Plastic surgery

This chapter evaluates plastic surgery, which is a constantly evolving surgical discipline based upon technical exactitude, detailed anatomical knowledge, and innovation. Plastic surgeons have strong aesthetic awareness, but the true scope of their practice is very much broader. The ethos of this work is to restore form and function. In pursuit of this goal, techniques have been refined that enable the transfer of tissues around the body as non-vascularised ‘grafts’, or vascularised ‘flaps’ that may be ‘pedicled’ on their anatomical blood supply, or revascularised after autologous transplantation by microvascular anastomosis. Globally, plastic surgeons collaborate with many specialties to enable oncological treatments and manage congenital abnormalities and trauma and severe soft tissue infections (SSTIs) across a broad range of conditions. In addition to this work, plastic surgeons have been involved in the development of composite tissue allotransplantation techniques that include facial, abdominal wall, and hand transplantation. The chapter then highlights some of the common reasons for referral to plastic surgery and describes some of the common plastic surgery techniques available to address these.

LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS (LRINEC) SCORE FOR THE ASSESSMENT OF NECROTIZING FASCIITIS IN HIMALAYAN REGION.

Background: The LRINEC score (laboratory risk indicators for necrotizing fasciitis) was established in 2004 to aid in the differentiation of necrotizing fasciitis from severe soft tissue infections. Methods: The study included all patients hospitalized to the department of general surgery at Dr. Rajendra Prasad Govt. Medical College & Hospital, Kangra, Tanda, H.P. India with a diagnosis of necrotizing fasciitis for a period of one year, from June 2018 to May 2019. At the time of admission, the patient’s hemoglobin, white blood cell count, C-reactive protein, blood glucose level, urea, sodium, potassium and creatinine levels (LIRNEC Score) were calculated. Results: In all the patients LRINEC Score was > 6. Out of 60 patients, 14(23%) patients had LRINEC Score in between 6 to 7 and 46 (76%) patients had LRINEC score >8. Conclusion: The LRINEC score of 6 and above suggest NF and therefore aiding in the early recognition of NSTI and its management.

Laboratory risk indicator for necrotising fasciitis [LRINEC] score as a tool for differentiating necrotising fasciitis from other soft tissue infections

Necrotizing fasciitis (NF) is often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The present study was aimed to validate the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score as a tool to predict/diagnose NF and to differentiate it from other soft tissue infections depending on the score. A Prospective Observational study was conducted in ESICMC PGI MSR, Medical College Hospital, Rajajinagar, Bengaluru, from Jan 2019 to June 2020. Patients ≥18 years of age with severe soft tissue infections were included in the study. Based on the LRINEC score, the patients were categorised as low (≤5), moderate (6-7) and high risk (≥8) for the prediction of onset or diagnosis of NF. Data analysis was performed using SPSS version 21.0. A total of 55 patients were included in the study. A significant 3 association was observed Dweitpharatgmee(npt=o0f.0X4X2)X, ,LURnINivEerCsitsycorfeX(pX=X0,.0X0X01X),TCraRineiancgtiavnedPRroetseianrc(hCRHPo;spi=ta0l.,0C00it1y),,Choauenmtroyglobin (p=0.008), serum 4 sodium levels (p=0.004), serum creatinine (0.D00e1p)a,ratmndenatmopfuXtaXtiXon, F(pac=u0l.t0y0o4f).XAXmXp,uCtaityio,nCwouanstdryone in 5 cases. Only 1 mortality was observed in LRINEC high risk group with NSSTI. To conclude, LRINEC scoring system showed a better positive predictive value in identifying the onset of NF and risk strategizing of the patients with severe soft tissue infections.

Delayed Peroneal Neuropathy After Bosworth Fracture Dislocation of the Ankle

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

Radical treatment of severe open fractures of extremities by orthoplastic surgery: a 10-year retrospective study

Objective This study aimed to retrospectively analyze clinical data of a series of patients with severe open fractures of extremities (Gustilo IIIb or IIIc), who achieved a satisfactory outcome through radical orthoplastic surgery, so as to provide a reference for determining the treatment of severe open fractures of extremities. Methods The clinical data of 41 consecutive patients with severe open fracture (Gustilo IIIb or IIIc) of the limb, who underwent successful surgical debridement, fixation, and soft tissue reconstruction in one stage between January 2008 and January 2019, were retrospectively reviewed. Postoperative indicators, including infection rate and union time, were acquired by a regular follow-up and analyzed. Results The mean (±SD) age of the patients was 38 ± 16 years. A total of 90 open fractures and severe soft tissue damages were analyzed. The soft tissue cover was achieved within 72 h. The overall rate of infection was 14.6% (6/41). Sex and the Mangled Extremity Severity Score were associated with infection. The median union time of 40 patients (one amputation) was 32 weeks. Conclusion The overall rate of infection exhibited a lower tendency in this study compared with previous studies on high-grade open fractures following a two-stage orthopedic approach. The consequence of infection rate and union time was similar to that in previous studies. These results indicated that the single-stage radical orthoplastic treatment was an effective and reliable option for reconstructing severe open fractures.

Successful surgical treatment approach for mitral valve vegetation of infective endocarditis after severe soft tissue infection with mediastinitis.

Transesophageal echocardiography is mandatory if you do suspect infective endocarditis. By approaching via a small right thoracotomy, vegetectomy and mitral valvuloplasty following severe mediastinitis were successfully accomplished without any complications.