Negative pressure wound therapy: eleven-year experience at a tertiary care hospital

Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used. Most of the patients improved with the NPWT.  No major complications were seen.Conclusions: NPWT is safe, effective and has proved to be revolutionary in managing difficult wounds. With the use of customized low cost NPWT the benefit can be extended to underprivileged population in under developed nations too

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity

Reconstruction of soft tissue defects in Fournier’s gangrene at a tertiary care centre

Background: Fournier’s gangrene is an acute and potentially lethal multi-bacterial necrotizing infection that primarily involves the scrotum but may extend beyond its confines to perineum and abdominal wall. The disease may result in sepsis and death if treatment is delayed. Management consists of timely diagnosis, aggressive debridement, broad-spectrum antibiotics followed by reconstruction which still remains a surgical challenge.Methods: It is a prospective study conducted from Jan 2006 to Dec 2015 on 29 patients of Fournier’s gangrene who were referred to the department of Plastic and Reconstructive Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, for reconstruction after initial debridement by general surgeon/urologist. The patient’s age, predisposing factors, site and the size of the defects, reconstructive options used and outcome were evaluated. Assessment of testicular function was done at 6 months by sperm count and morphology.Results: A total of 29 patients of Fournier’s gangrene consisting of 28 males and one female were included in the study. The mean age was 37 years and the most common comorbidity was diabetes mellitus in 18 patients (62%). Wounds were allowed to heal by secondary intension in 8 patients. Scrotal advancement flap was done in seven patients. Split thickness skin grafting (STSG) of extensive wounds was done in 11 patients and testes were placed in medial thigh subcutaneous pocket in one patient. Two elderly diabetic patients succumbed to sepsis and multi organ failure. Overall complication rate was 18.5%.Conclusions: Thorough debridement and early wound cover are essential in the management of Fournier’s gangrene for successful rehabilitation. Various reconstructive options are available with no conclusive evidence to support flap rather than skin graft and most of the procedures result in preservation of testicular function in the long term

Two stage flexor tendon reconstruction in hand: our experience

Background: Flexor tendon injuries in the digital flexor sheath area (zone II) are the most difficult to treat and remain a focus of both clinical attention and basic investigations. This prospective study was designed to evaluate the results of staged zone II flexor tendon repair.Methods: Seventy digits in thirty five patients were treated by Two Stage flexor tendon reconstruction and followed for an average of one and a half year. The procedure included placing a silicone catheter (cut to desire size) as an active implant and reconstruction of A2, A4 or both pulleys if damaged in first stage. During the second stage (performed three to eight months later), tendon graft replaced the silicone catheter in the pseudo sheath formed around the catheter. The proximal end of the transplanted tendon was fixed with flexor digitorum profundus tendon of respective finger using the Pulvertaft method, and the distal end of the graft was fixedwith the distal stump of respective flexor digitorum profundus tendon. Early controlled motion protocol was instituted in all cases.Results: As per Buck Gramcko scale total active motion obtained was Excellent in 70%, Good in 20%, Fair in 7.1%, and Poor in 2.9% of patients.Conclusions: Flexor tendon reconstruction using two stage tendon reconstructions is an effective way to restore digital tendon function in delayed zone II flexor tendon injuries

Improved Reactive Dye-fixation in Pad-Steam Process of Dyeing Cotton Fabric Using Tetrasodium N, NBiscarboxylatomethyl- L-Glutamate

Pad steam process of dyeing cotton with reactive dyes is known to give lower levels of dye-fixation on the fiber because of excessive dye-hydrolysis. This research presents improved reactive dye-fixation in padsteam process of dyeing cotton found in an effort of using biodegradable organic salts to improve the effluent quality. The CI Reactive Blue 250, a bissulphatoethylsulphone dye and the Tetrasodium N, Nbiscarboxylatomethyl- L-Glutamate, a biodegradable organic salt, were used. The new dye-bath formulation using the organic salt gave more than 90% dye-fixation. Traditional pad-steam process of dyeing cotton with reactive dyes requires the use of inorganic electrolyte, sodium-chloride, and alkali, sodium-carbonate, to ensure effective dye consumption and fixation. These inorganic chemicals when drained generate heavy contents of dissolved solids and oxygen demand in the effluent leading to environmental pollution. Thus, Tetrasodium N, N-biscarboxylatomethyl-L-Glutamate was used in place of inorganic electrolyte and alkali to improve effluent quality. A significant increase in dye-fixation and ultimate color-yield was obtained with same colorfastness properties of the dyed fabric comparing to the traditional pad-steam dye-bath formulation

Air Consumption Analysis of Air-Jet Weaving

In Textile industry, production is mostly key concern for Industry owner. This always has attracted researchers and machines manufacturers to make new developments in process and machines. Air-jet is one of the leading and successful highest productive weaving machines. However, it is now well established that due to add of charges of compressed air, manufacturing cost of air-jet weaving machine is higher as compared with rapier and projectile weaving machines. This is why countries having energy issues do not prefer air-jet weaving machines comparing projectile weaving machines. In this regard, several researchers and machine manufacturers have continuously been working to improve the efficiency of air-jet weft insertion. However, industry practice is as important as design made by researchers. The aim of this research is to investigate the air consumption of air-jet weaving on industrial scale practice. In this study, five weaving machine of same manufacturer and model were selected. It was observed that despite of manufacturing same quality of fabric, air consumption was varying almost in all weaving machines. Conventionally, mill workers adopt hit and trial practice in weaving industry including airpressure setting which leads to variation of nozzle pressure. Main reason of disparity of air consumption in air-jet weaving machines may be variation of distance from compressor to weaving machines, number of joints, un-necessary valve opening and pipes leakages cause an increase of compressed air consumption

Tensile Behavior Analysis on Different Structures of 3D Glass Woven Perform for Fibre Reinforced Composites

Three common 3D (Three Dimensional) Glass woven structures were studied to analyze the tensile behavior. Each type of strand (Warp, weft and binder) of 3D woven structure was studied in detail. Crimp percentage of those strands was measured by crimp meter. Standard size samples of each 3D woven structure were cut in warp and weft direction and were stretched by Instron Tensile testing computerized machine. Results reveal that hybrid possesses lowest crimp in core strands and higher strength in warp as well as weft direction. Layer to layer woven structure appeared with lower strength and higher strain value due to highest crimp percentage in core strands