brahmanand clinic

32 year old man suffered a near total amputation to right leg due to road traffic accident . By the time they reached hospital part was considered non replantable, So decision was taken to amputate the leg and cover stump with LD flap in order to preserve stump length. LD flap was connected to popliteal artery stump and vena comitans was used for venous drainage. Flap was skin grafted ,It took two months for all wounds to heal . Patient was fitted with prosthesis after another six months. Free flaps are sometime used to preserve the length of amputation stump , whenever skin cover is short . Usually muscle flap are used along with skin grafting to cover amputation stump. Sometimes Fasciocutaneous flaps ( ALT) are  used.  Preserving amputation stump length enables better ambulation and less energy consumption. It results in better ambulation and more gait speed. It is useful in young ampute

postop mouth opening post operative mouth opening Final mouth opening 22 yrs old boy who suffered facial burns and had total TMJ ankylosis.He underwent bilateral TM joint arthroplasty , Temporal fascia imposition arthroplasty . Post operative he regained excellent mouth opening and TM joint function. Patient was burned at the age of 4 years and he slowly developed ankylosis. He could not open even one finger both jaws were tight shut. 18 years he was living with this problem.Post operative he developed severe pain secondary to dental caries. he had a severe dental caries which flared post operatively. He did physiotherapy for 90 days to regain excellent jaw function. TM joint ankylosis is mainly due to trauma, infection. Burns is a unusual etiology for TM joint ankylosis. Dr Adhishwar Sharma MBBS,MS General Surgery Mch Plastic surgery Fellowship in microvascular and hand surgery  8860650846 adhishwar7@gmail.com

original wound Excised wound Flap marked Flap insetted Bed sore are common problem in bed ridden patients. Good nursing care ,2 hrs posture changing , keeping patient clean and dry can prevent bed sore but are really tough to follow. Bed sore are graded 1 to 4 . Grade 4 are the sore reached upto bone and grade 1 is just involving skin rest is in between. Grade 1 and 2 are managed with wound care only it is expected to heal but grade 3 and 4 require surgery. Surgery involves debridement of wound and flap cover. Various types of flaps are being described to cover the wound. Dr Adhishwar Sharma 8860650846 adhishwar7@gmail.com

Frontal view of defect Lateral view Another view Flap marked on tummy Internal mammary vessel dissected Flap fully dissected just before pedicle division Flap insetted Second post op day Lateral view 2nd post oop day bleed showing viable flap Dressing 2nd post op day Lateral view Frontal view 10 days frontal view Secondary breast reconstruction done by free TRAM flap . Recipient vessel are internal mammary, it results in better flap placement. Aesthetic outcome is better , breast volume can be controlled better. Free tummy tuck is added benefit. Donor site morbidity over pedicled TRAM is reduced. Nipple reconstruction and symmetrization can be done after at least one year . Primary breast reconstruction is called when it is done in same sitting as cancer surgery. Dr Adhishwar Sharma 91 8860650846 adhishwar7@gmail.com