cases), telecanthus and epiphora (two cases) were the minor complications. The available Literature highlights the need for multiple teams to reduce the long operating time, the use of multiple vein grafts and the complexities involved. Since, they are rare injuries, gaining wide experience is difficult. In this article we offer recommendations in pre-op preparation, vessel identification, technique of anchoring the avulsed scalp prior to vessel anastomosis and post-op care to make this rare procedure quicker, easier and successful.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ganga Hospital, 2, Swarnambika Lay Out, Ramnagar, Coimbatore 641 009, India.
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Abstract
The replantation of fingertip amputation (through the nail bed) requires repair of the artery and vein on the palmar side. These structures are present in different planes, with the artery being deeper and the veins superficial. The authors believe that vascular repair in such cases is facilitated by stabilization of the amputated part by nail-bed repair alone. This provides a certain degree of flexibility, which allows for easier placement of clamps in the limited space available. Although Kirschner wires were not used for bony fixation, bony union was achieved in all five cases in which this technique was used.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand, and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, India
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Sabapathy SR, Venkatramani H, Bharathi RR. Functional evaluation of a great toe transfer and the osteoplastic technique for thumb reconstruction in the same individual. J Hand Surg Br 2003; 28:405-8. [PMID: 12954246 DOI: 10.1016/s0266-7681(02)00304-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the popularization of microvascular toe transfer, there has been a tendency to relegate osteoplastic reconstruction techniques for the thumb to history. A case is presented which shows that a successful and well-planned osteoplastic thumb reconstruction can match microsurgical reconstruction in all functional activities. Cosmetically, the toe transfer is the better reconstructive option but it may cause significant donor site morbidity.
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Affiliation(s)
- S R Sabapathy
- Department of Plastic Surgery, Hand and Reconstructive Microsurgery, Ganga Hospital, Swarnambika Layout, Ramnagar, Coimbatore, India.
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Sabapathy SR, Mohan D, Bharathi RR. 'Jumping' cross finger flaps: a useful technique for salvaging parts in mutilating hand injuries. Br J Plast Surg 2000; 53:488-90. [PMID: 10927678 DOI: 10.1054/bjps.2000.3379] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In multi-digital injuries, soft tissue from non-adjacent injured fingers, which would have otherwise been discarded, can be used to cover small defects in salvageable digits. This was found useful in the salvage of four digits and one thumb. Anticipation of the need for a flap cover, and the possible availability of tissue in non-adjacent digits, is of paramount importance during the planning process in these injuries. This technique of using 'jumping' cross finger flaps is a useful method, when dealing with multiple finger mutilations that need soft tissue cover.
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Affiliation(s)
- S R Sabapathy
- Ganga Hospital, Swarnambika Layout, Coimbatore, Tamil Nadu, 641009, India
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