brahmanand clinic

marking for breast reduction Partial mastectomy scar Tram flap marked out internal mammary vessel dissected out Microvascular anastomosis done primary closure and lateral muscle mass Lie of vascular pedicle before final closure final closure  both breast shape 40 year old female developed right breast cancer which was excised partilly . Hence completion mastectomy and right axillary dissection was done . Right breast was reconstructed with muscle sparing tram flap and left breast was reduced by lejour method. Lejour method is superior pedicle reduction technique which results in linear scar well accepted by patients. Tram flap was raised by sparing lateral muscle and including only medial component . Inferior epigastric artery of flap was connected to internal mammary vessels .  Drains were placed and flap was monitored for vascularity for 5 days and patient discharged there of. Nipple reconstruction and any other revis...

                                                      degloving injury initial injury photo Immediate post op                                               at two weeks healed flap at three weeks At three weeks skin grafted donor site skin grafted thigh degloving injury finally healed flap at two months final hand function Degloving injury occurred to 21 years old male while coming from religious pilgrimage . Patient had total degloving of forearm skin , with extensive crushing of muscles. Patient had small liver injury as well as degloving of right thigh as well.   Pt was investigated and planne for debridement. After debridement patient was taken...

pre op wound after deridement gracillis muscle with pedicle muscle being insetted post op day 10 healthy muscle and graft taken up 42 year old iraqi male suffered electric contact burn ,which resulted in loss of skin ,tendons and exposed bone.. Wound was debrided and VAC was applied and culture was done . Antibiotics according to culture were given. After 10 days of VAC therapy decision to operate was taken. Bone was nibbled and gracillis flap was taken to cover it. Flap artery was connected end to side to anterior tibial artery and vein was connected end to end to venae comitantes. Patient was anticoagulated for 5 days and flap monitoring was done. After six days of surgery patient was discharged and put on ecosprin for one month. Regular dressing were done and flap epithelized rapidly . Microvascular surgery is difficult in high voltage electric burn injuries as in these case . Electric current travels through neurovascular bundles. Dead bone is a good...

pre op wound digital artery flap raised flap insetted checking bleeding before closure viable flap after two days after two days                                        suture removed after two weeks                                         Finger tip amputation are common emergency faced by plastic surgeons. Replantation is ideal but often not feasible. Cross finger flap and Thenar flap is usually  done to cover the stump.But these procedure are two stage with considerable morbidity. Digital artery perforator flap are single stage procedure with little or no morbidity. It is fast easy and has excellent results. Dr Adhishwar Sharma MBBS, MS General surgery PGIMER Chandigarh Mch Plastic Surgery Fellowship i...

pre op wound dorsal aspect flap marking dissected flap revesered and insetted connected to common digital artery lookis bad but bleed is bright red one week old 28 year old male with ring avulsion injury, refused option of groin flap. Patient was offered option of venous flap he accepted. A venous flap was designed and transferred . incoming vien to flap was connected to common digital artery and draining vein was connected to digital vien . Flap developed congestion first post op day , all sutures were removed flap improved . Subsequently it developed dusky appearance though bleeding was okay. I am waiting for one month to pass so that measures to reduce edema and proper shape can be given. 12/06/2018 Dr Adhishwar Sharma  MBBS, MS gen surgery PGIMER Mch Plastic surgery 8860650846 , adhishwar7@gmail.com brahmanand clinic.com