BLOGS

MAXILLOFACIAL & FACIAL PLASTIC SURGERY

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February 23, 2018

Maxillofacial surgery is the subspecialty of plastic surgery dealing with the trauma and deformities of face and underlying bony skeleton. The gamut of maxillofacial surgery ranges from congenital deformities of children to adult trauma and facial cosmesis.

Paediatric facial plastic surgeries done at Sparsh Clinics include clefts of lip, palate or face, congenital deformities of the skull and eye region, hypertolerism, hemifacial atrophy, craniofacial microsomia and ear reconstruction. Ear reconstruction is being done with autologous cartilage harvested from the patient’s ribcage with consistent results. These all are demanding surgeries which are being done efficiently at Sparsh Clinics, Nagpur.

Trauma to the face is commonly seen nowadays due to increased incidence of road traffic accidents which has led to the rise of facial injuries and fractures. Zygomatico-maxillary fractures are the most common facial fractures seen in our setup. Other commonly seen fractures are those of mandible, maxilla, nose, orbit and frontal bone. If uncorrected these fractures causes facial deformity and loss of function. Zygomatico-maxillary fractures causes depression of one side of face; nasal bone fractures causes nasal deformity; orbital fractures can lead to sunken eye with problems in the vision; fractures of maxilla and mandible causes facial deformity along with loss of occlusion and mouth opening disorders. Prompt recognition and appropriate fixation is required in these cases.

Orthognathic surgery is another field of plastic surgery wherein upper and lower jaws are surgically moved to increase the facial cosmesis. These subgroup of patients include those with congenital problems of face, mid face retrusion, protrusion or retrusion of mandible due to any cause. Other aesthetic procedures can also be performed simultaneously. The type of surgery in each patient has to be individualised.

The problems of temporo-mandibular joint are taken care of with equal effectiveness. The ankylosis of TM joint leads to mandibular deformity and decreased mouth opening. Long term ankylosis leads to a typical bird like facies. Inability to open mouth leads to under nutrition, problems of speech and oral hygiene. An appropriate surgical technique allows us to help these patients.

To summarise, maxillofacial surgery is a vast subspecialty of a vaster field of Plastic surgery. As this involves the surgery of face and facial skeleton, it can also be called as a ‘Confidence building’ surgery.

GENDER REASSIGNMENT SURGERY

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February 8, 2018

 

Gender reassignment surgery, or as it is commonly known as sex change operation, is a highly complex surgery performed for patients with gender identity disorder. Gender identity disorder is a unique human condition which is classified as psychological and behavioral condition. This is a condition where patient morphologically belongs to one of the two sexes but behaviorally takes the role of that of opposite sex.

The treatment of these patients involves multidisciplinary approach, the first step being confirming the diagnosis. The patient with gender identity disorder has distress or discomfort with his or her gender. Continuous psychological evaluation is required initially. A trial of cross living is given and his or her psychological functioning is assessed for a period of 1 to 2 years. Hormone therapy may be instituted during this period and its responsible intake is evaluated. This leads to suppression of secondary sexual characters and more successful gender transformation is achieved.

The final step in this journey of gender transformation is carried out by a plastic and reconstructive surgeon.

The demand for this surgery has outpaced the number of qualified caregivers. It should be thoroughly understood that gender confirmation is a complex process and multiple surgeries are required for complete transformation. For this reason only mentally stable patients who understand the risks and benefits are brought to the operation table after thorough psychoanalysis.

Male to female Transformation

The prevalence of male to female conversion are higher than that of female to male conversions. The surgery for male to female conversion is relatively straight forward and much less complex. Our surgical goals are to create perineal-genital complex as feminine as possible, free of any fistula/stenosis, minimal scars and neuromas as possible, creation of short urethra with an ability to void with a straight stream, and minimal donor site morbidity.

The options for vaginoplasty for male to female conversion are Penile inversion vaginoplasty and bowel segment vaginoplasty.

Penile inversion vaginoplasty involves use of penile and scrotal skin for lining the neovagina whereas, in bowel segment vaginoplasty intestine is used for lining the neovagina. We prefer to perform penile inversion vaginoplasty due to its simplicity of execution and its ability to provide good results. Moreover, an abdominal surgery is avoided with above technique and there is increased risk of stenosis, fistula, colitis and Crohn’s disease in bowel segment vaginoplasty.

Clitoroplasty and Labiaplasty is also performed along with the creation of neovagina. This provides good sensitivity and sexual satisfaction to these patients. Other ancillary surgical procedures that are required in male to female transformation are breast augmentation, facial feminization surgery, rhinoplasty, mentoplasty and thyroid cartilage reduction. Voice change surgery may be required in some patients.

Female to Male Transformation

The surgeries performed for female to male confirmation are highly complex. The goal of this surgery is to create a new phallus allowing the patient to micturate in standing position and perform gratifying sexual intercourse. The conversion from female to male starts from in removal of the uterus, ovaries and both breasts. Usually this is performed in the single stage. The next stage is creation of neophallus i.e. phalloplasty. Phalloplasty is performed using tissue from forearm or thigh and in some cases from the back.

We find radial forearm flap to be the best choice for penile reconstruction as it provides adequate tissue for creation of urethra and phallus along with good sensations for neophallus.

Inflatable implants or any other material insertion for stiffness of neophallus is done in the later stage.Vaginectomy and scrotoplasty is also required in these patients. Other ancillary procedures that are done are creation of Adam’s apple, testicular implants, hair transplant and voice change surgery.

BRACHIAL PLEXUS INJURY

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February 2, 2018
A patient with left side brachial plexus injury with inability to flex hiselbow

Brachial plexus is a plexus of nerves in the neck and shoulder region which supplies motor and sensory innervation to the whole of shoulder, arm, forearm and hand. Injury to the plexus leads to paralysis of part or whole of the upper limb leading to functional loss, eventually leading to socio-economic loss to the patient.

The most common cause of brachial plexus injury is the motor vehicle accident when a patient falls on his shoulder leading to stretching and rupture/avulsion of the plexus. This leads to loss of shoulder, elbow, wrist and finger movements along with loss of sensations.

Brachial plexus injuries were the most difficult injuries to treat until the last decade. Due to the advances in diagnostics, surgical and microvascular techniques, management of these patients have become increasingly possible. The introduction of novel distal nerve transfers and functioning muscle transfer has further revolutionized the field.

We, at Sparsh Clinics, strive to provide the best possible outcome to the patients with brachial plexus injuries. Improved microsurgical techniques and increasingly creative reconstructive options provided by our multidisciplinary team has helped us in achieving optimum results.

Full flexion achieved after nerve transfers

Dr Amol Dhopte joins Sparsh Team.

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January 11, 2018

A new entry in the team adds new facets to the work done at Sparsh Clinics. Dr Amol Dhopte is a dynamic young Surgeon trained at GMCH Nagpur, SMS Jaipur and Safdarjang Hospital New Delhi. He joins as a Full time Plastic Reconstructive and Aesthetic Surgeon. His special interests are Microsurgery, Brachial Plexus Rehabilitation and Peripheral Nerve Surgery. Gender Reassignment surgeries are added to the procedures done at Sparsh now. Dr Amol is known for his fine communication skills as well as his deft, confident surgical talent.

Work done at Sparsh Clinics

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March 24, 2013

1. Microsurgery

A. Replantation of amputated body parts eg hand, palm.
B. Reconstruction of lost parts with micro vascular tissue transfer
C. Micro neural transfer or anastomoses for nerve transaction or segmental nerve loss.
D. Micro Vaso-vasostomy
E. Micro Tubo-tubal anastomosis

F. Brachial Plexus Surgery – Nerve transfers, Nerve grafts, Tendon Transfers, Free functioning Muscle Transfers

2. Genital Plastic Surgery

A. Hypospadias – Cordee release with Urethroplasty
B. Vaginoplasty –  Vaginal Agenesis
C. Hymenoplasty
D. Scrotal Reconstruction, Testicular Implants
E. Penile Reconstruction

F. Sex Reassignment Surgery – Male to female and Female to male.

3. Breast Surgery

A. Lump Excision
B. Mastectomies
C. Breast Reconstruction
D. Reduction Mammoplasty
E. Breast Augmentation
F. Mastopexy
G. Gynaecomastia – Liposuction & /or Gland Excision

4. Aesthetic Surgery

A. Liposuction
B. Abdominoplasty
C. Thighplasty / Armplasty
D. Facelift
E. Rhinoplasty
F. Genioplasty – Chinplasty
G. Blepharoplasty
H. Ear reconstruction
I. Otoplasty – Correction of Cup Ear Deformity.

5. Clefts

A. Cleft Lip and Palate surgery
B. Cleft lip nose corrective Surgery
C. Secondary cleft deformity corrections
D. Complex facial cleft Surgery

6. Post Burn deformities

A. Contracture release
B. Scar improvement surgeries

7. Maxillofacial Surgery

A. Trauma and facial fractures
B. TM Joint Ankylosis and problems
C. Cosmetic Surgery of Face
D. Orthognathic Surgery

8. Wound Care and defect reconstruction

A. Skin Grafts for extensive areas
B. Fasciocutaneus and Myocutaneus Flaps
C. Micro vascular flap transfers
D. Bone and Mandibular reconstruction by micro vascular Fibula
E. VAC Therapy for complex, discharging or non-healing areas

9. Hand Surgery

A. Complex hand trauma
B. Carpal Tunnel and Nerve Compression Syndromes
C. Nail bed repairs and hook nail deformities
D. Thumb reconstruction and Pollicization
E. Congenital Hand Deformities

10. Oculoplastic Surgery

A. Orbital Surgery
B. Correction of Diplopia and Enopthalmos
C. Eyelid reconstruction after loss due to trauma or tumour
D. Aesthetic correction of Ageing eyelids

Cup/Bat Ears – safely correctable problem.

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April 7, 2012

Some things are surprising. Cup ear correction surgeries are one commonly performed procedure in developed countries. In India it is not commonly asked for. Probably it is our inherent attitude to accept….and be happy. And why not? It is one objective for all Cosmetic corrections….to be happy about oneself. So what if a body part is different than what is accepted. Nothing wrong in feeling that my difference is OK!

But it is also true that if one feels that this correction can make feel better about oneself it is possible. And without any side effects plus a reasonably rewarding result. In the near past two such people asked for it with a balanced mind and realistic expectations. They got a gratifying result with a scar hidden in the sulcus behind the ear. The shape was corrected and the angle between the ear – backside was reduced. Such help is safely available!

MIDPALM HAND REPLANTATION DONE SUCCESSFULLY.

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September 2, 2009

On Friday the 28th August 2009, a tin sheet cutting blade severed the dominant right hand of a worker. Accident time was 10.00AM. The amputated part was very correctly preserved by ‘bag in bag’ method by the local Consultant. He reached Sparsh at 3.30PM. Dissection of the amputated part, basic workup, anaesthesia was started at 4.00PM. Bony Synthesis achieved using 5 K wires, one for each finger. Flexor tendons were repaired. Microanastomosis of 2 arteries started blood flow in the severed part, 10 hours after separation. Extensor tendons were repaired and 3 dorsal veins anastomosed under the Operating Microscope. Good perfusion started and loose skin closure followed by plaster immobilisation done. The whole procedure took 9 hours for completion. On day 5, all fingers including the thumb are doing well. This is a difficult level for replantation, good planning, an able team and favorable factors yielded a gratifying result.

This August, it is 2 years since the accident. The patient has started moving the fingers and has regained sensations enough to make for him to use those fingers. He has joined back in the same factory, in the same position that he was in before the injury. This is the final parameter of the usefulness of replantation.

Update -sparshclinics.

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August 1, 2009

 Dear Friends,

At Sparsh Clinics we attempt to offer all Plastic Surgical Services under one roof, with the best results at the most optimum cost. The Speciality has seen immense advances in the recent past. To stay at par we have implemented the following measures.

1.
Stryker drill/saw/wire driver System 6 has been added to our armamentarium of precise and efficient equipments.This will be adding to our time and result management in Orthognathic Surgery, Hand and Maxillofacial Trauma, Mandibular reconstruction with microvascular transfer of fibula.

2.       Operating Rooms have been upgraded by including a dedicated Liposuction Machine, and Power driven Infiltrator for effective tumescence. A top end Cautery Machine makes surgery more precise and results outstanding. For patient monitoring a Multi-parameter Monitor has been added. Microsurgical sets and equipments are kept in readiness to attend to emergencies like amputations, complex trauma, and crush injuries.

3.       Appropriate counselling has been our hallmark at all times. Patient Information booklets, photographs to convey the point with greater clarity is being used and kept ready. Detailed explanation of the various options for the given problem, with details of the procedure, expected outcome and the possible complications or residual problems has been made a rule.

We are trying our best to provide all possible solutions to cosmetic and reconstructive desires of the community at Nagpur, maintaining the highest standards. We hope that you give us the opportunity to help you and your patients to the best of our capacities.

Thanking you,

The Sparsh Team.

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