Oral cavity cancer involving lower jaw (mandible) is common . After excision of involved part of mandible , its reconstruction is must to facilitate normal function of remaining mandible (proper relation of teeth of upper and lower jaw) and to achieve normal aesthetic appearance of face.
The best bone to reconstruct mandible is fibula, but it is straight and mandible is convex angulated at places. To achieve shape of mandible , we have to do osteotomies in fibula .
To know exact site and number of osteotomies required, 3D printing models are of great help. By doing virtual surgeries on 3D models, we come to know exact site and number of osteotomies required in fibula to achieve normal function and shape of reconstructed mandible.
bisoniya hospital#cancer reconstruction#mandible reconstruction#3D printing#dr hari singh bisoniya
In old injuries with tendon division/rupture , it is difficult to get approximation of tendon ends for repair , because the proximal end of tendon get retracted. More the time gap since injury more is the retraction.
In such cases options are -either reconstruct the retracted tendon with tendon graft or do tendon transfer.
In this case 28 yrs old male met an accident about 3 months back . He has complaint of pain and swelling at base of his lt thumb and is unable to flex the thumb since then.
On exploration lt FPL tendon was found totally ruptured at base of proximal phalanx of thumb with proximal end of tendon retracted to wrist level. PL tendon graft harvested from lt forearm and used to reconstruct FPL tendon (about 6cm long graft was used).
Tendon injury#tendon repair/reconstruction#hand surgery#bisoniya hospital# dr hari singh bisoniya
Defects over Proximal half of dorsum of any finger can be best managed with respective dorsal metacarpal artery perforator based reverse flap from dorsum of hand.
Advantages are single stage, same tissue in thickness and colour as on finger, in most cases donor defect can be closed primarily , reliable flap with consistent anatomy.
This patient has composite defect over dorsum of proximal phalanx of rt middle finger with exposed tendon and bone. skin loss over 3rd web space, ring and little fingers.
Wounds were debrided and flap based on 3rd dorsal metacarpal artery perforator raised and rotated almost 180 degree to reconstruct defect over middle finger. skin graft harvested from rt forearm and applied over donor area of flap and other raw areas. JESS applied to keep fingers abducted.
Hand surgery#bisoniya hospital#dr hari singh bisoniya#perforator flap
This young male was suffering from grade 3 gynaecomastia for last 8-9 years. Gradually he became introvert, stopped mixing with peers, became low in confidence and all this affected his studies and finally career.
Few days back he came to know about Bisoniya Hospital and Dr Hari Singh Bisoniya. He underwent a day care surgery at Bisoniya Hospital to get gynaecomastia corrected.
Now he is happy and full of confidence. He is now ready to enjoy the life to the fullest.
#gynaecomastia#cosmetic surgery#male breast reduction#bisoniya hospital#dr hari singh bisoniya
A Young male patient met with an accident (side swap injury) with the crushed right arm, loss of mid-segment of humerus, 6 cm segment loss of brachial vein, crushed brachial artery, segment loss of median and radial nerves. crushed and devitalized muscles of the arm. Cold forearm and hand with absent pulsations and spo2 in fingers. reached hospital 5 hours after the accident. Revascularized 9 hours after the accident.
Brachial artery and vein reconstructed with 6cm long interposition vein grafts. Radial artery repaired after thrombectomy. Nailing done for both bone forearm.
Median and radial nerves reconstructed with cables of sural nerve grafts. Humerus reconstructed with osteocutaneos free vascularized fibula flap. Fibula stabilized with plates and flap artery (peroneal) anastomosed end to side to brachial artery and vein to branch of brachial vein. Distally based fasciocutaneous flap transposed from cubital fossa to cover distal part of plate and radial nerve.
After 40 days
In conclusion, debridement, reconstruction of brachial artery and vein with vein graft, radial artery repair, reconstruction of median and radial nerves with sural nerve grafts, reconstruction of humerus with vascularized fibula flap and fasciocutaneos flap to cover distal part of plate/humerus done to save the limb.
A young farmer while working at his farm on a thrasher met an accident and got his rt thumb totally amputated. Incidence took place in village of district Vidisha about 70km from Bisoniya Hospital at Bhopal. Patient first went to a private hospital at Vidisha, surgeon of that hospital guided him to come to Bisoniya Hospital. Patient reached Bisoniya Hospital 5 hours after accident.
on examination thumb was crushed and heavily contaminated with straw. Dr Hari Singh Bisoniya cleaned the amputated thumb and replanted it successfully at Bisoniya Hospital.It shows that even crushed and contaminated amputated parts can be successfully replanted if brought to proper centre .
Can imagine the importance of rt thumb of a farmer.
It was 101st successful replantation by Dr Hari Singh Bisoniya.