Are we following the road traffic rules?

 FACE INJURY, FOREHEAD INJURY, ROAD TRAFFIC ACCIDENT, TREATED BY PLASTIC AND COSMETIC SURGERY PRINCIPLES

Road traffic accidents commonly lead to face and head injuries. Driving within the car or other vehicles the absence of an airbag means be thrown against the windscreen or other areas and suferring severe injuries. The gentleman shown in the first picture above was involved in a road traffic acccident. Pieces of broken glass were embedded in his wound as well as the skin and soft tissue were lost. He underwent two plastic and reconstructive procedures to achieve the result shown above. His scars will need further treatment and follow up to improve them. The second picture shows a similar patient involved in a car road accident with loss of skin and soft tissue and exposed skull bones. An immediate reconstruction picture is shown alongside.

Road traffic accidents occur almost everyday and in almost every city, town or village. Millions of lives are lost from rash and drunken driving, over speeding, not following road traffic rules, not wearing  helmets and not using seat-belts and child restraints.  Very few countries actually have rules that correctly address these issues. According to WHO estimates approximately 1.24 million people die every year on the world’s roads, and another 20 to 50 million sustain nonfatal injuries as a result of road traffic crashes. Eritrea  appears to top the list with about 48.4 deaths per 100,000 inhabitants while the Dominican republic, Libya, Oman, Iran, Thailand and others follow closely.  India  stands at  18.9 while the USA had 10.4 deaths per 100000 inhabitants by these statistics.

Imagine the anguish and the pain that each of these individuals who have sustained serious injuries go through. The financial implications of these accidents have often been grossly underestimated or has been difficult to estimate due to lack of proper information and logistical support. Children are orphaned, millions are maimed, others bedridden and still other  families robbed of their breadwinners.

We may not be able to entirely stop traffic accidents that occur by chance or 'accidentally'. Yet, we can by uniting ourselves in this en-devour reduce the number of accidents. Creating awareness in the community is the only way and stressing the need to follow all the traffic rules on every road or lane will help in the long run+

Gynecomastia - male breast enlargement, plastic surgery, cosmetic surgery, keyhole surgery, liposuction+

Gynecomastia or make breast enlargement continues to be a perpetual problem that can lead to psychological problems besides social ones. This gentleman shown above could not attend the gym nor go swimming because of fear of mockery. Often young individuals go around suffering silently not knowing that treatment is available for such conditions. The pre and post pictures ( before and after pictures) are shown here following liposuction which was the only procedure needed in this case.

For a detailed discussion on Gynecomastia please visit+
http://thecosmeticplasticsurgeon.blogspot.in/2012/12/cosmetic-surgery-asthetic-surgery.html


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Gynecomastia male breast surgery video by Dr Alexander cosmetic plastic surgeon cochin, kerala, India+

Gynecomastia, male breast surgery, liposuction, breast enlargement in male, surgical gland excision, Dr Alexander, Plastic cosmetic surgeon, cochin, kerala, India+

 

Gynecomastia or male breast enlargement can often be a source of embarrassment and young men often wear loose clothing to hide their large breasts. Surgery can be of great help in these patients but one has to be aware that often there is a combination of gland and fat in these breasts. The fat can often be managed by liposuction whereby a small opening is made just below and lateral to the breast, a canula or tube is inserted in and the fat slowly sucked away. However when the fat has been sucked away sometimes the gland may manifest itself and this may not come out through the canula. In such cases often the surgeon has to make a second incision which is usually masked and not easily seen, to remove this gland. The picture shown above is that of a male breast gland removed during gynecomastia surgery combined with liposuction.

For a detailed discussion on gynecomastia please visit+
http://thecosmeticplasticsurgeon.blogspot.in/2012/12/cosmetic-surgery-asthetic-surgery.html

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nail lesion for opinion ? +

Mommy make over, post pregnancy changes in the body shape and size, liposuction, body sculpture, body sculpturing, breast reduction, mammoplasty, mastopexy, tummy tuck, abdominoplasty, thigh lift, brachioplasty, arm surgery, Dr Alexander, plastic surgeon, cosmetic surgeon, aesthetic surgeon, cochin, kochi kerala, India, plastic surgery, cosmetic surgery, medical tourism, India +

The greatest gift that a woman has is the ability to give birth to a baby. The bonding that occurs lasts a lifetime and this bond can never be broken- come whatever!!

Pregnancy brings about changes in the female body making it conducive to nurture the baby in the womb. These changes however are not very attractive and once the baby has been delivered it becomes the mother’s duty to work hard to get back to her original form. Most often women forget this fact and ignore their bodies and reach a state of no return. The fat depositions that are supposed to provide calories during lean times become their permanent attires. Sagging skin needs to be tightened and muscles need to be retoned. The Indian customs and traditions of resting for two months post delivery and eating a lot of fatty medications and foods further help in worsening their appearance. Often the mother has no one to care for the baby or no one to help her and finds little time to look after herself. Unfortunately once the lady returns back to her husband – he some how finds her totally different from what she was before her pregnancy and in many ways unattractive.

Mommy makeover is a plastic and cosmetic surgery procedure that tries to revert these changes in the appearance of the mother thereby making her more attractive.

The breast and the abdomen are the most common areas where pregnancy affects the woman.

The breast sags and become ptotic. A breast mastopexy procedure can be helpful. Here the breasts put back in it normal position by surgery from its sagging position. Also if the size is an issue then a reduction mammoplasty or a reduction in size of the breast is carried out.

The abodominal muscles loose their tone especially if the mother has delivered multiple times. The tummy protrudes and sags down, sometimes even covering the pubic area. A liposuction or a tummy tuck procedure or abdominoplasty will help the woman to regain her original youthful shape. The fat can be sucked out, the muscles tightened and the excess tummy skin can be removed by surgery.

If the thighs are a problem then liposuction helps by sucking away the fat selectively. Also if the skin sags then a thigh lift procedure can help to tighten the skin of the thighs.

Seeking help from a plastic and cosmetic surgeon can go a long way as he may pick up simple problems that can be easily addressed to make you look more attractive. If the arms are a problem then brachioplasty or arm reduction can help. Similarly body sculpting or changing the shape and size of other parts of the body can be carried out.

Many women take a lot of trouble by exercising and dieting to get back in shape. However sometimes even this may not help and then plastic surgery, aesthetic and cosmetic surgery can come to their rescue. This will help to improve their body image as well their self confidence and be more successful in their personal, married, family, social and professional life.

 ‘Every woman has the right to look good and feel good

Every woman must demand this right and ask for it’

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HAND BURNS, SKIN GRAFTING, HAND VIDEO, DR ALEXANDER, PLASTIC SURGEON, COSMETIC SURGEON, COCHIN, KERALA, INDIA, PLASTIC SURGERY, COSMETIC SURGERY+

Male breast surgery, gynecomastia correction, male boob surgery, keyhole surgery, Dr Alexander, Plastic surgeon, cosmetic surgeon, plastic surgery, cosmetic surgery, cochin, kochi, kerala, India+

For a detailed discussion on gynecomastia please visit+

http://thecosmeticplasticsurgeon.blogspot.in/2012/12/cosmetic-surgery-asthetic-surgery.html

Gangrene of the hand, wrist and fingers in a new born child- an unusual rare case, Dr Alexander, Plastic surgeon, cosmetic surgeon, hand surgery, hand gangrene, finger gangrene, neonatal gangrene, plastic surgery, cosmetic surgery, cochin, kochi, kerala, India++

Gangrene in a new born child is an uncommon and rare event. The picture above is that of a newborn child who was born with gangrene of his left hand, wrist and fingers. However it does happen sometime and can be very devastating for the family to see their new born child loose a limb, an arm or a leg from gangrene. A review of the medical literature shows that upper limb gangrene is more common as compared to lower limbs. While it may be difficult to diagnose the exact reason, a number of causes can predispose to gangrene in the newborn child like:

Sepsis

prematurity

hyper-coagulable state

thermal abnormality

umbilical artery cannulation

polycythemia

arterial thrombosis

maternal diabetes

intravenous hyperosmolar infusions

Abnormal fetal presentation with extremity compression causing loss of blood circulation in a limb

Arterial occlusion due to normal obliteration of ductus arteriosus or umbilical arteries

While the condition can be a very traumatic experience, wherever possible, one must wait for a definite demarcation to appear between the dead and normal tissues before planning an amputation or removal of the dead part. Also one must plan the amputation so as to preserve the growth plates if this is possible so that an adequate stump can be obtained for prosthetic fitting as the child grows+

What is Dengue fever? viral fever, travelers disease, travelers fever, mosquito spreading disease

Dengue is a viral disease, commonly transmitted by a mosquito called Aedes mosquito. It is a common disease in some parts of the world- parts of Asia and America where the disease is endemic.  In the rest of the world the disease most often is brought in by travellers (70 to 80%) who visit these endemic areas. About 100 million people get infected by dengue virus every year, so it is important that we know more about dengue and develop methods to prevent it. There is no vaccine or prophylactic drug or medicine available to prevent it.

The Aedes mosquito is a funny guy: he prefers to bite and drink human blood during the day time and hide and rest in dark areas. The female mosquito whose average life span is 8 to 14 days lays eggs in damp places that can remain viable for months.

What causes dengue?

Dengue is caused by the dengue virus which is a RNA virus belonging to the flavivirus genus. A person gets the virus when he is bitten by the dengue virus carrying mosquito. Once the virus enters the body the person may manifest with signs and symptoms of the disease which the WHO classifies as dengue fever and severe dengue fever.

 How does the World Health Organization classify dengue?

The WHO classifies Dengue as dengue fever and severe dengue fever.

Dengue fever

Acute febrile illness, live in or travel to endemic region, with two or more of the following:

Nausea and/or vomiting

Headache and/or retro-orbital pain and back pain

Aches and pains

Rash

Tourniquet test positive

Leukopenia

Any warning signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increase in hematocrit, falling platelet count with laboratory confirmation)

Severe Dengue Including Dengue Shock Syndrome

Severe capillary permeability and plasma leakage leading to dengue shock syndrome

Fluid accumulation and respiratory distress

Severe bleeding

Severe organ involvement (liver, CNS, heart, kidneys, and others) 

What are the signs and symptoms of a patient suffering from dengue?

In its uncomplicated course dengue fever manifest with fever that may have associated with rashes, aches and pains. Sore throat, coryza, cough, anorexia, nausea, vomiting, diarrhoea, headache, back pain, myalgia, arthralgia, and conjunctivitis also may occur.  It usually subsides over period of time with supportive treatment. However in contrast, in severe dengue fever the walls of our blood vessels become damaged and unable to properly function. As a result our plasma leaks out and the blood pressure may rapidly come down- ending in shock stage called Dengue shock syndrome. Platelet cells that are needed for normal blood clotting mechanism also can be abnormal or decrease to dangerous levels so that bleed can easily occur in these patients. The capillary leakage can end up in lung edema- pulmonary edema, pleural effusion and fluid in our peritoneal cavity- ascites. Bleeding tendencies can result in skin bleeding- petechiae, mucosal bleeding, peptic ulcer bleeds, menorrhagia and others. In severe cases intracerebral (brain) and pulmonary (lung) bleeding can also occur. FDP or Fibrin degradation products have not been found to be elevated to a degree consistent with classic disseminated intravascular coagulation (DIC). Some patients may also develop encephalopathy, pneumonia, and liver dysfunction.

In mild grade of dengue the virus or viral load can be tackled by our immune system. However in the severe grades of dengue the increasing virus numbers outdo our immune system (by  enhanced infection of monocytes in the presence of pre-existing anti dengue antibodies at sub neutralizing levels thereby leading to antibody-dependent immune enhancement) and therefore presents with severe problems affecting all the body systems slowly.

What are the diseases that may be confused with dengue fever? (Differential diagnosis)

A number of diseases can be confused with dengue and this will depend on the region where the patient resides, at what stage the patient presents to the doctor and also the season it occurs:   measles, rubella, enterovirus, influenza, scrub and murine typhus, septicemia, other viral hemorrhagic fevers (e.g., Ebola, Lassa fever), chikungunya, West Nile fever, o’nyong-nyong fever, malaria, typhoid, leptospirosis, hepatitis A, rickettsiosis, Hanta virus infection, and Rift Valley fever.

How do we confirm that the patient has dengue infection?

Once the diagnosis of dengue- like disease is thought of after a through history taking and clinical examination, one must confirm the diagnosis.  Laboratory confirmation is by the following means:

 1) Serologic confirmation in acute dengue infection -demonstration of specific immunoglobulin IgM and IgG antibodies against dengue in the serum of patients

2) RT-PCR - Dengue virus RNA also can be amplified by reverse transcriptase nested polymerase chain reaction (RT-PCR) from serum

3) Viral isolation-culturing the patient's serum with Aedes albopictus C6/36 cell monolayers and confirming the virus infection of these cells by immunofluorescent assay using a flavivirus-specific monoclonal antibody.

How is dengue infection treated?

Patients may present with dengue fever or severe dengue complicated by shock. Careful clinical assessment with added laboratory investigations will show grade of dengue infection.  There are no specific drugs for dengue so uncomplicated dengue fever will need good supportive care.

In severe dengue the plasma leak and the clotting abnormalities are the main problems that need to be tackled. Hypotension and shock must be treated by judicious fluid resuscitation. The blood volume must be brought back to normal otherwise the shock will progress to organ failure and death. The patient's mental status, pulse, temperature, respiratory rate, blood pressure, central venous pressure, oxygen saturation and urine output must be measured frequently and checked. Regular hematocrit evaluation will show if any hemoconcentration is present. The blood volume restoration may need isotonic crystalloid solutions, plasma or colloid solutions like starch, dextran and others as deemed by the physician.

(For professionals treating dengue- In patients with dengue shock, studies have suggested that ringer lactate solution should be started at a rate of 15 to 20 mL/kg over 1 hour. The patient should be monitored (by various parameters mentioned before) as then the rate can be reduced to 10 mL/kg/h for 2 hours. As his condition improves it may be reduced to 7.5 ml/kg/ hr. for 2 hrs. then 5 mL/kg/h for 4 hours, then 2 to 3 mL/kg/h for 24 to 36 hours. If the clinical condition stabilizes then the fluids can be stopped after this period. After the first hour of resuscitation colloid solutions or plasma expanders (6% dextran 70 or 6% starch solution) should be added as needed by the physician if ringer's by itself is unable to tackle the circulatory collapse. The plasma leak takes time to settle down and that usually happens by the 7th day. Children and those below one year as well as those with cardiac or renal diseases will  need special care since they are unable to withstand fluid disturbance or blood volume changes as adults.)

The presence of co morbid conditions like cardiac diseases and lung diseases will play a great role in the recovery of the patient. Each body system like the lung and the heart will have to be observed and supported depending on their performances. For e.g.

Heart- may need inotropic support if it fails to pump well

Lung – may need artificial ventilation support

Fluid collections in lung and peritoneal cavities may need drainage

Electrolyte imbalances – need to be corrected

Metabolic abnormalities – need corrections

Nutritional support- needed

Bleeding abnormalities will need good evaluation and corrections depending on the severity. Blood transfusion, platelet concentrates and fresh frozen plasma may be needed as deemed by the physician treating the case and not as routine. Steroids are not usually recommended in the treatment of dengue fever.

How can we avoid getting dengue illness?

Dengue fever is now considered the most important mosquito-borne viral disease in the world with increasing occurrences in Asia, Pacific Islands, Caribbean, South America and Africa. Within India in places like Kerala the weather conditions and water logging helps the mosquito to breed well, thereby increasing the number of mosquito borne diseases. 

Trying to reduce dengue can be done by the following ways:

1)      Mosquito control- mosquitoes can be controlled by killing them. This can be achieved by pyrethrin knock-down sprays or organophosphate sprays delivered in micro droplets.

2)      Prevent breeding of mosquitoes- unwanted containers should be discarded, buried or filled with sand, as water collecting in them provides good breeding grounds. Water potholes and unwanted water collecting sites should be filled in or destroyed.

3)      Killing the mosquito larvae- Larvae killing small fish or crustaceans called Mesocyclops can provide control of mosquito larvae.

4)      There are efforts being made to develop a dengue vaccine

5)      Research is being made to develop genetically modified mosquitoes to prevent the breeding of aedes mosquito

6)      Research is being done to produce antiviral therapies against the dengue virus

7)      Avoid mosquito bites by wearing protective clothing and appropriate repellents

8)      Cover all entry areas into the house by mosquito nets : this will prevent the mosquitoes from passing in

9)      Use electric bats to swat the mosquito that have entered the house and are likely to bite you while sleeping or resting

10)    Travelers who have returned from endemic areas or those with symptoms and signs mimicking dengue illness should be observed or even quarantined till cleared of the illness, 

(This original article by Dr Alexander+ is written and compiled in 'public interest’ to create public awareness about Dengue fever and not meant to replace physician evaluation and treatment++)

Additional resources

  www.cdc.gov/dengue

What is a probiotic?

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The term 'antibiotic' is a common term and known to most of us. It refers to compounds that are produced by microorganisms which inhibit the growth of other germs or microorganisms. Antibiotics came into existence in the 20^th century. Before the advent of antibiotics, antiseptics or compounds substances  were in use for long being applied topically or locally  to prevent the growth of microorganisms; they were however ineffective against systemic infections or infections present and spreading in the body. The first compound with antimicrobial activity was pioneered by Erlich in 1911. He centered his investigations on the discovery of a "magic bullet" to treat the dreadful sexually transmitted disease (STD, Venereal disease) syphilis. The first 'sulfa' drug brought in a new era in medicine, when it was shown that the dye 'protosil' protected mice against systemic streptococcal infections as well as cured such infections in infected patients in 1935. Alexander Fleming realized that the mold 'Penicillium' prevented the multiplication of staphylococci and the first antibiotic penicillin came into existence. Streptomycin, tetracyclines, aminoglycosides, semisynthetic penicillins, cephalosporins, quinolones, and other antimicrobials were soon discovered to have similar effects. Recently newer antibiotics have recently been discovered and these include glycylcyclines (tigecycline), lipopeptides (daptomycin), streptogramins (quinupristin-dalfopristin), ketolides (e.g., telithromycin), and oxazolidinones (linezolid).

While a number of countries have contributed to the research and development of antibiotics, Japan is one country that can boast of discoveries of more than 100 useful antibiotics and related medications. The first antibiotic from Japan was colistin (1950) which was followed by: mitomycin C (1955), kanamycin (1957) and bleomycin (1965). Others followed soon - cefazolin (1969), amikacin (1972), piperacillin (1976), norfloxacin (1977), cefoperazone (1978), ofloxacin (1980), clarithromycin (1984), and meropenem (1987). Lately even drugs like   tacrolimus for atopic diseases and pravastatin for hyperlipidemia have been researched and discovered in Japan. Other countries should take note of this and must make more efforts in this direction.

Alas, with all these developments taking place, germs and microorganisms are also at work trying to outdo these drugs by developing resistance. Antibiotics will therefore not always be our magic wand to beat them. We will have to develop and evolve other ways to do it. 

So what is a probiotic?

 First coined in 1965 by Lilley and Stillwell, the term 'probiotic' is derived from the Greek language and means ' for life’. They intended to use this term to describe substances secreted by one microorganism that stimulate the growth of other as opposed to antibiotics that inhibit the growth of other microorganisms. The interpretations kept changing over time and presently the world health organisation (WHO) defines probiotics as  ' live microorganisms which when administered in adequate amounts confer a health benefit to the host'.

 Our ancestors ate probiotics or useful live microorganisms for centuries without actually realizing it in the form of fermented foods such as yogurt, kefir and sauerkraut which contain microorganisms like lactobacilli and bifidobacteria.  Beer, wine, tempeh and cheese are all products of microbial cultures. Lactobacilli and bifidobacteria are two main microorganisms that play a significant role in human health. Lactobacilli are rod shaped, produce lactic acid as a major end product of carbohydrate fermentation and can be isolated from different environments like human gastrointestinal tract, vagina, and fermented diary foods and vegetables.  However the bifidobacteria which are rod shaped and produce acetic acid as their major fermentative end product, are not found in natural fermentative processes and are native to the human intestines.

How do these bacteria reach our intestine?

It is interesting to note that our intestines while we are in the womb are sterile: there are no bacteria. During birth, the baby gets exposed to microorganism s from the birth canal, the mother's fecal organisms and organisms in the environment.  In the beginning enterococci, streptococci and e coli abound in the intestines but soon the baby’s diet of breast milk favors the growth of bifidobacteria and other anaerobes. Breast milk that is produced by the mammary glands may contain up to 10⁹   bacteria/l including lactobacilli and bifidobacteria. However as the baby grows and the feeds change to solid food the flora also changes and organisms like enterococci, bacteroides, streptococci and clostridia increase in large numbers as happen in the adult gastrointestinal tract.

How do probiotics help us?

While the exact mechanism of action of probiotics is unknown, various theories have been proposed.

It has been suggested that probiotics may compete with pathogenic organisms for nutrients which can be aggressively consumed by them thereby inhibiting the growth of the pathogens. For example probiotics can inhibit cl difficile organisms when present in significant numbers by competing with them and utilizing most of the available mono saccharides on which the cl difficile is dependent.

A lot of pathogenic organisms attach themselves to the intestinal mucosa and then go about causing disease. Some strains of lactobacilli and bifidobacteria can attach themselves to the epithelium and act as watchmen preventing pathogens from attaching to the mucosa. For example e coli can be prevented from adhering to the human intestinal cells by lactobacillus rhamnosus strain GG.

A third mechanism by which probiotics act is through the production and release of antimicrobial compounds called Bacteriocins which can kill or inhibit other organisms. Lactobacilli and bifidobacteria can produce bacteriocins and lactobacilli in addition can produce other biologically active compounds like hydrogen peroxide, diacetyl and short chain fatty acids, the release of which is though to improve the intestinal flora and decrease the number of pathogenic organisms. 

Studies have shown that probiotics can stimulate the human immune response by elevating the number of natural killer cells, bettering the phagocytic activity of macrophages and even increasing the secretion of immunoglobulins - leading to a decrease in the number of pathogenic organisms in the GI tract.

What then are the characteristics of a good probiotic?

Well, for one they should be able withstand the gastric acid and bile salts in the gut. They must get easily attached to the intestinal mucosa and finally colonize the intestinal tract thereby displacing and inhibiting some of the pathogenic organisms.

What are the common probiotic microorganisms in use today?

The Bifidobacterium spp (acidophilus) and lactobacillus spp (bifudum) are the most common ones that are useful. Others include enterococcus spp (fecium), bacillus spp (coagulans), sacchoromyces spp (cerevisiae) and streptoccus spp (thermophilus). The action of probiotics is strain specific and only proven strains will actually act as probiotics. To exert therapeutic effects once ingested the bacterial numbers must be more than 10 ⁶/ ml in case of yogurt.

What are the benefits of probiotics?

By taking probiotics we can promote and improve our health. A large number of advantages have been attributed to probiotics. By modifying the intestinal flora we can improve the intestinal digestion, have better motility and function and enhance the absorption of nutrients. In addition gas induced abdominal distension can be reduced, pathogens that colonize the intestine can be suppressed, synthesis of vitamins like k and B can be improved and finally the immune system itself can be stimulated. Probiotics also release bacteriocins which can kill other pathogenic microorganisms.

Research on probiotics have shown that probiotic therapy  can lead to  better treatment of diseases like  bacterial vaginosis, chronic fatigue syndrome, crohn’s  disease, gastrointestinal and vaginal  candidiasis, h pylori infections, gestational diabetes, cl difficile diarrhea’s, and even some  cancer and chemotherapy problems. Probiotics also lead to reduced colds in children, reduction in loose motions or diarrhea, decrease in abdominal distension, and better control of halitosis and eczema.

What are the common probiotics that we can eat to promote good health?

To exert therapeutic effects once ingested the bacterial numbers must be more than 10 ⁶/ ml. Fermented diary products and sour milks have been in use since ages as promoters of good health. Yogurt forms a good medium to transport the probiotic organisms to the GI tract and leads to their better survival. If the yogurt will contain more than 10 ⁶ viable bacteria per ml then a 100 gm serving will provide adequate probiotic bacteria for therapeutic effects.

Fermented vegetables like Kim chi and sauerkraut are common food items in Southeast Asia and Eastern Europe. L plantarum strains are commonly found in these fermented vegetables and these often can withstand the GIT acidity, adhere to the mucosa and colonize them effectively. Most traditionally prepared fermented vegetable usually contain more than 10⁸ living bacteria perm gm so that ten gm may be the minimum dosage required.

Supplemental forms of probiotics include tablets, capsules and powders and they must be in dosage of more that 10⁹ bacteria per dose to have any therapeutic effects.

 

An original article from Dr Alexander+

Treating complex burn injuries, accidents, electric transformer burns, AC alternating current burns, DC direct current burns, scalp transposition flap, electrical burns, high voltage burns, hair, head burn, skin loss, skin grafting, tissue loss, Dr Alexander George, plastic surgeon, cosmetic surgeon, Cochin, kerala, India+ +

Electrical burns can be a serious affair, particularly when the patient suffers high voltage burns. The unfortunate gentleman shown above suffered severe deep burns from a high voltage (11000 volts) burn from a transformer related accident. The burns shown on the scalp or back of head is a full thickness burn or probably a 4th degree burn reaching deep down to the skull bone. This was confirmed in the second stage where the debridement or removal of dead tissues resulted in the bone being exposed. While the areas with viable tissues could be covered by a skin graft, the central with exposed skull bone needed a flap cover which was provided by shifting the adjoining skin - ( referred to as a transposition flap). The last picture shows all the wounds to have healed well. However he will need some surgery in the future - such as a tissue expander insertion to expand the adjoining hairy skin to provide good hair coverage. Wigs, hair weaving or  other non surgical techniques can be used for those  who wish to avoid further surgery+

Sewing machine needle injury, finger injury, hand injuries, plastic surgery, cosmetic surgery, Dr Alexander, cosmetic surgeon, plastic surgeon, cochin kerala India +

 

Sewing can be a profession or a hobby. Some do it for pleasure, other because they were forced into it and still others because they just enjoy it. Before the era of machines, sewing was done manually.  My first experience with sewing was almost 45 years ago when the first manual 'Usha' sewing machine arrived at home. The machine fascinated me and I spent hours trying to fathom how it worked, how a simple thread placed on the top ended up in such beautiful patterns, how every part moved the thread in a particular manner and how malfunction of a single part could destroy the entire sewing process.  I marveled as the thread passed through each part and finally through the eye of the needle and then through the cloth that was being stitched. Finally, it pulled in the second thread from the bobbin situated on the underside to complete the stitch. Even plastic surgeons like Dr Bates (http://rlbatesmd.blogspot.in/ ) are seriously devoted to sewing and quilting. I guess when you infuse love, enthusiasm and passion into any profession, simple jobs like stitching can get elevated to artistic expressions.

The Englishman Thomas saint is believed to be the first to patent a design for a sewing machine in 1790. In 1830, French tailor Barthelemy Thimonnier patented a machine that sewed straight seams using a chain stitch. However other  French tailors destroyed his factory of 80 machines because they were afraid of loosing their livelihood. Elias Howe, an American gentleman created his sewing machine in 1845.  In 1851, Isaac Merritt singer an engineer  developed his machine based on the knowledge he gained from his predecessors. The singer machine has evolved and today is one of the leading sewing machines in the world. 

We must remember that most of the inventions that we have benefited from have been developed based on the efforts of many people and while some had original ideas other developed it and still others helped to market it so that the world would benefit from it. Some names will always be missed and it is the duty of historians and people privy to this information to find these names and grant them the honor they truly deserve.

While all these developments have taken place, there still is the issue of safety which needs to be addressed. The needles are bare and unprotected, most of the injuries happen when the cloth is guided to the needle so that the stitch falls at the desired site.  Our unfortunate patient shown above suffered an injury with the needle that passed through the skin, soft tissues and also the bone. At times, the needle tends to break inside the finger and removal becomes more difficult.Surgery was needed to remove the needle as well as to clean up the tract through which the needle had passed, so that infection would not occur after the needle was removed. Appropriate antibiotic coverage was also provided.

It is time that someone in the sewing industry notices and addresses this issue seriously.  If we can cage the needle in some way that will prevent the finger from approaching the needle, we will be able to avoid serious injuries. As surgeons it is also our duty to write and make people aware of these injuries+

Abdominoplasty, tummy tuck, mommy make over, liposuction, plastic surgery, cosmetic surgery, fat aspiration, body contouring, Dr Alexander plastic surgeon India, cosmetic surgeon, kochi, cochin, kerala, India, +

for a related post-
http://thecosmeticplasticsurgeon.blogspot.in/2012/12/tummy-tuck-abdominoplasty.html

Diabetic foot, infection, toe, amputation,podiatric surgery, plastic surgery, foot surgery, foot care, foot injury, accident, Dr Alexander plastic surgeon India, cosmetic surgeon India, cochin, kerala, kochi++

Patients with diabetes need to be very careful with their feet. This elderly gentleman suffered  an injury to his fifth toe and seemingly ignored it. Over a period of time the wound got infected and diabetes worsened. He ended up with gangrene (death of toe tissues). He had a previous history of having the same problem with his big toe which was also removed. The dead toe was removed and the wound closed.
Diabetic patients need to control their blood sugar with great care since uncontrolled diabetes leads to- diabetic neuropathy ( nerves being damaged), diabetic nephropathy (kidney gets damaged), diabetic retinopathy ( eye gets damaged) and diabetic angiopathy (blood vessels get damaged). The neuropathy and angiopathy is bad news, because it helps in the development of foot injuries and wounds as the person does not feel the pain . The wounds worsen because the blood supply to that part is also inadequate.

 Diabetic patients must  always follow the dictum and I tell this to all my diabetic patients-

' Take care of your feet, as you take care of your hands '

 For a related post-

http://thecosmeticplasticsurgeon.blogspot.in/2013/01/diabetes-wound-healing-non-healing.html

'Karma' - what does it mean to you+

Often in life, we find ourselves disillusioned and lost. Life does not seem to be going the way it should- position, money and relationships seem to be going haywire. Sometimes we just don't seem to know the right way to go. The path trodden by others may seem like a maze.Our goals may be set, but the path which we want to take may not seem to materialize. People whom we love and trust may cheat us- knowingly or unknowingly. People we work for may take advantage of us or may not pay us our wages- the laborer must be paid his wages. People who work for us may seem aghast at our actions. Our spouses may mistrust us and our children may question our good motives. We may find our peers and friends palming us the wrong cards: the aces may seem to evade us and the numbers may look irrational. Our moods may reach its nadir, our tempers their worst. Depressions and desperation may follow us as we try to tread the path we have chosen to reach our goals.  The principles that we stood up for all our life may suddenly seem to be wrong in others eyes. We may find our own  past actions  as totally unacceptable. The goals themselves may not look too attractive, the futility of life may set in....

Suddenly we begin to look around, we think, introspect, contemplate and ruminate- thoughts that we once put aside as unreasonable. We start to question- the 'why' of things that happen- why the bad seem to be more successful than the good.... why truth seems to falter in the shadows of lies..... why things happen the way they should not happen... we wonder why most people share their sorrows and not their happiness-es and their profits.... why sellers label their cheating strategies as 'great business'...... why people  who never use a product suddenly advertise them with great gusto...why the rich want to be richer at the cost of making the poor- poorer....... why normal men and women take advantage of the handicapped and the downtrodden....... why like and love is mistaken for lust...... why people who were in love for centuries suddenly hate each other...... Why people feel that they should have expressed their love,  only after their loved ones have left them.... why people build statues in honor of the dead, when in real life they have always belittled them...why politicians forget their promises they once made..... why diseases overcome us and make us suffer beyond our understanding.... why death seem to defeat life-when it is at its best... why relationships must end someday ... why nothing materialistic we experience is eternal......why cricketers like Hansie Cronje must fix overs at the peak of their careers....why Bear Grylls must risk his life every time with death lurking round the corner trying to teach us survival tactics.... why Steve Irwin  had to be stung by a sting ray when he could have used a robotic camera....why innocent men, women and children must become the victims of a war unknown to them.....why the religious suddenly become atheist ....why  some people seek treatment when the disease is beyond control while others like Angelina Jolie must have defective BRCA1 gene and undergo double mastectomies at the peak of her career…Why the forbidden fruit is tasty…. Why familiarity breeds contempt…..the thoughts go on...and on ..

 what should we do?????
Here's where the 'karma' of life sets in.

Karma is a deed or act causing the cycle of cause and effect (or samsara as referred to in ancient India). This concept probably came through observations made by our early ancestors and as time passed by …got incorporated into religions that came into being. All religions believe and end in the principle ‘we reap what we sow’. Whether it be in this present life.. or in rebirth…. the cycles of life …all profess that good deeds must be done. For the atheist, religion and God does not play a role..  Yet most believe in the goodness of life and in doing good deeds and not evil ones… for the people who support ‘’humanity’- to be humane means one has to be good and civilized….history is privy to this,  the good have always overshadowed the bad in the end.  Hitler committed suicide in his bunker after slaughtering millions of innocent souls and Saddam was hung for the same… what we do … will come back to us… the cycles of life will continue.. the sun will go down… the moon will come up….. Seasons will go and come….. we will also be gone someday… and what will remain will be the karma or good that we leave behind…

While karma may be good deeds or bad deeds, when we say 'do your  karma' we mean the good deeds and acts….karma must be unconditional.. only then the results will bear fruit. for if it is conditional, one might stop his karma every time he doubts his goals. Once you follow this principle of karma, your pain and suffering will slowly flow away… for where there is no expectation there can be no pain…in fact the results can only make you ecstatic...we have to do what we have to do.. sounds funny, but that’s the truth. A mother must take care of her baby.. a father his family.. an owner must pay his workers wages and see to their well being… a leader must guide his followers… a doctor must minister to his patients… a priest must lead his believers… a student must concentrate on his studies…a labourer must be true to his profession...

The christian philosophy of 'treating people as we would like them to treat us'  sums up in very simple terms the life we would like to lead. Unless you are a  masochist..enjoying pain,  you will always treat your neighbors with love and compassion. The law of equality must prevail.. fear must go .. hope and trust must develop.. altruism must replace selfishness ...love must replace all.... we must do what we have to do...our responsibilities to our families, friends, relatives, peers, employers, employees, our society, our parishes and our nation must be fulfilled....we cannot let down the people who have placed their trust in us.... our karma of good deeds must go on...the karmic cycle of good will go on.....the hands of time will bring it back to us...

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Skin graft, grafting, Humby knife, Aesculap dermatome, wounds, skin loss, injuries, burns, tumors, cancers, plastic surgery India, cosmetic surgery India, Dr Alexander, Cochin, kerala, medical tourism, India+

Sometimes the skin of our body may be lost or damaged and this may happen due to many causes. Commonly, road traffic accidents are the one which result in skin loss. Skin tumors when removed may lead to loss of skin. When burns occur, the skin may be destroyed and lost. Sometimes infections and conditions like necrotising fasciitis can lead to massive skin and tissue loss.  In all these cases the lost skin will have to be replaced. While skin can be obtained from different sources like cadavers and other living persons, (allograft or homograft), animals like pigs (heterograft or xenograft), or even artificial skin like Integra (bovine collagen and silicone layer), it’s the  individual's own skin that is the best sources and match. The take of this graft (auto graft) is good and the cosmetic and functional results are acceptable as well.

The skin has two layers – dermis the deeper one and epidermis the surface layer. Depending in the thickness of the graft taken, the grafts are named differently. There are two types of skin grafts that are harvested- thick and thin, depending on the requirements in a particular case. Small areas of full thickness grafts can be obtained from behind the ear and that area can be closed primarily. This is done by using a scalpel, cutting the skin out and closing the defect. When a large area of skin is needed, then a partial thickness skin graft is harvested from the thigh or other areas. The first picture seen above, shows how a skin graft can be harvested from our body using a Humby knife. Both the Humby knife and the electric dermatome (Aesculap) is shown in the second picture. Sometimes the area of skin graft required is very big and then we find that our donor skin is limited. The skin grafting mesher allows us to expand the skin by cutting it into a mesh like pattern. This also prevents the blood and serum from collecting under the graft and thereby allows good approximation between the wound bed and the graft itself, so the graft will firmly adhere to the wound bed and will not be rejected. The skin graft must get its nutrition and slowly develop its blood supply from the wound bed. This process takes time and therefore post operative care of the graft is very important. A plaster support or splint will help to immobilize the grafted area and prevent shearing of the graft. Once the graft is well adhered to the wound bed, gentle movements may be allowed – usually about 2 to 3 weeks after surgery. The donor site from where the grafts have been taken takes about 2 to 3 week to heal and thereafter will need some cream applications and moisturizers as well. Avoiding sunlight on the operated areas is important as it can lead to hyperpigmentation +