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Biomedical subjects

H M Bhathena

Publications and source records attributed to H M Bhathena.

At least 19 recordsLinked to original sources
PubMed2004

Mandibular reconstruction with local live vascularised bone transfer.

There are different methods to provide a skeletal support for mandibular reconstruction following the trauma or ablation for tumor in head and neck region. These methods vary from complicated techniques like vascularised free bone grafts to methods like free bone grafts, local vascularised bone grafts, cadaveric irradiated bone grafts and alloplastic material spacers including silastic rubber, polyvinyl plastics, ceramics, hydroxylapatite or metal. The technique employed solely depends upon many factors like expertise available, existing infrastructure, the available time factor and complexity of the defects including the type and extent of tissue loss in the particular patient. The sliding mandibulectomy is a simple method of mandibular reconstruction. This surgical technique is indicated for repairing short mandibular defects up to 9 cm in overall length including the mandibular arch for which extra vertical osteotomies are needed to bend the segment. More so it has its value in patients with poor prognosis and poor general conditions in whom longer and complicated mandibular reconstruction procedures with free vascularised bone flaps are not advisable. This article describes different types of sliding osteotomies used to harvest live bone flaps for rebuilding the mandibular defects including the arch of the mandible for patients who have undergone malignant tumor ablation. Primary reconstruction for the mandibular skeletal support was obtained in 18 cases with vascularised live-bone graft through various sliding osteotomies in different combinations. Complications, failures and success rate of sliding mandibulectomies and osteotomies have been analyzed and discussed in detail.

Aged↗
PubMed2002

The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous flap: case reports.

Complex soft-tissue defects of the lower third of the leg, the heel and the ankle still present a challenge for the reconstructive surgeon. In addition to skin replacement, many of these defects require muscle bulk, which promotes the healing of open bone fractures, effectively fills osteomyelitic cavities and deep three-dimensional defects, and helps to reconstruct the Achilles tendon. In an anatomical study, we developed a new flap based on the 'neuromuscular concept'. This flap consists of a paddle of gastrocnemius muscle and a skin paddle based distally on the sural venoneuroadipofascial pedicle supplied by the lower peroneal perforators. Three cases are presented to illustrate the versatile use of this flap.

Achilles Tendon↗
PubMed2002

The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous and muscle flaps: anatomical basis of a new concept.

Reconstruction of soft-tissue defects of the lower third of the leg, the heel and the foot remains a challenge. The distally based sural neurocutaneous flap has been used effectively to resurface these defects. However, the paucity of bulk in this flap makes it inadequate for complex post-traumatic or post-ablative soft-tissue reconstruction. We dissected 20 freshly amputated lower limbs after injecting them with a mixture of lead oxide and gelatin. We found muscular branches of the accompanying artery of the sural nerve to the gastrocnemius muscle in all 20 limbs. This led us to conceptualise the distally based venoneuroadipofascial pedicled island sural myofasciocutaneous and muscle flaps. These flaps are useful for the reconstruction of complex soft-tissue defects of the lower third of the leg, the heel and the foot.

Arteries↗
PubMed2002

Free jejunal transfer for pharyngo-esophageal reconstruction.

During the course of head and neck surgery for cancer the reconstructive surgeon is involved in replacement of pharyngeal mucosal defects. Siedenberg (7) first reported free transplantation in 1959 using a segment of jejunum, Roberts (5) using jejunum, Nakayama (3) using colon and Jurkiewicz (4) using ileum and jejunum. Green (2) in 1966 using microsurgical techniques demonstrated 100% survival of free transfers of jejunum and also patches of jejunum in dogs. We have used free interposing iso-peristaltic jejunal loop transfer in 30 patients to bridge the cervical esophagus defects for advanced cancer of hypopharynx, larynx and cervical esophagus after ablative cancer surgery. The major complication rate was 13% (4/30 cases) including total flap failure and loss of interposed jejunal segment. The minor complication rate was 36% (11/30 cases) including postoperative hypothyroidism in 2 patients. Intra-abdominal hemorrhage or peri-operative mortality was not observed in any of our cases. Total post-operative average hospital stay was 15 days, and median swallowing time was 10 days. Complication rates and success of early functional and social restoration have been analyzed.

Esophageal Neoplasms↗
PubMed2000

A simple, cost effective, innovative method of securing burns dressing.

An easy, simple way of securing the burns dressing has been described. This is achieved by using an ordinary office stapler and staple pins. The use of long, encircling gauze bandages for fixation of burns wound dressings around the torso and extremities, is eliminated. This article describes the use of this innovative, cost effective, quick, easy and simple method of fixation of burns wound dressings.

Burns↗
PubMed1999

The hemithigh microvascular transfer (combined anterolateral thigh flap and tensor fasciae latae flap) for a full thickness abdominal wall reconstruction: a case report.

In large, full thickness upper abdominal wall defects a free microvascular tissue transfer is the only option which will enable reconstruction of the structural integrity of the abdominal wall as well as give a good aesthetic appearance. We present a case in which such a defect was reconstructed by a 29 x 19 cm hemithigh free flap, combining the adjacent vascular territories of the anterolateral thigh flap and the tensor fasciae latae flap based on the lateral circumflex femoral artery.

Abdominal Muscles↗
PubMed1999

Tumor implantation at the flap donor site: a case report.

The genesis of cancer and its variable patterns of spread have been theorized and debated upon for decades. Recurrences, both local and metastatic, are dreaded by both the patient as well as the surgeon. An interesting case of tumor implantation at the flap donor site was noted in a patient who underwent a primary flap reconstruction for cancer of the cheek. The details of the case and theories regarding tumor implantation have been enumerated in this report.

Carcinoma, Squamous Cell↗
PubMed1998

Primary reconstruction of mandible in head and neck cancer with silastic implant--a review of 69 cases.

Different methods of primary mandibular reconstruction carried out at the Tata Memorial Cancer Hospital range from the pectoralis major myocutaneous or osteomyocutaneous composite flap, which is the most frequently performed procedure, to a free vascularised composite tissue transfer with microvascular anastomosis, including, iliac crest free vascularised bone grafts or radial artery forearm flap free vascularised radius bone grafts, free vascularised fibular bone grafts and silastic mandibular implants. The clinical results of immediate mandibular reconstruction with a silastic mandibular implant (SMI) in 69 patients is presented. Out of the 69 cases, 2 patients died in the early post-operative period. Twenty (30%) SMI were retained for a period of 1 year to 5 years. Forty seven (70%) SMI were retained for a period of less than 1 year. These implants have been used in a variety of cases, with or without major flap reconstruction, where a skeletal support was indicated, especially after mandibular arch resection. The results of this series indicates the importance of these implants as a short term spacer, even in advanced, fungating lesions of head and neck cancer where the risk of infection, haematoma and salivary leak is very high. Bone replacements were undertaken at a later date in suitable cases. The effects of preoperative chemotherapy and radiotherapy on the retention of these implants has also been studied.

Carcinoma, Squamous Cell↗
PubMed1998

Prophylactic antibiotics administration head and neck cancer surgery with major flap reconstruction: 1-day cefoperazone versus 5-day cefotaxime.

Patients who undergo surgery of the head and neck cancer with major flap reconstruction, benefit from perioperative antibiotic prophylaxis. Head and neck surgery, especially ablative cancer surgery with major flap reconstruction is potentially contaminated iatrogenic wound, and the use of preoperative, perioperative and post operative chemoprophylaxis for infection is mandatory. This study is being done to determine if shorter course of antibiotic administration (Cefoperazone) would be more effective than conventional 5-day antibiotic administration (Cefotaxime). Patients who are identified as requiring major flap reconstruction after extensive ablative surgery for head and neck cancer, are considered as potential candidates for this study. The choice of ideal antibiotics and duration period are still under discussion. Patients were assigned randomly to receive Cefoperazone sodium for either 24 hr. (study group) or Cefotaxime sodium for 120 hr. (control group). A total of fifty patients were studied. The incidence of wound infection, flap death and major complications are evaluated. Out of the fifty patients studied, twenty-eight were assigned to 1-day prophylaxis. Incidence of failure of prophylaxis (F. P.) was 7.1% in this group. Twenty-two patients were assigned to 5-day prophylaxis, in whom F. P. rate was 9.8%. This study suggests that, there is no beneficial effect from administration of antibiotics for more than 24 hr. postoperatively in patients two undergo major flap reconstruction for head and neck cancer after extensive radical ablation surgery.

Antibiotic Prophylaxis↗
PubMed1998

The submental island flap for reconstruction of facial defects.

The procedure of facial resurfacing dictates that there should be an excellent colour and texture match between the facial and the transposed skin. Cervical flaps e.g. platysma flap are commonly used for reconstruction of facial defects but, with disadvantages like limited mobility, unacceptable donor site and unpredictable outcomes. The submental island flap is a new addition to the armamentorium of the Plastic Surgeon. It is an axial pattern flap based on the submental branch of facial artery and the submental tributary of common facial vein. We report the use of this flap for the reconstruction of postexcisional facial defects in two patients having basal cell carcinoma and recurrent parotid tumour. In both patients, the flap provided an excellent colour and texture match. Other advantages of this flap are inconspicuous donor site, wide arc of rotation, simple dissection and a reliable pedicle.

Aged↗
PubMed1996

Comparative evaluation of function after surgery for cancer of the alveolobuccal complex.

PURPOSE: The current study was undertaken to assess the functional deficit after hemiresection of the mandible and to determine whether lateral segment resection with reconstruction was a functionally superior alternative in the management of patients suffering from alveolobuccal cancer. PATIENTS AND METHODS: Eighty-three patients were assigned to one of two main groups: Group I, hemiresection of the mandible (n = 47), and group II, lateral segment defects (n = 36). Functional assessment of patients included subjective evaluation of overall well-being, feeding, and cosmesis, as well as objective assessment of mastication, speech, and cosmesis. Mean scores for each of these categories were compared across groups using the Duncan Multiple Range Test with .01 confidence intervals. RESULTS: Subjective assessment of overall well-being, feeding, and cosmesis did not yield statistically significant differences between groups. Objective evaluation of mastication showed significantly better function after hemiresection in dentate patients as compared with their edentulous counterparts. However, masticatory scores for hemimandibulectomy patients with intact residual dentition were not significantly different from those for patients whose lateral segmental defects had been reconstructed. Although objective cosmetic scores for reconstruction of lateral segment defects were significantly better than those for hemiresection of the mandible, most patients in the latter group accepted the resultant deformity as a consequence of their treatment and did not let it affect their routine activities. CONCLUSION: Until functional results in patients undergoing lateral segmental resection for alveolobuccal cancer can be improved by better prosthetic techniques, hemiresection of the mandible remains a simple, safe, reliable, and cost-effective option that produces acceptable postoperative function.

Adult↗
PubMed1996

Reconstruction with different free flaps in oro-facial cancer patients.

In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary.

Adolescent↗
PubMed1996

Caudal trapezius composite island flap for extensive shoulder defects.

The trapezius composite flap was first described by Demergasso in 1979 (2). The caudal trapezius island flap was described by Mathes and Nahai (4), in head and neck cancer reconstruction. Baek and Biller (1) described the descending branch of the transverse cervical artery, as a dominant blood supply. It is an useful flap for the reconstruction of defects around shoulder, neck and cheek regions. The anatomy of the trapezius muscle, its blood supply, vascular territories and its function is described in brief. Use of this flap in the reconstruction of compound extensive tissue defects in shoulder region of our patient is presented.

Adult↗