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Biomedical subjects

S Raja Sabapathy

Publications and source records attributed to S Raja Sabapathy.

12 recordsLinked to original sources
PubMed2006

Recommendations for the improvement of hand injury care across the world.

This paper discusses the four aspects, which need attention if the management of hand injury is to improve globally. These areas include the provision of information, targeted education, relevant and well-supported audit and research and the improvement of infrastructure. The paper explores what needs to be done, the time frame for improvement and how this may be achieved. The strategy developed needs to remain sensitive to the local needs and capacity.

Delivery of Health Care↗
PubMed2006

Management of complex tissue injuries and replantation across the world.

Management of complex tissue injuries and provision of replantation services calls for the availability of a dedicated team with high skill levels and good infrastructure. Centres of excellence which provide consistent good care exist in many parts of the world, but large populations are still left uncovered. In the developed world, the reduced exposure to such injuries, lesser training opportunities and poor reimbursement for the efforts put in are the problems. In the developing countries, lack of awareness of the possibilities, inadequate transport systems and infrastructure are the problems. In both systems the cornerstone for improvement will be the availability of well trained surgeons who will deliver consistent good results. Public education and developing a team around the surgeon will improve the results in developing countries. Collaboration with good units with high volume load in the developing countries will be beneficial for training and maintainance of the required skill levels in the developed world.

Developed Countries↗
PubMed2006

A philosophy of care of open injuries based on the Ganga hospital score.

In the management of Type IIIb injuries, Gustilo's classification has the disadvantages of a poor intra and inter-observer agreement rate, low specificity and sensitivity to salvage and inability to predict functional outcomes. We propose here a validated score which assesses the severity of injury to the covering structures, skeletal structures and functional tissues of the injured limb separately along with providing weightage to the presence of co-morbid factors. A high sensitivity and specificity for amputation was documented when a score of 14 was used as the threshold score. In salvaged limbs, the score was found to offer guidelines in protocols for reconstruction. According to the total score, injuries were treated by 'Fix and close' protocol; 'Fix, Bone Graft and Close' protocol, 'Fix and Flap' protocol or 'Stabilise, Watch, Assess and Reconstruct' protocol. The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction.

Amputation, Surgical↗
PubMed2006

Tube pedicle flap in the management of a Grade III C lower limb injury.

Salvage of a Grade III C lower limb injury is a challenging problem. Apart from microsurgical revascularisation, they frequently need soft tissue coverage procedures. Due to the magnitude of the injury, local flaps from adjacent tissues may not be available and microsurgical free flaps are the flaps of choice. We present an instance where the defect in the middle third of a revascularised leg was covered by a tube pedicle flap raised from the groin and transferred, with the wrist as the carrier. This was chosen because of the below knee amputation on the opposite side combined with long segment circumferential loss of skin in the affected extremity and paucity of vein graft sources. Thus the reconstruction of a limb which was saved by microsurgery was completed by tube pedicle flap. In exceptional circumstances 'old' techniques are still useful.

Amputation, Traumatic↗
PubMed2006

Technical considerations in replantation of total scalp avulsions.

Total scalp avulsions are devastating injuries and replantation is the best form of reconstruction. We present our experience of replantation of six totally avulsed scalps done between 1996 and 2004. All were technically successful, but one was lost in the post-operative period due to accidental shearing of the scalp during nursing care. A single team performed the surgery in all cases and the average operating time was 6 h. No vein grafts were used. Hair growth was satisfactory in all cases. None underwent formal nerve repair but there was adequate sensory recovery in all of them by 6-9 months. A small area of skin necrosis in the occipital area (three cases), telecanthus and epiphora (two cases) were the minor complications. The available Literature highlights the need for multiple teams to reduce the long operating time, the use of multiple vein grafts and the complexities involved. Since, they are rare injuries, gaining wide experience is difficult. In this article we offer recommendations in pre-op preparation, vessel identification, technique of anchoring the avulsed scalp prior to vessel anastomosis and post-op care to make this rare procedure quicker, easier and successful.

Accidents, Occupational↗
PubMed2005

Functional outcome of extensor carpi radialis longus transfer for finger flexion in posttraumatic flexor muscle loss.

PURPOSE: The purpose of this study was to assess the functional outcome after extensor carpi radialis longus (ECRL) transfer for restoration of finger flexion in patients with flexor muscle loss after direct trauma. METHODS: We evaluated 8 patients who had ECRL transfer between 1995 and 2003. Flexion gained was assessed by measuring the digit-to-palm distance (DPD). The grip strength was compared with that of the opposite normal limb. The average follow-up period was 41 months. We compared the results obtained with other modalities of restoration of finger flexion, namely a pedicled latissimus dorsi muscle transfer or a free functioning muscle transfer (FFMT) using the series available in the literature. RESULTS: Four patients had a good result with a DPD of 0 cm in all fingers and an average grip strength of 65% of the opposite hand. Two patients had an average result with a DPD of 1.5, 2, 1.7, and 1.5 cm for the index, middle, ring, and small fingers, respectively, and an average grip strength of 58%; 2 patients had a poor result with a DPD of 5.0, 5.5, 5.0, and 3.0 cm for the index, middle, ring, and small fingers, respectively, and with an average grip strength of 21% of the opposite hand. CONCLUSIONS: The ECRL transfer yields good results if the intrinsic muscles of the hand are functioning, the extensor compartment is uninjured, and the lower third of the forearm where the tendon junction is performed is relatively unscarred. In such instances the range of movement and grip strength achieved are better than a latissimus dorsi muscle pedicle graft and are comparable with a FFMT. This is achieved earlier than the time taken for reinnervation of FFMT and without the attendant risks for flap failure. The ECRL transfer for finger flexor restoration is a more simple alternative that should be considered when possible.

Adolescent↗
PubMed2005

Distal fingertip replantation without skeletal fixation.

The replantation of fingertip amputation (through the nail bed) requires repair of the artery and vein on the palmar side. These structures are present in different planes, with the artery being deeper and the veins superficial. The authors believe that vascular repair in such cases is facilitated by stabilization of the amputated part by nail-bed repair alone. This provides a certain degree of flexibility, which allows for easier placement of clamps in the limited space available. Although Kirschner wires were not used for bony fixation, bony union was achieved in all five cases in which this technique was used.

Amputation, Traumatic↗
PubMed2004

Primary use of the index finger for reconstruction of amputated thumbs.

Seven cases of primary reconstruction of traumatic amputation of the thumb using the index finger are reported. In six cases, the reconstruction was done using an injured index finger, while in one case where the amputation of the thumb was through the carpometacarpal joint, an intact index finger was primarily pollicised. This reduces cost of treatment, hospitalisation period and allows earlier rehabilitation without a period of a 'no thumb experience'. We have followed all the patients for a minimum period of 2 years and all of them have excellent functional results. We believe that pollicisation of a normal index finger, if thumb amputation is through the carpometacarpal joint or an injured index finger at the time of initial management of a severely traumatised hand with thumb amputation is an excellent technique for thumb reconstruction.

Accidents, Occupational↗
PubMed2002

Reconstruction of finger tip amputations with advancement flap and free nail bed graft.

Fifteen finger tip amputations through the proximal half of the nail bed were reconstructed with palmar V-Y advancement flaps and full thickness nail bed grafts. The undersurface of the V-Y flap was sutured to the nail bed remnant and the raw area was covered with full thickness nail bed grafts from the amputated part. They were followed for a minimum period of one year and the nail bed grafts took fully in all patients. The results were best in the thumb and least favourable in the little finger but all the patients were happy with the cosmetic result and the functional outcome. This technique results in an average gain of 5 mm of extra length to the nail. This is a useful technique when replantation of a distal fingertip amputation is not possible.

Amputation, Traumatic↗