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PLASTIC SURGERY
A. CONGENITAL ANOMALIES
• Cleft lip :
For repair of the cleft lip baby should be >3months and >10 pounds .I prefer Millard's method of repair for cleft lip. Bilateral cleft lip is dealt with in two stages.
• Cleft palate :
For repair of cleft palate baby should be >10 months and > 10 K.g. Various techniques are available for repair of cleft palate but results mainly depends upon proper release and midline repair without tension. Anaesthetist plays an important role in operation of cleft lip & cleft palate.
• Syndactaly : Syndactaly is corrected by release of joined fingers and reconstruction of web space.
• Ear deformity :
Depending upon severity, deformity of Ear is corrected by minor adjustment to reconstruction of pinna by rib cartilage.
• Hypospadias: Repair of
hypospadias.
B. BURNS & POST BURN SCARS, CONTRACTURE :
A. Flame burns .
B. Chemical burns (Acid throw)
C. Electric burns
Management : Patients are treated in the usual lines of
1.Fluid resuscitation 2.Control of infection and 3.Dressings
POST BURN SCARS & CONTRACTURES :
Post burn scars and contractures are usually seen in Hands, Face, Neck, Axilla & Elbow.
Management :
• Contracture Fingers & hand : Release of contracture + Full thickness skin grafting.
• Scar Face : Excision of scar + Local flaps or z-plasty or post auricular full thickness grafting.
• Contracture /Scar neck :
Release of contracture/ Excision of scar + Flaps or split thickness skin grafting.
• Contracture Axilla :
Release of contracture + Z-plasty or split thickness skin grafting.
• Contracture Elbow :
Release of contracture + Z-plasty or split thickness skin grafting.
C. WOUNDS & DEFORMITIES
a) ACUTE WOUNDS :
Types of injuries commonly encountered are:
• Crush injury Hands: Workers who operate Plastic moulding machines, Biscuit factory machines, Sugarcane Juice machines and who work in Mines are usual victims of this type of injury.
Management : Such type of injury is managed by Assessment of injury, proper cleaning of wound, Removal of devitalized tissue and Repair. Wound cover is done by direct closure or by skin graft or by flaps. Tendon repair & Nerve repair if possible should be undertaken at the same time.
• Crush injury feet and Legs :
Usually seen in Mine workers and can occur to Pedestrians by run over wheel.
Management : Is on the same line as Crush injury hands.
• Cut Injury : Cut injury from glass or knife is quite common because of personal conflicts
Management : After primary cleaning such wounds can be closed primarily. Repair of Tendons, Nerves and Arteries is possible at the same time.
DEFORMITY FOLLOWING TRAUMA :
Management : Depending upon the sites deformities can be corrected by release of contractures, and the wound is closed by skin grafting or flap, Tendon repair and Nerve repair are undertaken depending upon the loss of function.
b) CHRONIC WOUNDS :
Common chronic wounds seen & their management is as follows:
• Diabetic Foot Ulcers : Control of Diabetes,Dressings, Excision of Ulcer+Skin grafting.
• Venous Ulcer : Treatment of varicose veins, Dressings, Excision of Ulcer+Skin grafting.
• Decubitus Ulcer (Bed sore) : Dressings, Excision of ulcer+Rotational flap.
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