Browsing by Author "Siddhartha Bhattacharya"

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Cadaveric study and clinical application of turnover fascial flap for lower-limb defects
(2011) Visweswar Bhattacharya; Partha Sarathi Barooah; Saurabh Rawat; Gaurab Ranjan Chaudhuri; Neeraj Kant Agrawal; Siddhartha Bhattacharya; Sunil Kumar Tripathi
Moderately sized defects of various etiologies are encountered frequently in the lower limb. Several reconstructive modalities are available. Majority of them do not meet all the desirable criterion of recipient and donor site. In a search for an optimal procedure, the fascial flap emerged. We found the fascial flap to be suitable and advantageous for many defects. This paper describes the anatomical basis, planning, technique, and application of the fascial flap. To establish the technique, we divided the study in to two parts (a) cadaveric dissection and (b) clinical application. Dissection in 12 fresh cadaver limbs confirmed the location of the perforators of the posterior tibial and peroneal vessels. It also visualised the rich vascular network associated on either side of the deep fascia. The findings also suggested the safe dimension of a retrograde flap which is the key to success. Convinced and encouraged with the above findings, fascial flaps were successfully used for moderately sized defects at various non-weight-bearing areas of lower limb in 20 patients. Out of these, eight were random flaps and 12 were pre-Dopplered perforator flaps. Out of 20, 16 flaps healed uneventfully. In four cases one had complete necrosis while another had partial necrosis. Two cases had complete graft loss although the flap survived. These cases were followed up from 6 months to 2.5 years with an average of 1.5 years. Fascial flaps provide gratifying results in the majority of moderately sized lower-limb defects in non-weight-bearing areas. It meets most of the requirements of reconstruction in a single stage. Therefore, wherever feasible this simple method is justified. © 2010 Springer-Verlag.
Detail microscopic analysis of deep fascia of lower limb and its surgical implication
(2010) Visweswar Bhattacharya; Partha Sarathi Barooah; Tapas Chandra Nag; Gaurab Ranjan Chaudhuri; Siddhartha Bhattacharya
Background: The knowledge regarding the structural details of deep fascia remains inadequate. It was described to be relatively avascular having predominantly protective function. Anatomical and surgical studies revealed that it had associated vascular arcade and hence incorporated it to ascertain additional vascularity to the flaps. However, not much importance has been directed towards the detailed study of the various constituents of deep fascia in order to explain its physiological and clinical implications. Therefore, this study was undertaken to unveil these details. Materials and Methods: Fifty fresh specimens of human deep fascia overlying the gastrocnemius muscle were analyzed regarding the (i) vasculature, (ii) matrix, and (iii) other structural elements. The deep fascia was procured in three forms; (a) both the layers, (b) superficial layer, and (c) deep layer. Detail study was conducted by light, confocal, and electron microscopy. Results: Under light microscopy, blood vessels including capillaries were seen associated with both the layers. Perforators traversing the intra-fascial plane could be visualized. Confocal microscope optical sections showed well-organized bright fluorescent collagen fibers and nuclei of various cells. Electron microscopic evaluation revealed many interesting constituents which are relatively unknown to the anatomist and clinicians. There were arterioles, capillaries, venules, lymphatics, nerves, mast cells, and myofibroblasts apart from collagen and elastic fibers. Conclusion: The detail structural analysis of deep fascia provided the clue to its rich vascularity and other structural constituents. They all contribute to enhance the vascularity and maintenance of the physiological functions of fasciocutaneous, adipofascial, and fascial flaps, frequently used for reconstructions. Thus, incorporation of deep fascia in the flaps during reconstruction is highly beneficial for ensuring optimal vascularity.
Effect of surgical traumas on microcirculation
(2009) Visweswar Bhattacharya; Biswajit Mishra; Binayak Mishra; Umesh Kumar; Siddhartha Bhattacharya
Background: Adequate microcirculation in different tissues maintains the physiological function and heals surgical wounds. In any surgical procedure, the commonly used instruments are cautery, tissue forceps, and clamps. The fact that their inappropriate use produces an adverse effect on microcirculation is often not realized. By this study, we could demonstrate live, the effect of these surgical traumas. Methods: The study was conducted on the inferiorly based fasciocutaneous flap with a fascial extension in patients with a distal leg defect. The extended fascial flap was mounted on a glass slide and observed for live microcirculation under x160 magnification. Three methods were used: (a) cautery in low power, (b) microcrushing forceps to crush the vessels, and (c) noncrushing clamps at the base of the fascial flap. Results: It was observed that the vessels are well protected within the deep fascia. Once the fascia was pierced the current damaged the vessel wall. As the wattage was increased, it caused charring of the tissue and multiple vessels ultimately leading to cessation of blood flow. Once the vessel wall was crushed by forceps, blood extravasated in a variable intensity depending upon the size of the vessel. Clamping led to gradual slowing of blood flow with microclot formation. In certain vessels, there was discontinuity in the blood column and ultimately the blood flow stopped. Conclusion: This study showed live demonstration of the effect of surgical traumas on microcirculation. It should guide the surgeons to select the use of appropriate instruments which will cause minimal damage to vascularity and thereby lead to a better surgical outcome.
Grafts and flaps for the lower limb
(Springer India, 2016) V. Bhattacharya; Siddhartha Bhattacharya
[No abstract available]
Lymphangiectasis of lower limb: A rare challenging case
(2009) Visweswar Bhattacharya; Biswajit Mishra; Partha Barooah; Gaurab Ranjan Chaudhuri; Siddhartha Bhattacharya
Lymphangiectasis usually occurs in the viscera. Involvement of the lower limb is very rare. It is difficult to establish the diagnosis without detailed investigations. Clinical features are peculiar and may mimic lymphoedema of different origins which needs to be ruled out. Contrary to the expectation, the post-operative result is excellent in the long-term follow-up.
Measurement of wound healing and tissue repair
(Springer-Verlag London Ltd, 2013) Visweswar Bhattacharya; Nilesh K. Agarwal; Siddhartha Bhattacharya
Wounds, acute or chronic, have varied etiologies ranging from trauma to trophic ulcers. Prompt and optimum treatment should be done to prevent functional, sociopsychological and economical burden on the patient. Wound measurement in reconstructive surgery is important for selection of the type of tissue to be used for resurfacing a defect. Two dimensional and three dimensional measurements of the wound are done to precisely assess the size of the tissue required to cover the defect. Acute wounds should be adequately debrided and then the defect is measured. Chronic wounds require a well vascularised tissue for cover. The reconstructive options vary from skin graft to different types of flap. The common flaps are suitable for majority of the defects. Wounds are judiciously assessed to decide upon the option of cover. The chapter deals with the importance of wound measurement, different measurement techniques, different reconstructive modalities, their vascular basis and clinical applications. © 2013 Springer-Verlag London. All rights are reserved.