ASSOCIATION OF PLASTIC SURGEONS OF INDIA – U.P.CHAPTER
JANUARY, 2007 VOL 1/07
TEMPOROPARIETAL FLAP Co mposite skin and cartilage graft fro m
helical root for alar reconstruction
Co mposite fascia and hair-bearing skin for
T emporoparietal flap on the Superficial temporal scalp and lip reconstruction, soft tissue filler
pedicle is an unique flap with applicat ions in temporal and parotid defects
limited only by the surgeon‟s imagination. In Co mposite fascia and non hairy skin or fascia
1898, the temporoparietal fascia flap was described with skin graft for eyelid and facial
nearly simultaneously for reconstruction of the external reconstruction
ear (after a horse bite [Bro wn, 1898]) and for Microvascular free t issue graft - use with or
reconstruction of the lower eyelid (Monks, 1898). without a vein interposition graft to obviate
Despite these descriptions of its utility for head and the limitation of the pedicle
neck reconstruction, the flap remained an obscure and Coverage of large scalp defects
underused tool until an exp losion of new descriptions Coverage of contralateral temporal defects
of its use (as either a pedicled or a microvascular free Double-layered fascial g raft - Another
tissue transfer) resurrected it during the past 2 decades. description of the temporoparietal flap when it
In 1983, Brent et al reported the successful use of the is harvested with temporalis muscular fascia
flap as an axial-pattern fascial flap, a rando m-pattern supplied by the middle temporal artery (This
fascial flap, and a free fascial flap for secondary ear flap can accept cartilage and bone grafts
reconstruction, and in 1993, Cheney et al described 21 placed in the envelope between the 2 layers of
cases using the flap for a variety of reconstructions in fascia.)
the head and neck. Today, the temporoparietal flaps Oral and nasal reconstruction
remain the only single-layered fascia flap that can be As pre-expanded flap
used as a pedicled vascular flap in the head and neck. As per-fabricated flap
The flap is thin and pliable, and it readily accepts a
skin graft. Temporoparietal flaps can drape into
concavities and over convexit ies, such as those present Although the temporoparietal fascia flap is highly
in the external ear, and they are highly vascular and vascular and reliable, prior injury to the temporal field
resistant to infection.
could result in flap necrosis. Radiat ion therapy, trauma,
Indications or previous surgery around the superficial temporal
Temporoparietal fascial flaps have been described for arteriovenous supply may increase the risk of flap
vascularized soft tissue coverage in a remarkab le
necrosis and should be considered relative
variety of head and neck defects as follows: contraindications. In the bald patient or the patient with
Pedicled fascial flap for a receding hairline, this incision would be much more
o auricular reconstruction (primary and visible and be a relative contraindication to flap
secondary) harvest. This would be a significant consideration in
o intraoral reconstruction – OSMF the younger male with early onset of male pattern
o soft tissue filler around the eye baldness. Prior trau ma to the area may also increase the
o covering osteotomy sites and non- risk of postoperative alopecia, which is always a risk
vascularized bone grafts around the anytime this flap is harvested.
Pedicle for vascularized calvarial bone grafts Relevant Anatomy
o Orbital roof, wall and floor The relevant anatomy of the scalp is emphasized to
o mandib le every med ical student with the following mnemonic:
S - Skin approximate course of the frontal branch of the facial
C - Subcutaneous tissue nerve transcutaneously.
A - Aponeurosis and occipitofrontalis muscle Intraoperative details: The face and scalp are prepared
L - Loose subaponeurotic tissue and draped. The flap can usually be harvested without
P - Pericran iu m shaving hair if the hair is carefully prepped out of the
In the temporoparietal reg ion, this mnemonic is an field with oint ment and tape or rubber bands.
oversimplification. The literature surrounding this The important topography of the temporoparietal flap
anatomy contains a jumbling of no menclature to mark on the scalp includes the superior temporal
describing the various layers of temporal fascia, which line, the course of the superficial temporal artery trun k
can further frustrate surgeons trying to master this flap. and the frontal and parietal branches, and the
To be accurate, the scalp in the temporoparietal area approximate course of the frontal branch of the facial
consists of mo re than 5 separate layers. nerve.The incision is marked as a vertical incision fro m
The first layer consists of the skin and subcutaneous the root of the helix to the superior temporal line. This
tissue. Immed iately deep and firmly bound to this layer incision can be extended as a V superiorly to gain
is the temporoparietal (somet imes called superficial additional access to the galea. The preauricular portion
temporal) fascia. This layer is contiguous with the of the incision is extended as a face-lift incision around
superficial musculoaponeurotic system (SMAS) as it the tragus as necessary.
passes over the zygomatic arch into the mid face, and it The anterior and posterior scalp flaps are elevated in
is contiguous with the galea aponeurotica above the the subcutaneous plane immed iately deep to the hair
superior temporal line. follicles. The temporoparietal fascia adheres to this
Beneath the temporoparietal fascia lies a loose areolar subcutaneous tissue, and meticulous sharp dissection is
and avascular tissue layer that separates the fascia fro m necessary to avoid injuring either the vascular supply
the temporalis muscular fascia (so metimes termed the of the flap or the hair follicles. The frontal branch of
deep temporal fascia). This areolar layer allo ws the the superficial temporal artery and the anterior edge of
superficial scalp to move freely over the deeper and the flap are ligated. As with any frontal dissection in
more fixed temporalis muscular fascia, temporalis the superficial p lanes, care should be taken anterior to
muscle, and pericraniu m. this point to avoid injury to the frontal b ranch of the
Confusing the issue further is the division of the facial nerve. If d issection becomes necessary anterior
temporalis muscular fascia as it splits into a superficial to this point, then the frontal branch should be
and deep layer (of the deep temporal fascia) identified and carefully preserved.
surrounding a fatty tissue pad at the temporal line of After elevation of the skin flaps, the superior, posterior,
fusion, approximately 2 cm above the zygomatic arch. and anterior edges of the flap are div ided. The flap can
The temporalis muscular fascia is contiguous with the now be harvested by dissecting the loose areolar tissue
pericraniu m above the superior temporal line and is avascular plane between the 2 layers of fascia. As the
contiguous with the masseter muscle fascia belo w the surgeon approaches the root of the helix, dissection
arch. must proceed carefully to avoid injury to the vascular
The superficial temporal a rtery supplies the pedicle. The pedicle is identified, and the flap base is
temporoparietal fascia flap. The artery emerges fro m narrowed to 2.0-2.5 cm, if necessary, to improve
the parotid tissue, gives off the middle temporal artery, rotation. Dissection inferior to the root of the helix is
and traverses a tortuous course in the preauricular area. limited by the parotid gland and the risk of in jury to the
Approximately 3 cm above the zygomatic arch, it main trunk of the facial nerve.
divides into the terminal frontal and parietal branches. A two layers of vascularized fascia can be harvested by
The superficial temporal vein generally runs superficial identifying and carefully d issecting the temporalis
to and with the artery, but variability, including muscular fascia with its nutrient middle temporal
branching or a posterior course, may be encountered. artery. The artery can be fo llowed to its orig in fro m the
The auriculotemporal nerve, a sensory branch of the superficial temporal artery in the region of the
mandibular nerve, lies posterior to the superficial zygomat ic arch.
temporal artery within the temporoparietal fascia. The The pliability of the flap makes it uniquely suited to
frontal branch of the facial nerve traverses an oblique draping over irregular surfaces. A skin graft may be
course over the zygomatic arch, which can be applied to the flap and held in place with sutures and
estimated by a line connecting a point 0.5 cm inferior suction drainage. The wound is dried carefully with
to the tragus to a point 1.5 cm lateral to the superior cautery and then irrigated. Suction drainage is placed
brow. Th is nerve also lies within the temporoparietal in the superior donor site away fro m the pedicle, and
fascia, and flap elevation anterior to the frontal branch the wound is closed in layers. A pressure dressing is
of the superficial temporal artery should proceed with applied to the scalp for 12-24 hours.
caution to avoid injuring this nerve.
Fl ap in practice Potential Complications
Preoperative details:. Doppler ultrasonography should 1. A lopecia along the incision line is the most frequent
be used preoperatively to determine the reliability of complication, and patients should be aware of this. The
the superficial temporal artery and to map the course of affected areas may be excised at a later time if it is
the main pedicle, frontal branch, and parietal branch. particularly noticeable.
With the nerve stimulator on 10, we identify the 2. Injury to the frontal branch of the facial nerve is a
potential co mplication.
3. The vascularity of the scalp edges may be tenuous However, appro ximately one-third of all patients are
following the elevation of a large flap. Th is may result unhappy with how their b reasts look after undergoing
in wound breakdown and require healing by secondary breast conservation therapy and many would consider
intention. reconstruction, according to a study presented today
4. A lthough this flap is well vascularized and robust, at the American Society of Plastic Surgeons (ASPS)
dissection of the flap is tedious, and great care must be Plastic Surgery 2006 conference in San Francisco.
taken in separating the subcutaneous tissue fro m the Lu mpectomy was supposed to save a lady‟s breast
underlying axial vascular supply. If the superficial but what's left doesn't look like a breast to them.
temporal artery or veins are in jured during elevation, Howard Wang, ASPS Member Surgeon and co-
the flap may not be useable. Great care must be taken author of the study opined that conservation is
in the init ial elevation of skin flaps away fro m the believed to be an acceptable way of saving a wo man's
temporoparietal fascia to develop the correct level of breast but many of these women are co ming to plastic
dissection and avoid injury to the vasculature. surgeons for help, saying it isn't so.
In the study, 28 percent of the breast cancer patients
stated they were dissatisfied with the cosmetic result
of their lu mpectomy. Of those patients, 46 percent
stated their physical appearance was worse or much
worse after the surgery and were considering
VIEWS reconstruction. Only nine percent of patients who
were satisfied with the outcome, however, would
consider reconstruction if it were offered.
Approximately 26 percent of patients were unhappy
with their physical appearance after the lu mpectomy
FAC E M ELTIN G W ITH TIME but had an improved sense of body image. Plastic
surgeons believe this disparity occurred because
many patients felt relieved to be free of the cancer,
A little known and alarming fact about growing old as leading them to feel better about their bodies even
a wo man is that basically, their facial skeleton is though they were not happy with how their b reasts
disintegrating and no amount of skin tightening can looked.
make them look forever 21. According to the American Cancer Society, almost
Dr. Dav id Kahn at Stanford and Dr. Robert Shaw have 213,000 wo men will be d iagnosed with breast cancer
published two studies this year. Almost 58,000 wo men underwent breast
1. Shaw, R.B. et al., Aging of the Bony Orb it: reconstruction surgery in 2005, according to ASPS.
A Three Dimensional CT Study. Plast. "Patients should know their options and understand
Reconstr. Surg. Plastic Surgery 2006 Astract that just because they undergo a lumpectomy to save
Supplement. their breast does not mean they will be happy with
2. Shaw, R.B. et al., Aging of the Midface the cosmetic outcome," said Dr. Wang. "Oncologists
Bony Elements: A Three Dimensional CT need to work with patients to help them understand
Study. Plast. Reconstr. Surg. In Press (they the potential physical outcomes and refer them to a
presented this one at Plastic Surgery 2005) board-certified plastic surgeon to consider all of their
showing that while the skin sags and wrinkles, the choices."
facial bones are are shrinking and changing shape - and
this happens significantly earlier for wo men than men.
Skin tightening, collagen and fat injections, Botox
injections, don't take into account changes to the bones. W E W ILL MIS S HIM
After getting a face-lift when some patients look at
photos of them when they were young, they look very
different. Part o f that may be the tightening of the skin Dr. Charles Edwin Horton, a plastic surgeon and
over a bony scaffolding that has deteriorated and founder of the international human itarian group
changed in shape from when they were 21. So surgeons Physicians for Peace, has died after battling cancer on
should concentrate on restoring volume to co mpensate October 23, 2006 in his ho me in Suffolk, Virgin ia. He
for the loss of bony volume, and lift ing and reducing was 81.
the aged and less elastic soft tissue. The fact remains Horton became Hampton Roads' first plastic surgeon
that Plastic surgeons can't turn back the clock. It's more when he moved to Norfolk in 1955. He was a pioneer
of a 'freshening up'. in the field of genital reconstruction and also
specialized in correcting congenital deformities. He
founded Eastern Virg inia Medical School's plastic
LUMP IN G IT B UT NO T LIKIN G IT surgery division.
But it was a medical mission to Haiti in the 1960s
through his Rotary Club that changed his life. In
Women with breast cancer often undergo a 1989 he founded Physicians for Peace, a nonprofit
lu mpectomy and radiat ion to save their breasts and group that organizes teams of volunteer med ical
avoid the need for additional reconstructive surgery. professionals to train their counterparts in
underdeveloped countries. Last year, the group
went on 52 missions and donated more than $25
million (€19.87 million) in medical supplies and
more than $2 million (€1.59 million) in medical
services, said Ron Sconyers, the groups' chief
executive officer. COS MO LAS ER CO N 2 0 0 6
Horton retired fro m his private practice in 2000 to
work fu ll-time with Physicians for Peace. His (Personal communication to the Editor from
salary was $1 a year. Dr. Eid B. Mustafa, a Conference Chairman Dr. Lakshyajit Dhami and
Physicians for Peace board of trustees member who Secretary Dr. Uddhav Patil)
practices in Wichita Falls, Texas, said Horton IACLS (Indian Association of Cos metic Laser
trained generations of plastic surgeons from all over Surgeons) is a National Association of Plastic
the world. " But he also realized that med icine is not Surgeons, Dermatologists and other doctors who are
everything, and to help people further, he realized using lasers for skin & cosmet ic purposes. IACLS was
that one has to address the big picture," Mustafa founded in Mar. 2006. As it‟s inaugural gesture, a two
said. "...He went way above and beyond the line of and half days Conference cum Live Workshop was
med ical duty." Dr. Juan Montero, a general and successfully conducted under the auspices of IACLS at
thoracic surgeon, called Horton a "true a Unique 3 level centrally A/c Auditoriu m of Nanavati
humanitarian." "To him, everybody was the same. Hospital fro m 2 to 4 June 2006.
He was colorblind," said Montero, who also serves The entire programme was arranged in 9 sessions
on the group's board. "His genius in plastic surgery covering topics like Laser Basics, Hair Removal,
is matched by his love of his fellow man." Vascular & Pig mented Lesions, Tattoos, Acne, Laser
Horton was born on June 27, 1925 in Purdy, Missouri. PhotoRejuvenation, Boto x & Fillers, Vit iligo & Setting
He received his medical degree fro m the Un iversity of up of a laser center.
Virgin ia, co mpleted his surgical residency at George The entire faculty was INDIAN and the entire
Washington University Hospital and also trained experience presented was obtained on Indian skin type
during the Korean War at the U.S. Naval Medical & in Indian population and work set up. As Lasers is
Center in Bethesda, Maryland. It was there that Horton an emerging Hyper-Speciality, TRUTH was kept as
discovered his calling to plastic surgery. Horton is the crux of the entire conference with side effects,
survived by his wife and five children complications and their management pro jected
uninhibited for the delegates to know. Physical and
technical essentials of the laser systems, and cost
effectiveness of such high cost projects and majors to
make it feasib le were also discussed by the non-medico
CO N GRA TULA TIONS ! & non-medico experts to give a true insight to the
delegates who were looking towards lasers as a wonder
mag ic lamp.
It was indeed a heart warming news and we all were Each session had an average of 5 speakers. Starting
delighted to know about the prestigious honour of 'Sitar with the basics, various aspects of the topic were
e Essar' being conferred upon the President of Pakistan covered, ending with the recent developments in the
Association of Plastic Surgeons (PAPS), Col. Mamoon field. Except the last session, this was followed by live
Rashid! With his brave and tireless efforts and most demonstration of the procedure on the same dias, done
humane qualit ies, which he exhib ited in an exemp lary with different technologies and with the different make
way during the aftermath of the unfortunate natural of laser systems in the same technology. To give
disaster in Kash mir, we can imag ine that he must have delegates a wider exposure, pers onal technical tricks
been a very natural choice for such a distinction. Please were demonstrated & pearls of wisdom were told on
accept our Salaam Colonel Saab! the same machine by different experts. The details of
For a leader, being good is not good enough, he has to the procedure were projected live on a big 20 feet
be the cause of good in others. In Co lonel Mamoon screen with essential close ups of the treatment end
both his team in Co mmand Hospital Islamabad as well points & immediate results. There was a two way free
as the PAPS have an excellent leader who has always communicat ion going live while the procedures were
led by examp le. His quality of surgical work has performed and the demonstrators and speakers were in
always been a source of inspiration for the junio r a panel to clarify any ult imate doubts at the end. At the
colleagues, but his capacity to deliver that quality in end of each session, not only all doubts and queries in
the mammoth quantity that was expected of him for the the minds of the delegates were clarified to their
quake victims was simp ly mind boggling! This is just satisfaction but also a simple carry ho me messages
the beginning. We hope to see him decorated with were also given. In case of controversial topics, the
Nishan e Pakistan one day! Insha Allah! panel came to a particular consensus and conveyed it to
the delegates. It was also told to them that this
consensus is subject to modifications by further
addition of knowledge during forthcoming conferences
& workshops of the society.
It was attended by 275 delegates who ranged fro m soft tissue trauma, thyroid ophthalmology and surgical
laser system users of 5 years standing in India to the and non surgical peri-ocular aesthetic corrections.
new entrants who had just purchased the system to Management of Ptosis was discussed in great details by
those who were desirous of exploring this field. They Dr. Nirmala Subraman ian and Dr. Usha Kim
came fro m all over the country fro m Guwahati to (Chennai), Dr. Vinita Singh and Dr. P.K. Agarwal
Rajasthan & Delhi to Chennai as well as fro m (Lucknow), and Dr. Golam Haider of Bangladesh. Dr.
Bangaladesh & Pakistan. It was aptly supported by a Daljit Sing‟s sutureless levator plication and Dr. M.
one hall co mmercial exh ib ition of 20 stalls of & fro m Moin‟s (Pakistan) lecture on redo ptosis surgery for
laser distributors. over correction deserve a special ment ion.
Overall the Cosmo LaserCon 2006 was a sweeping Inflammatory conditions also found a mention with Dr.
success and the delegates went back with much more Harpreet Singh fro m U.K. discussing Necrotizing
than what they had expected to carry. The whole fascitis, Dr. Usha Kim elaborating on orbital and
proceeding has been recorded live & is availab le in CD adenexal tuberculosis, and Dr. A jay Tripathi and Dr. G.
& DVD fo rmat if any one desires to go through the Bhaskarajan deliberat ing on the myths and facts of
whole programme. The organizers are now geared up orbital inflammat ion.
for CLC 2007. Dr. A.K. Grover of New Delh i talked about surgical
decision making in lid malignancies, Dr. Ganesh Kuri
and Dr. Kasturi Bhattacharya (Guwahati) presented
BAN KIN G O N EN D UR IN G S MILES their 10 years experience of managing eyelid tu mours,
and Dr. Madhu mati Goel (Lucknow) came up with the
current concepts of orbital biopsy. A session on naso-
Dutch-Bangla Bank Limited organised a 4-day-long lacrimal diseases and trauma and a session on eye
plastic surgery operation, September 06-09, 2006 in changes with age were very interesting and
Faridpur, Bangladesh for the poor children with cleft- informat ive. DCR by external approach (Dr. Harpreet
lip and palate at the Bank's own cost to bring back Singh), Conjunctivo DCR by Dr. Anita Sethi, Balloon
enduring smile on their faces. The operations were dacroplasty by Dr. E.R. Mohan and Endonasal DCR by
performed at Faridpur Diabetic Association Hospital Dr. Sunil Morekar were all very interesting
by a surgery team headed by eminent plastic surgeon presentations.
Prof. Dr. A J. M. Salek. A session on eye socket had Dr. Harpreet Singh
The Bank Managing Director Mr. Yeasin Ali, in his involved in an ongoing debate on enucleation vs.
speech informed the gathering that DBBL has taken evisceration, Dr. Santosh Honavar enunciating the
this noble initiative since 2003 to bring back smile on concepts of enucleation, and Dr. Raman M ittal
the faces of the boys and girls cursed with cleft-lipped increasing the depth of a contracted socket by dermis -
face wh ich creates lot of problems in their social life. fat graft.
He further mentioned that Dutch-Bangla Bank is Aesthetic Oculoplastic surgery was addressed in a
making every effort to discharge its cooperate social separate session. Dr. Nirmala Subraman ian wh ile
responsibility by way of carry ing out diverse discussing Blepharoplasty, emphasized on when to do
philanthropic activit ies. it and how to execute the plan. Dr. N. Shah discussed
The parents of cleft-lipped boys and girls, local the use of brow lift. Dr. S.S. Sethi (New Delhi)
doctors, journalists and the elite people of the town deliberated on the role of lasers around the eye, Dr.
were present on the occasion. Medical Consultant of Kasturi Bhattacharya (Gu wahati) d welt on the role of
the Bank Dr. Mozammel Hossain Khan informed the botox and Dr. A.K. Grover p resented his views on
gathering that, about 120 children with cleft-lip have Radiosurgery in oculoplasty. Dr. Anupam Sharan
been enlisted for surgery and out of them 52 boys and (Lucknow) discussed at great length the role of nun-
girls were successfully operated during the campaign. surgical and surgical options of rejuvenating the aging
The rest of the boys and girls will be operated very eye and Dr. C. Chavan talked about achieving cosmesis
soon. and symmetry in ocular prosthesis.
The session on trauma had Dr. Usha Yadav (New
Delh i) d welling on lid trau ma, Dr. V.B. Pratap
(Lucknow) discussing retained intra-orbital foreign
OPA ICO N 2 0 0 6 bodies, Dr. Arnab Biswas (Kolkata) presenting a
beautiful animat ion of mode of injury in Blowout
fractures and Dr. A.K. Singh (Lucknow) deliberating
The Annual Conference of Oculoplastics Association on reanimation procedures of the paralyzed eyelids. Dr.
of India was held in Lucknow on October 28 and 29, S. Bhattacharya (Lucknow) p resented an overview of
2006. Organized by Dr. Apjit Kaur Chabra and her the complex orbital fractures, emphasizing on a mu lti-
team fro m the Eye Depart ment of King George‟s disciplinary approach with the motto of „basics first
Medical University, the 2 days meet saw almost 200 and perfection next‟.
delegates deliberate on the a wide range of subjects The highlight of the conference was a co mpetitive
ranging fro m Ptosis to congenital malformations, video session and it saw Dr. Neelam Pushkar present 7
benign lid tu mours, lid malignancies , vascular techniques of tarsorraphy and Dr. J.K. Das make
malfo rmations, naso lachrymal diseases, orbital and orbitotomy easy by cryoextraction. Dr. Roshmi Gupta
demonstrated enucleation using scleral cap technique
with porous polyethylene implants. The conference fro m Dr. Asopa‟s center at Agra which is the Mecca of
ended with a session on difficult clinical situations and Hypospadias reconstruction. Dr. A. Gopalakrishna,
later on an exiting Quiz. If the Organizers had Hyderabad presented the Anatomical and
apprehension that Oculoplastics and Orbit lacked the Emb ryological considerations in Hypospadias. The
glamour that is associated with other subspecialities, lecture on comp licat ions and management was well
the keen and rich participation fro m all over the sub- attended and discussed with great interest.
continent must have been a great relief to them and to Dr. Obaidullah Obaid demonstrated first stage of
the association. Looking forward to the next meeting! Bracka‟s Urethroplasty as the first surgery of the
workshop. He operated two more patients by this
technique. The technique of release of chordee and the
defatening of the prepucial graft were worth watching.
Dr. Benoy Verghese fro m Trivandru m demonstrated
WOR KS HOP ON MED PO R E EA R Asopa‟s double prepucial island flap technique. The
R EC ONS TR UC TION execution of the procedure was interesting. The third
surgery in this list was performed by Dr.S.P.Bajaj fro m
(Personal communication to the Editor from Dr. R. K. New Delhi. He demonstrated the Midline Scrotal Flap
Khazanchi, Sr. Consultant and Chairman, Department technique for one stage urethroplasty. This technique
of Plastic Surgery, Sir Ganga Ram Hospital, New was innovated by Dr. Bajaj himself and was a treat for
Delhi). the delegates with many questions for discussion.
theatre Dr. Mu kul Garg demonstrated classical Meatal
A "Workshop on Medpore Ear Reconstruction 2006" Advancement and Glanuloplasty procedure for a
was conducted at Sir Ganga Ram Hospital in coronal hypospadias. In the second patient Dr. Mukul
partnership with “Operation Smile International” on demonstrated single stage chordee correction, dorsal
November 4th & 5th 2006. The faculty for the workshop plication and Transverse preputial onlay patch
comprised of Dr. John F. Rein isch, Chief Div ision of urethroplasty. The third patient was operated by Dr.
Plastic Surgery, Childrens' Hospital of Los Angeles, Kishore Panjawani fro m Agra who demonstrated
Dr. P. S. Bhandari and Dr. Shalabh Sharma Snodgrass Tubularised incised urethral p late
About 100 delegates fro m all over India participated in urethroplasty. All the procedures were d ifferent; they
this workshop. First day of workshop was devoted on were d iscussed very thoroughly and executed masterly.
lectures on contemporary and Medpore ear Dr. Mukul Garg demonstrated perimeatal flap
reconstruction techniques, management of congenital urethroplasty in an already operated patient. Dr.
ear atresia and bone anchored hearing aids. On the Kishore demonstrated Dorsal Meatotomy in a case of
second day Dr. Rein isch gave a live demonstration of Postoperative Meatal stenosis after Epispadias
one stage ear reconstruction using medpore implant, urethroplasty. Dr. Jiten Kulkarn i fro m Aurangabad
temporoparietal fascia and fu ll thickness skin grafts on demonstrated Snodgrass tabularized Incised Plate
a 3 years old boy. The technique was highly Urethroplasty with waterproofing in a distal penile
appreciated by all delegates. It was a great oppurtunity hypospadias. DR. G.V.Sudhakar p lanned a flip-flap
to interact first hand with a pioneer in the field of Ear procedure in a coronal hypospadias with
Reconstruction. waterproofing. A ll the surgeons kept their time and the
surgical session concluded as per schedule. The
demonstration was highly educative and useful for
WOR KS HOP ON HYPOS PA D IAS even the senior members in the gathering.
An evaluation proforma was designed to get the
feedback fro m the participants regarding the workshop
An operative workshop on Hypospadias was organized and response for future programme. The organizing
by Depart ment of Plastic Surgery, JIPM ER, committee collected duly filled up evaluation proforma
Pondicherry, under the Chairmanship of Dr. karoon fro m 60 delegates in exchange of the conference
Agarwal on 22 – 24th September 2006. The main theme certificates. The response in the evaluation proforma is
of the workshop was operative demonstration of quite encouraging. All the surgical sessions are well
surgery for Hypospadias. The idea was to present all appreciated. Each surgery was different in whole
the patients to the faculty and delegates and discuss workshop. A large nu mber of the delegates want
about the surgical technique for the management of the continuation of the workshop as Hypospadias -2 as
patient. Same t ime the facu lty selected patients for soon as possible.
demonstration of their techniques. Eighteen patients
were presented, out of which 12 patients were selected
for surgical demonstration.
The international faculty Dr. Obaidullah Obaid fro m
Peshawar, Pakistan presented overview of h is choice of
technique i.e. Bracka‟s two stage urethroplasty. The
presentation was lucid and the result presented was
very impressive. Dr. Muku l Garg and Dr. Kishore
Panjawan i fro m Agra presented the experience and
innovations in the field of hypospadias urethroplasty SEAS
suicide rates, they suggest greater attention be paid to
MUC H A DO ABO UT NO THIN G the psychiatric state of potential cosmetic surgery
"Serious consideration should be given to providing
A Chinese man who had the world's first penis consultation for patients who are considered by the
transplant had the organ removed two weeks later plastic surgeon to be at high risk of psychiatric disorder
because he and his wife had a "severe psychological or suicide," says an article on the study, published
problem" with his new penis. The man's penis was recently in the A merican Journal of Epidemiology.
damaged beyond repair in an accident this year, Previous international studies have reported similar
leaving him with a one centimetre-long stump with results but small samp le sizes have limited their
which he was unable to urinate or have sexual impact. The study, funded by Health Canada and
intercourse. carried out jo intly by the Public Health Agency of
"His quality of life was affected severely," said Dr Canada, the University of Toronto, Cancer Care
Weilie Hu, a surgeon at Guangzhou General Hospital. Ontario and the University of Laval, is the largest such
Doctors spent 15 hours attaching a 10-centimetre penis study to date, according to the researchers.
to the 44-year-old man after the parents of a brain-dead They combed vital statistics and death certificates of
man half h is age agreed to donate their son's organ. 24,558 wo men in Ontario and Quebec who underwent
The procedure, described in a case study due to appear breast imp lant surgery fro m 1974 to 1989. They also
in the journal European Urology next month, tracked nearly 16,000 wo men who underwent other
represents a big leap forward in transplant surgery. plastic surgeries during the same period and compared
After 10 days, tests revealed the organ had a rich blood both with the general female population. What they
supply and the man was able to urinate normally. found is that, overall, wo men who underwent breast
Although the operation was a surgical success, implantation had lower rates of mo rtality than the
surgeons said they had to remove the penis two weeks general population, at comparab le ages over the same
later. period. They also had lower rates of cancer, contrary to
An examination of the organ however showed no signs popular belief, with 229 cancer deaths among the
of it being rejected by the body. nearly 25,000 wo men. About 303 would be expected in
Jean-Michel Dubernard, the French surgeon who this the general female population.
year performed the wo rld's first face transplant on a But when it came to suicide, researchers identified 58
wo man who had been attacked by a dog, said suicides among the 480 breast-imp lant recip ients who
psychological factors were a serious issue for many died. In a co mparab le general female population
patients receiving certain "allografts", or organs fro m without imp lants, they would have expected 33 suicide
donors. "Psychological consequences of hand and face deaths. Dr. Jacques Brisson of the department of social
allografts show that it is not so easy to use and see and preventive medicine at Laval University in Quebec
permanently a dead person's hands, nor is it easy to thought that there was an increase in the number of
look in a mirror to see a dead person's face," Dr deaths related to suicide but the number itself is not
Dubernard wrote in European Urology. (large). So the risk of suicide among wo men with
"Clearly, in the Chinese case the failure at a very early breast imp lants is not great. It's actually s mall,
stage was first psychological. It involved the recipient's relatively speaking, but it still is larger than the general
wife and raised many questions." population.
In 2001, surgeons were forced to amputate the world's Thirty-three of 383 deaths among women who had
first transplanted hand fro m Clint Hallam, a 50-year- other plastic surgery were suicide. The researchers said
old New Zealander, who said he wanted the "hideous they would have expected 22 suicide deaths for a
and withered" hand removed because he had become comparable group in the general population. It
"mentally detached" fro m it. reinforces the need to be pay attention to patients'
Andrew George, a t ransplant expert at Imperial Co llege motivations and underlying psychological states. The
London, said: "Doing a penis transplant should be no study comes as Health Canada is considering putting
more co mplex than anything else. But it takes time for silicone implants back on the market for general use.
nerve sensations to kick in and it's not clear whether They've been available only under a co mpassionate
the patient would ever be able to have sex with it." release program since 1992, the height of fears over the
The Guardi an health effects of silicone. The program is largely
symbolic, requiring some extra paperwork by
physicians and patients to obtain the imp lants.
The study raises important questions about the
psychiatric state of some of the wo men who seek
IMP LA N TS S A FE B UT P A TIEN TS NO T! implants and plastic surgery. There have been studies
showing that many of these women have low self-
esteem. They tend to be anxious and depressed and the
Women with breast implants and those who've had researchers admonish that there s hould be screening of
plastic surgeries have lower rates of cancer than the these women very carefully before they're given
general population but higher rates of suicide, suggests implants.
a recent Canadian study. Although the researchers
offered no defin itive exp lanation for the increased Source : The Canadian Press
RO LL UP THA T LAP TOP Contact: NABICON 2007 Office, VAMA Events, 69
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a new "shape shifting" technology for solid structures II INTERNATIONAL TUTORIALS – IDEAS AND
developed at Cambridge Un iversity. INNOVATIONS IN AES THETIC S URGER Y
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FORTHCOMING February, 2007
12th Annual Conference of the Pakistan Association
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EVENTS of the Hand
Venue: Depart ment of Plastic & Reconstructive
surgery, Hayatabad Medical Co mplex, Peshawar-
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