Browsing by Author "Visweswar Bhattacharya"

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A dye study in fresh cadavers to outline retrograde flaps of the lower limbs and to examine clinical implications
(2006) Visweswar Bhattacharya; Sunish Goyal
The reconstruction of distal lower limb defects to meet functional and cosmetic requirements is challenging. The aim of this study was to ascertain the safe hemodynamic territory of various retrograde flaps that are frequently used. We carried out a dye study on both lower limbs of ten fresh cadavers using methylene blue to assess the safe limit of retrograde flaps of different types (i.e., fasciocutaneous flap, adipofascial flap, and fasciocutaneous flap with adipofascial extension) based on the two lower perforators of the posterior tibial artery. The dye penetrated the vascular network up to 20 cm in the fasciocutaneous flaps from a point 8 cm proximal to the tip of the medial malleolus. The extent of the dye was 40 and 20% less in adipofascial flaps and fasciocutaneous flaps with adipofascial extension, respectively, compared to fasciocutaneous flaps. In live subjects, the safe territory is expected to be about 2 cm more in each flap, based on our clinical observations. These findings are of significance since such flaps can be safely selected for various defects depending on their location, their dimensions, and the availability of suitable local tissues. © Springer-Verlag 2005.
A novel GLI3c.750delC truncation mutation in a multiplex Greig cephalopolysyndactyly syndrome family with an unusual phenotypic combination in a patient
(Elsevier B.V., 2014) Rashmi Patel; Fanish Mani Tripathi; Subodh Kumar Singh; Anjali Rani; Visweswar Bhattacharya; Akhtar Ali
Greig cephalopolysyndactyly (GCPS) syndrome is an autosomal dominant disorder with high penetrance in majority of cases, characterized by a triad of polysyndactyly, macrocephaly and hypertelorism. GCPS is known to be caused by mutations in the transcription factor GLI3 gene (7p13) which results in functional haploinsufficiency of this gene. The present study reports a large multiplex family having 12 members affected with GCPS in 3 generations and several unaffected members showing autosomal dominant pattern of inheritance with complete penetrance. Interestingly an affected member of the family had unusual features including thumb which is although biphalangeal (confirmed with X-ray) but morphologically looks like finger and a unilateral tiny bony outgrown (externally indistinguishable) on the distal phalanx of the first toe of the left foot. This member also presented with mild ichthyosis. Although it is also possible that one or more of these features are coincidentally present in this member and might not be part of GCPS. Resequencing of the GLI3 gene detected a novel frame-shift mutation c.750delC in heterozygous state transmitting in the family and co-segregating with the disorder suggesting it to be the causal for the GCPS phenotype in the family. In silico analysis suggests that this mutation creates a truncated GLI3 protein resulting in its haploinsufficiency leading to GCPS syndrome. Furthermore, genotype-phenotype correlation is supported by the mutation as it lies in the amino terminal domain of the protein. © 2014.
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.
Conjunctivo dacrocysto rhinal fistula
(2007) Visweswar Bhattacharya; Ganji Reddy
Conjunctivo dacrocysto rhinal fistula is an abnormal communication between the conjunctival sac and nose through the lacrimal sac. This is a rare and infrequent complication of acute dacrocystitis and only scanty literature is available. Its management requires two layered closure, one for nasal lining and the other for the conjunctiva. We report such a fistula and its management in a young girl. © 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
CT angiographic evaluation of perforators in the lower limb and their reconstructive implication
(2012) Visweswar Bhattacharya; Neeraj K. Agrawal; Gurab R. Chaudhary; Srivastava Arvind; Siddharth Bhattacharya
Background: The perforator flaps evolved on the knowledge of the vascular tree from the main vascular trunk up to the subdermal plexus. Therefore, we thought that it′s necessary to map the whole vascular arcade by CT angiography. The aim of this study is to evaluate the perforators and the whole vascular tree of the lower limb by peripheral CT angiography with 3D reconstruction and intraoperative evaluation. This study helps in designing flaps of different constituents based on the selected perforators. Materials and Methods: Twenty patients having lower limb defects were selected. CT angiography was done using a non-ionic iodinated contrast media injected through the antecubital vein. The lower limbs were imaged using volume rendering CT scan machine. Three dimensional reconstructions were made. The whole arterial tree, along with the perforators, were mapped. Findings of the audio-Doppler were correlated with the CT angiographic observations. Further these evaluations were confirmed by intraoperative findings. Results: The three dimensional CT angiographic reconstruction with bone and soft tissue provided advanced knowledge of this vascular network. It delineated the main vessel, the perforators, their caliber, distance from fixed bony landmarks and course up to the subdermal plexus. These findings were confirmed during dissection of the proposed flap. The perforators were mainly musculocutaneous in the proximal leg and septocutaneous distally. Conclusions: The vascular details visualized by this technique made advancement over the existing methods namely color Doppler, audio Doppler, two dimensional angiography etc. It improved the understanding of perforator flaps and their successful clinical application.
Demonstration of live lymphatic circulation in the deep fascia and its implication
(2011) Visweswar Bhattacharya; Gaurab R. Chaudhuri; Biswajit Mishra; Umesh Kumar
It is well known that vascular arcades and lymphatic networks co-exist all over the body with distinct physiological functions complimentary to each other. We visualized lymphatics in the deep fascia under electron microscope using 4000 magnification. Encouraged by our previous research with demonstration of live microcirculation in the deep fascia, we successfully explored the possibility of demonstrating live lymphatic circulation. The fascial extension of inferiorly based fasciocutaneous flaps were dissected in five patients with distal leg defects. The fascial extension was mounted on a glass slide and examined under microscope using 600 magnification (x40 lens). We witnessed live microcirculation as well as live lymphatic circulation in the same field of observation with specific characteristics. A video recording was made to document these important features which to the best of our knowledge is not mentioned in the literature. The theme of this study is to explain, how by incorporating the deep fascia in the flap, besides vascularity, other physiological functions are augmented. © Springer-Verlag 2010.
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.
GLI3 mutations in syndromic and non-syndromic polydactyly in two Indian families
(Blackwell Publishing, 2016) Rashmi Patel; Chandra Bhan Singh; Visweswar Bhattacharya; Subodh Kumar Singh; Akhtar Ali
The GLI3 protein is a zinc finger transcription factor, expressed early in development. The GLI3 gene exhibits allelic heterogeneity as mutations in this gene are associated with several developmental syndromic and non-syndromic polydactyly. The present study reports two cases: first, a familial case of Greig Cephalopolysyndactyly Syndrome (GCPS); the second is a sporadic case with both postaxial polydactyly (PAP) type A and B. Resequencing of GLI3 gene reveals a previously reported nonsense truncation mutation g.42007251G>A (p.R792X; rs121917714) in the GCPS family and a novel single nucleotide insertion g.42004239_42004240insA (p.E1478X) in the sporadic case of postaxial polydactyly (PAP). Both nonsense truncation mutations; p.R792X (GCPS) and p.E1478X (PAP) introduce a premature stop codon leading to loss of C-terminal domains. © 2016 Japanese Teratology Society.
Ipsilateral fasciocutaneous flaps for leg and foot defects
(Georg Thieme Verlag, 2024) Visweswar Bhattacharya; Rajesh Kumar Watts
It was a revolutionary enhancement for lower limb reconstruction when fasciocutaneous flaps were first described and used in clinical practice in 1981. Subsequently persistent studies were made to emphasize and confirm the rich vasculai net'"voik associated with deep iascia. Thereafter studies were directed to identify the various types of perforators supplying the deep fascia and the overlying subcutaneous tissue and skin. Accordingly the scientists classified these flaps keeping in mind theii clinical applications. The authors of this articie have aiso performed extensive research on various aspects. This has led to better understanding about the finer details of vascularity. Based on this various modifications have been made for safe application of reconstruction for defects extending from knee to sole. To avoid complications the clinician should be able to select the proper procedure as regards the donor site and the possible preoperative and postoperative technical faults. A well-designed and meticulously executed flap usually has smooth recovery. Both Colour Doppler and Audio Doppler are useful tools in planning a safe flap. Now these flaps have proved to be standard technique without requiring a special set up extensive training. © 2024 Georg Thieme Verlag. All rights reserved.
Lingual Mucosal Graft Urethroplasty for Anterior Urethral Strictures
(2009) Suren K. Das; Abhay Kumar; Girish K. Sharma; Ashwani K. Pandey; Harbans Bansal; Sameer Trivedi; Udai S. Dwivedi; Visweswar Bhattacharya; Pratap B. Singh
Objective: To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for anterior urethral strictures and the donor site complications. Methods: A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal on-lay of a LMG from March 2006 to December 2006. Most patients had balanitis xerotica obliterans as the etiology. The mean stricture length was 10.2 cm (range 3.7-16.5). Postoperatively, all patients underwent pericatheter urethrography at 3 weeks, followed by retrograde urethrography with micturating cystourethrography, and uroflowmetry at 3 and 6 months. Repeat uroflowmetry was done as, and when, required. Results: The mean period of follow-up was 9 months (range 4-12). The overall success rate was 83.3%. The mean peak flow rate increased postoperatively from 4.36 mL/s to 35.5 mL/s at 3 months and 25.06 mL/s at 6 months of follow-up. One patient developed repeat stricture at the anastomotic site, and 4 patients developed recurrent meatal stenosis. Conclusions: The results of LMG urethroplasty were comparable to that of buccal mucosal graft urethroplasty. LMG is easy to harvest. Most importantly, the donor site complications were minimal without any functional or esthetic deficiency. © 2009 Elsevier Inc. All rights reserved.
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.
Marvels of plastic surgery [23]
(2005) Shipra Bhattacharya; Visweswar Bhattacharya
[No abstract available]
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.
Novel GLI3 pathogenic variants in complex pre- and postaxial polysyndactyly and Greig cephalopolysyndactyly syndrome
(John Wiley and Sons Inc, 2021) Rashmi Patel; Subodh Kumar Singh; Visweswar Bhattacharya; Akhtar Ali
Polydactyly is a limb malformation and can occur as nonsyndromic polydactyly, syndromic polydactyly, or along with other limb defects. A few genes have been identified that cause various forms of syndromic and nonsyndromic polydactyly, of which GLI3 has been extensively explored. In the present study, GLI3 gene was screened by direct resequencing in 15 polydactyly cases with or without other anomalies. GLI3 screening revealed two novel pathogenic variants, NM_000168.6:c.3414delC [p.(H1138Qfs*68)] and NM_000168.6:c.1862C>T [p.(P621L)], found in two unrelated cases of familial complex pre- and postaxial polysyndactyly and sporadic Greig cephalopolysyndactyly syndrome (GCPS), respectively. The first pathogenic GLI3 variant, NM_000168.6:c.3414delC, causes premature protein truncation at the C-terminal domain of GLI3. Alternatively, the second pathogenic variant, NM_000168.6:c.1862C>T, lies in the DNA binding domain of GLI3 protein and may affect its hydrophobic interaction with DNA. Both pathogenic GLI3 variants had reduced transcriptional activity in HEK293 cells that likely had led to haploinsufficiency and, consequently, the clinical phenotypes. Overall, the present study reports a novel familial case of complex pre- and postaxial polysyndactyly and the underlying novel pathogenic GLI3 variant expanding the clinical criteria for GLI3 mutational spectrum to complex pre- and postaxial polysyndactyly. Furthermore, this study also reports a novel GLI3 pathogenic variant linked to GCPS, highlighting the known genotype–phenotype correlation. © 2020 Wiley Periodicals LLC
Novel HOXD13 variants in syndactyly type 1b and type 1c, and a new spectrum of TP63-related disorders
(Springer Nature, 2022) Rashmi Patel; Subodh Kumar Singh; Visweswar Bhattacharya; Akhtar Ali
Syndactyly is the most common limb defect depicting the bony and/or cutaneous fusion of digits. Syndactyly can be of various types depending on the digits involved in the fusion. To date, eight syndactyly-associated genes have been reported, of which HOXD13 and GJA1 have been explored in a few syndactyly but most of them have unknown underlying genetics. In the present study HOXD13, GJA1 and TP63 genes have been screened by resequencing in 24 unrelated sporadic cases with various syndactyly. The screening revealed two pathogenic HOXD13 variants, NM_000523:c.500 A > G [p.(Y167C)], and NM_000523:c.961 A > C [p.(T321P)] in syndactyly type 1b and type 1c, respectively. This is the first report to identify HOXD13 pathogenic variant in syndactyly type 1b and third report in syndactyly type 1c pathogenesis. Furthermore, this study also reports a TP63 pathogenic variant, NM_003722:c.953 G > A [p.(R318H)] in Ectrodactyly and Cleft lip and palate (ECLP). In conclusion, the current study expands the clinical spectrum of HOXD13 and TP63-related disorders. © 2021, The Author(s), under exclusive licence to The Japan Society of Human Genetics.
ProfJai Kumar Sinha: A Doyen in Plastic Surgery
(Georg Thieme Verlag, 2022) Visweswar Bhattacharya
[No abstract available]
Radiological Evaluation of Postsurgical Course of Perforators in Retrograde Posterior Tibial Fasciocutaneous Flaps for Distal Leg and Foot Defects
(Georg Thieme Verlag, 2021) Neeraj Kant Agrawal; Visweswar Bhattacharya; Rahul Dubepuria
Background Mapping of vascular perforators by various methodologies have been described for planning of a variety of flaps in the lower limbs. We attempted to assess the changes in posterior tibial perforators after transfer of fasciocutaneous flaps for leg defects. Methods 20 patients with distal leg and foot defects were studied by computed tomography angiography (CTA) and preoperative audio Doppler to ascertain perforators of posterior tibial artery. Fasciocutaneous flaps were raised, based on these perforators, depending on the site and size of soft-tissue defects. The number of perforators and their distance from the medial malleolus were also studied. Postoperative CTA was performed on the 7th to 10th day, with emphasis on postoperative changes of the perforators on which the flaps were based. Results One to four posterior tibial perforators were found between 5 cm and 8 cm proximal to the medial malleolus. After flap transfer, the perforators could be traced to variable distance through the total length of the flap. The perforators formed small vascular loop in 12 patients, following retrograde posterior tibial flap transfer. The height of the loop, the number of such loops, the dilatation and tortuosity of the perforators, and their longitudinal orientation were studied in detail. Most of the findings can be explained by mechanical realignment of perforators as well as by the delay phenomenon associated with retrograde fasciocutaneous flaps. Conclusion It was concluded that the morphological changes associated with the perforators explained the vascular rationality and success of these flaps. © 2021 Georg Thieme Verlag. All rights reserved.
Retrograde perforator-based cross-leg fasciocutaneous flaps for distal leg and foot defects [21]
(2006) Visweswar Bhattacharya; Ganji Raveendra Reddy
[No abstract available]
The palmaris longus tendon-rationality of the finger manoeuvres [2]
(2005) Visweswar Bhattacharya; Ganji Raveendra Reddy
[No abstract available]