Search PubMed⌕ Search

Biomedical subjects

N S Niranjan

Publications and source records attributed to N S Niranjan.

At least 19 recordsLinked to original sources
PubMed2006

Large fasciocutaneous perforator based V-Y advancement flap for large post-mastectomy wound reconstruction--our experience with three cases.

Old and frail patients with advance breast malignancy require mastectomy which often results in large defects requiring soft tissue cover. We present three cases of large fasciocutaneous perforator based V-Y advancement flaps for reconstruction of large post-mastectomy wounds in older patients with large tumours. This technique reduces the morbidity of patients who have severe co-existing morbidity factor in addition to the advance breast disease.

Aged, 80 and over↗
PubMed2005

Long-term results of primary syndactyly correction by the trilobed flap technique.

This paper describes the long term results of a surgical technique used for correction of syndactyly. This technique has been practised by the senior author since 1987 and was published in 1990. The technique involves the use of a dorsal trilobed flap for the reconstruction of the commissure and zig-zag incisions for the fingers. This technique does not require the use of skin grafts. This technique has been used in 62 webs in 44 patients. In this total group, there were 30 patients of primary hand syndactyly with 40 webs. Seventeen patients of primary syndactyly with 25 webs were followed up. The follow-up of these patients ranged from 2 years to 12 years. The long term results reveal a simple, effective technique which does not require the use of skin grafts, and is associated with good functional and far superior cosmetic results.

Child↗
PubMed2004

Four V-Y islanded flap reconstruction of full thickness defect of chin and labial sulcus.

Few techniques are described specifically for reconstruction of full thickness defects involving the chin. We present a new method of reconstruction of a large full thickness defect over the chin and lower labial sulcus with four V-Y island flaps. Two of these were mental neurovascular island flaps. The other two were islanded musculomucosal flap. The mental flaps, previously described for reconstruction of the lower lip, were cosmetically more suitable for reconstruction of tissue defects of the chin. The principle of covering the tissue defect of chin with local tissue to provide good matching and function is achieved.

Aged↗
PubMed2002

Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic socially debilitating disorder of unknown aetiology. Treatments include simple incision and drainage, excision and healing by secondary intention, spilt-skin grafting, and local-flap reconstructions. All of these methods can leave unsightly scars. Recurrence of the disease can be significantly reduced only by wide local excision of all the hair-bearing skin. Most methods involve repeated hospital admission, and leave contour defects in the upper arm and axilla. We describe a new method using double opposing V-Y perforator-based flaps to recreate the axillary contour after wide excision of the hair-bearing skin of the axilla. This method allows both axillae to be treated in a single stage, and represents a new alternative in the treatment of axillary hidradenitis suppurativa. Four patients are described: three underwent bilateral excision and reconstruction, while the fourth had a unilateral procedure. All patients had a single surgical procedure with no flap loss. The result following known reconstructive procedures is far from satisfactory: skin grafting leaves a divot deformity, and when a local flap, such as the posterior arm or thoracodorsal flap, is used it leaves a large bulky flap in the axilla. In our technique the flaps maintain the diamond shape of the axilla.

Adult↗
PubMed2001

Venous augmentation of the free TRAM flap.

Venous congestion in a free TRAM or DIEP flap when the main pedicle is still patent (both the artery and the vein) is an occasional dire situation. Here, we describe ways of salvaging the free TRAM or DIEP flap from imminent loss. In the last 4 years, we have had three patients who developed venous congestion after the use of the TRAM or DIEP flap for breast reconstruction. This was detected as late as the third postoperative day in our first patient. On exploration, patent arterial and venous anastomoses were found. Fortunately, the opposite pedicle had been dissected and preserved with the flap. The patent congested vein in this pedicle was anastomosed to the cephalic vein using an interpositional vein graft, relieving the congestion. In the other two patients congestion was detected earlier and relieved using the superficial inferior epigastric vein. It has been our policy to dissect a length of the opposite pedicle and/or preserve a length of the superficial inferior epigastric vein or the superficial circumflex iliac vein. These can then be used to augment venous drainage if inadequacy is noted at the end of the operation or during the postoperative period.

Adult↗
PubMed2000

Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects.

The principle of the V-Y advancement flap has been used since its first description by Blasius (1848) for reconstruction of smaller defects. We wish to describe V-Y advancement flaps, the design of which includes distinct perforator or fascial feeder vessels, which may originate from periosteum, muscle, cutaneous nerve or from large tendon sheaths. These flaps are planned in an oblique manner when there is a defect over the anterior, antero-lateral or antero-medial aspect, and in a vertical manner when there is a defect over the posterior aspect of the leg. The main advantage of this design is the ability to close the secondary defect primarily, allowing adequate cover of the defect, particularly in the pre-tibial region, without the unsightly divot left by a split skin graft in this area. When the flap includes branches of the long saphenous nerve on the medial aspect, superficial peroneal nerve laterally or sural nerve posteriorly it results in a sensate flap, giving protection in this vulnerable area, which has previously not been possible. We describe 40 cases where perforator-based V-Y advancement flaps have been used to cover large defects of the lower leg following excision of malignant skin lesions and in selected trauma cases that do not involve degloving injuries. This technique allows adequate soft tissue cover in the pre-tibial area and around the ankle with excellent aesthetic results. The planning, operative technique and the results with case presentations have been described.

Adolescent↗
PubMed2000

Metastatic basal cell carcinoma of the axilla: report of a case and reconstruction with an island lateral pectoral flap.

A case of metastatic basal cell carcinoma arising from the skin of the axilla is reported. Multiple surgical procedures performed previously for recurrences of basal cell carcinoma limited the availability of conventional local flaps in the reconstruction of the axillary defect after excision of the recurrent tumor and axillary nodal dissection. The use of an island flap based on the lateral pectoral vessels and lateral cutaneous branches of the intercostal vessels is described.

Axilla↗
PubMed1999

Fasciocutaneous flaps based on fascial feeding vessels for defects in the periolecranon area.

Skin defects over the olecranon process are usually a result of wound dehiscence following trauma or following joint replacement. Rarely, breakdown occurs over the olecranon in degenerative joint diseases and as the result of pressure necrosis. We have used a fascial feeding vessel-based fasciocutaneous flap to reconstruct 10 defects in nine patients. The technique provides a thin and supple local flap that is easy to raise and is reliable.

Adult↗
PubMed1999

Fascial flaps based on perforators for reconstruction of defects in the distal forearm.

Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand.

Adolescent↗
PubMed1996

Cervical necrotising fasciitis with pharyngeal perforation: treatment and reconstruction.

We present a case of life-threatening necrotising fasciitis of the neck with acute pharyngeal perforation following a parapharyngeal abscess caused by tonsillitis. The joint occurrence of cervical necrotising fasciitis and acute pharyngeal perforation has not been previously reported. A new way of reconstructing the pharyngeal defect using an islanded submental perforator flap is presented.

Acute Disease↗
PubMed1996

Lotus petal flaps in vulvo-vaginal reconstruction.

The perineum is an area of rich blood supply with multiple arterial anastomoses. Flaps raised on perforators around the perineum resemble the petals of the lotus and can be used to reconstruct a variety of vulvo-vaginal defects. Thirteen such flaps have been used successfully without any loss of flaps in eight patients. Eight flaps in four patients were used for vulvar reconstruction following radical vulvectomy.

Adult↗