Biomedical subjects

T Ayyappan

Publications and source records attributed to T Ayyappan.

4 recordsLinked to original sources

PubMed2006

Microsurgical reconstruction in children's burns.

There have been few reports on microsurgical procedures performed on children who have been left with disability and deformity as a result of burn injury. The reality is that whilst there are many children who could benefit from such procedures they do not have access to the resources that can provide them. Where these resources are available there has been a reluctance to use them partially due to a misconception that such procedures are technically challenging and carry significant risk. This paper presents a series of 21 children in whom 29 microsurgical procedures were performed. There were two failures but in all other cases there was significant improvements in the functional ability and/or the aesthetic appearance of the child. This series includes novel variations on the antero-lateral thigh flap; tissue engineering, dual flap harvest, size and age. Refinements of inset are described to prevent pin-cushioning and linear scar contracture. In selected cases microsurgical reconstruction can produce life long benefits, with minimal surgical and donor site morbidity.

Adolescent↗

PubMed2006

Decompression not escharotomy in acute burns.

The concept of escharotomy has long been associated with acute burns care. Nevertheless the practice of escharotomy is frequently flawed and there is considerable diversity in the teaching of the procedure. It is proposed that there should be a fundamental change in the teaching of acute burn management and the concept of decompression should be promoted. The justification for this change comes from a review of the present knowledge base using indexed, library and web-based information sources and also a review of a series of patients transferred to a regional burns unit over a five-year period which revealed that 37% of patients who required surgical decompression had not been appropriately treated prior to transfer. Based on relevant compartmental anatomy a change in the surgical decompression of limbs is proposed to allow safer and more effective management.

Burns↗

PubMed2002

Super sural neurofasciocutaneous flaps in acute traumatic heel reconstructions.

Conventional reversed sural flaps have been used to cover heel defects; however, the experience of the authors indicates that the reach of these flaps falls just short of the critical area to be covered. With the limitation being the location of the flap (the middle third of the leg), the authors thought that if the flap territory were extended proximally, they would have a super flap with immense potential. Nevertheless, the critical question remained, "How far?" The massive earthquake in January of 2001 in Gujarat, India, made medical personnel pressed for time, manpower, resources, and other ancillary supports. The authors were forced to make some innovations in their management of extensive heel defects. On the basis of preexisting anatomic studies, they developed the possibility of using distally based neuroskin flaps of huge dimensions that extend well beyond the conventional confines. The versatility of this extended, reversed, neuro-fasciocutaneous flap in regard to its reliability and safety, despite its huge dimensions, is commendable. The hallmarks of this successful extended sural flap, which the authors used to cover large heel defects, were basically accurate understanding of the anatomy and the use of Doppler to map the perforators and the lesser saphenous vein for inclusion in the lie of the pedicle. The authors share their experience of five cases of difficult heel reconstructions salvaged with this flap, which made them attempt to define maximum flap dimensions that can be harvested. The authors learned that the flap can be extended proximally to include the entire upper one-third of the leg posteriorly, drastically improving its reach and size, without compromising safety. The largest flap used measured 17 x 16 cm, far more than ever reported in the literature. The flaps truly deserve the classification of "super," which is usually reserved for Ponten's flaps.

Adolescent↗

PubMed2001

Axial aponeurofasciocutaneous groin flap: an extended concept.

The concept of including external oblique aponeurosis along with the time-tested groin flap as a single vascularized unit heralds a versatile and unique application in the armamentarium presently available. This concept, though simple, has not been previously reported in the world literature. In view of its potential benefits and simplicity, we felt the need to bring this concept to the attention of our colleagues.

Child↗