Plastic Surgery
Presented by,
Dr. Damodhar. M.V
Case Report
Case Report - 1
Evaluation Classification Reversible tx Surgery
Plastic
Personal data
Name: Ali Mohammed Yahya Gamre (Figh...
Personal data / past history
Evaluation Classification Reversible tx Surgery
Plastic
Past history
Previous cerebellar stro...
Case presentation Plastic & Reconstruction surgery
> Clinical examination
> History
> Investigations
> Multidisciplinary a...
Physical examination
Evaluation Classification Reversible tx Surgery
Plastic
Physical examination (systemic)
General appea...
Local examination
evaluation classification reversible tx surgery
Plastic
Foul smelling, discharging wound extending from ...
Case presentation Plastic & Reconstruction surgery
> Clinical examination
> History
> Investigations
> Multidisciplinary a...
Laboratory investigations
evaluation classification reversible tx surgery
Plastic
Wound culture
Hb: 8.1
Hematocrit- 24.9
L...
Radiological Study
Evaluation Classification Reversible tx Surgery
Plastic
Conclusion:
-Extensive DVT of the right lower l...
Case presentation Plastic & Reconstruction surgery
> Clinical examination
> History
> Radiologic investigations
> Multidis...
Multidisciplinary approach
Evaluation Classification Reversible tx Surgery
Plastic
Internal medicine:
Managing Type 2 DM, ...
Case presentation Plastic & Reconstruction surgery
> Clinical examination
> History
> Investigations
> Multidisciplinary a...
evaluation classification reversible tx surgery
Plastic clinical diagnosis & treatment plan
Type 2 DM, previous stroke wit...
evaluation classification reversible tx surgery
Plastic
To stop the spread of infection:
• Cefotaxime,
• Cefuroxime
• Cipo...
Case presentation Plastic & Reconstruction surgery
> Clinical examination
> History
> Investigations
> Multidisciplinary a...
Surgical procedures
evaluation classification reversible tx surgery
Plastic
Wound debridement
Case presentation Plastic & Reconstruction surgery
Necrotizing Fasciitis- Review
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
History
- Hippocrates in the 5th century BC ...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
History
-In 1952 the term “Necrotizing fasci...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Definition & Risk Factors
• Immunosuppressio...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Clinical Features- Early
-Most frequently in...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Clinical Features- Late
- Tense skin
- Color...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Diagnosis
- High index of suspicion, mainly ...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Management
- Aggressive resuscitation and se...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Surgical Management
-Early and aggressive de...
Necrotizing fasciitis
Evaluation Classification Reversible tx Surgery
Plastic
Mortality
• Type I: 20%, *
• Type II: 30-35%...
Case Report – 2 A Very Rare Case Velopharyngeal
Incompetence
Evaluation Classification Reversible tx Surgery
Plastic
Perso...
Velopharyngeal Insufficiency
Evaluation Classification Reversible tx Surgery
Plastic
• He is the only son of a 30-year-old...
Velopharyngeal Insufficiency
Evaluation Classification Reversible tx Surgery
Plastic
It is hard to explain this rare condi...
Plastic & Reconstructive SurgeryPlastic
Plastic Surgery Team
Thank you,
Dr.Damodhar.M.V
Upcoming SlideShare
Loading in …5
×

Necrotizing fasciitis and velopharyngeal aplasia by dr.damodhar.m.v

1,277 views

Published on

Necrotizing Fasciitis and Velopharyngeal Aplasia by Dr.Damodhar.M.V
drdamodhar, dr.damodhar,

Published in: Healthcare

Necrotizing fasciitis and velopharyngeal aplasia by dr.damodhar.m.v

  1. 1. Plastic Surgery Presented by, Dr. Damodhar. M.V Case Report
  2. 2. Case Report - 1 Evaluation Classification Reversible tx Surgery Plastic Personal data Name: Ali Mohammed Yahya Gamre (Fighter) Age: 67 y/o Sex: Male MRN: 27902 Marital status: Married with children Chief Complaint Right thigh lateral aspect bed sore, Gangrenous superficial patch at the tip of his right big toe.
  3. 3. Personal data / past history Evaluation Classification Reversible tx Surgery Plastic Past history Previous cerebellar stroke Type 2 DM, Irritable bowel syndrome Past Surgical history
  4. 4. Case presentation Plastic & Reconstruction surgery > Clinical examination > History > Investigations > Multidisciplinary approach > Surgical procedures
  5. 5. Physical examination Evaluation Classification Reversible tx Surgery Plastic Physical examination (systemic) General appearance: Poorly built, Severely malnourished, emaciated Vital sign: BP:138/64mmHg, PR: 72/min, RR: 22/min, BT:35.2 > > > Chest & Lung: percussion: normal; auscultation: wheezing(+), rales(+) Heart: Regular heart beat, No murmus Abdomen: Soft, lax, Extremities: Joint stiffness(+), CNS: GCS 7, sluggish pupillary reaction.
  6. 6. Local examination evaluation classification reversible tx surgery Plastic Foul smelling, discharging wound extending from the right hip to back almost up to the lower scapular region on the right side.. Skin hot and tender up to the lower scapular region. Wound
  7. 7. Case presentation Plastic & Reconstruction surgery > Clinical examination > History > Investigations > Multidisciplinary approach > Surgical procedures
  8. 8. Laboratory investigations evaluation classification reversible tx surgery Plastic Wound culture Hb: 8.1 Hematocrit- 24.9 Leucocytes: 10.8 D-Dimer-1.7 LDH-335 Blood work up
  9. 9. Radiological Study Evaluation Classification Reversible tx Surgery Plastic Conclusion: -Extensive DVT of the right lower limb as described . -Soft tissue edema at the right leg X-ray and Doppler
  10. 10. Case presentation Plastic & Reconstruction surgery > Clinical examination > History > Radiologic investigations > Multidisciplinary approach > Surgical procedures
  11. 11. Multidisciplinary approach Evaluation Classification Reversible tx Surgery Plastic Internal medicine: Managing Type 2 DM, previous stroke, patient was on ventilator on and off due to impaired lung function Surgical: Insertion of feeding gastrostomy and regular care of gastrostomy tube. Plastic Surgery: Wound debridement and serial debridement's was done at regular intervals.
  12. 12. Case presentation Plastic & Reconstruction surgery > Clinical examination > History > Investigations > Multidisciplinary approach > Clinical diagnosis & treatment plan > Surgical procedures
  13. 13. evaluation classification reversible tx surgery Plastic clinical diagnosis & treatment plan Type 2 DM, previous stroke with on and off respiratory distress Primary Diagnosis wide spreading wound over the right hip and back suggestive of Necrotizing Fasciitis Clinical diagnosis and staging: Necrotizing fasciitis Type 2 Secondary Diagnosis
  14. 14. evaluation classification reversible tx surgery Plastic To stop the spread of infection: • Cefotaxime, • Cefuroxime • Ciporfloxacin Surgical Debridement • Wide excision and through debridement of wound. • Regular change of dressing • Serial debridement's was planned. Clinical diagnosis & treatment plan
  15. 15. Case presentation Plastic & Reconstruction surgery > Clinical examination > History > Investigations > Multidisciplinary approach > Clinical diagnosis & treatment plan > Surgical procedures
  16. 16. Surgical procedures evaluation classification reversible tx surgery Plastic Wound debridement
  17. 17. Case presentation Plastic & Reconstruction surgery Necrotizing Fasciitis- Review
  18. 18. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic History - Hippocrates in the 5th century BC noted it, known as malignant ulcer, gangrenous ulcer putrid ulcer. - Was termed as hospital gangrene in the 18th century - In1871 after the Civil War was called hospital gangrene by a war surgeon - In 1924 called hemolytic streptococcal gangrene
  19. 19. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic History -In 1952 the term “Necrotizing fasciitis” was used. -It was termed as the “killer bug”, “flesh eating bacteria” by the media -1989 toxic shock syndrome and strep A necrotizing fasciitis reported -Estimated 10,000-15,000 strep A infections with 5% of patients developing necrotizing fasciitis
  20. 20. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Definition & Risk Factors • Immunosuppression • Diabetes • Other chronic disease • Malnutrition • Advanced age • Obesity • Renal failure • Malignancy Fulminant, deep-seated infection with necrosis of fascia and soft-tissue, generally sparing of muscle and possible sparing of the skin -Hasham S, Matteucci P, Stanley PR, Hart NB. Necrotising fasciitis. BMJ. 2005 Apr 9;330(7495):830-3
  21. 21. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Clinical Features- Early -Most frequently involved areas : 1) Extremities 2) Perineum 3) Trunk -Can advance over hours or days -Early symptoms Pain, swelling, induration, fever, tachycardia Severe pain out of proportion with exam
  22. 22. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Clinical Features- Late - Tense skin - Color changes (red-purple->dusky blue-> black) -Bullae – initially clear- hemorrhagic -Crepitus (only about 10-40%) -Sepsis / Multiorgan failure
  23. 23. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Diagnosis - High index of suspicion, mainly a clinical diagnosis. - Laboratory investigations: Leucocytosis Acidosis Altered coagulation profile Abnormal renal function - Plain radiography: Soft tissue gas - CT or MRI: May delineate extent of disease Soft tissue gas - Incisional exploration or biopsy (can be done at bedside): Tissue culture to identify pathogens and sensitivities -Hasham S, Matteucci P, Stanley PR, Hart NB. Necrotising fasciitis. BMJ. 2005 Apr 9;330(7495):830-3
  24. 24. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Management - Aggressive resuscitation and sepsis management Frequently multi-organ failure (esp. ARF or ARDS) Broad IV antibiotics Gram positive, gram negative and anaerobic coverage clindamycin - inhibiting streptococcal toxin production Vancomycin- if MRSA concerns Continue IV antibiotics until debridement's complete -Anaya D, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. -Clinical Infect Dis. 2007 Mar 1;44(5):705-10
  25. 25. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Surgical Management -Early and aggressive debridement important -Surgery may also be needed for diagnosis -Serial debridement's until no further necrosis or infection is seen -Beware of hemorrhage (DIC common) -Reconstructive surgery once fully stabilized and infection eliminated -Anaya D, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. -Clinical Infect Dis. 2007 Mar 1;44(5):705-10
  26. 26. Necrotizing fasciitis Evaluation Classification Reversible tx Surgery Plastic Mortality • Type I: 20%, * • Type II: 30-35%* • Admission to surgery time > 24 hr independent predictor of mortality after controlling for age, sex, DM, and Hypotension* • Amputation does not affect mortality • Cervical necrotizing fasciitis: ~20% • Fournier's gangrene: ~20-40% *Wong CH, Chang HC, Pasupathy S, et al. J Bone Joint Surg Am 2003; 85:1454-1460
  27. 27. Case Report – 2 A Very Rare Case Velopharyngeal Incompetence Evaluation Classification Reversible tx Surgery Plastic Personal data Name: Muqbel Al Mutairi Age: 6y/o Sex: Male MRN: 27279 Chief Complaint Defective speech, nasal emmision with regurgitation of food. Left side unilateral soft palate aplasia.
  28. 28. Velopharyngeal Insufficiency Evaluation Classification Reversible tx Surgery Plastic • He is the only son of a 30-year-old father and 23-year-old mother with 2nd degree consanguinity. The family history was normal. • He was assessed by speech and language by ENT specialists in our hospital. • Severe consistent hypernasality, consistent nasal emission, cleft-type misarticulations and nasal grimace were observed. • Physical examination: Revealed that the left side of her velum appeared shorter tonsillar pillar was absent on the left side Nasal endoscopic examination was done
  29. 29. Velopharyngeal Insufficiency Evaluation Classification Reversible tx Surgery Plastic It is hard to explain this rare condition’s pathogenesis, but it may occur in three ways: • The first theory is an atypical cleft case. • The second theory is that this condition could occur as a part of branchial arch syndrome. However, there were no data to support this theory. • The last theory involves vasculature during embryogenesis. A pathology (such as torsion, occlusion, etc.) in the ascending palatine artery during embryogenesis would cause this situation. The Cleft Palate-Craniofacial Journal 49(4) pp. 494–497 July 2012 ’ Copyright 2012 American Cleft Palate-Craniofacial Association Figen O¨ zgu¨ r, M.D., Haldun Onuralp Kamburog˘ lu, M.D., F.E.B.O.P.R.A.S. Asymmetric
  30. 30. Plastic & Reconstructive SurgeryPlastic Plastic Surgery Team
  31. 31. Thank you, Dr.Damodhar.M.V

×