» Management of Acute Trauma
Management of Acute Trauma (Injury) including Burns
Injury is the commonest reason for medical advice.
It can be of several types Mechanical injuries, thermal injuries (Burns due
to flame heat or excess of cold) or Chemical. In the modern day plastic
Surgery forms an important pillar in the management of all forms of trauma.
Burns are injuries produced by Heat, Cold or Chemicals . These types of
injury often lead to Destruction of Skin. These injuries require specialized
treatment which is pioneered by plastic Surgeons.
Injury due to mechanical force injury may be limited to cuts over the skin
or to broken bones to very sever injury to the limbs with multiple bony
fractures and wounds. Very sever injury can lead to total detachment of body
parts. Simple cuts over the face or exposed parts of body is repaired with
precision to produce minimal scar by plastic Surgery, Complex injuries
leading to skin loss over the face & else where over the body.
Fractures of the Facial Bones produce some of the biggest challenge for
treatment and are treated by plastic surgery. The Development of newer mini
& micro plating systems to stabilize the bones in their correct position
without producing any externally visible scar has been mastered by plastic
Surgeons. Fractures of the limbs that are associated with wound either upper
limb or lower limb needs attention of Plastic Surgeon along with orthopedic
surgeon right from the first day of management. The use of microsurgery and
use of muscle flaps in the early period of injury has improved recovery and
made even very severely injured limbs salvageable.
Micro vascular Surgery
One of the most charismatic advance in plastic
surgery. Microvascular surgery requires special training. This advance has
made it possible to reattach a totally amputated part from the body. The
surgery is called Replantation the replanted part will look normal and
functions normally. Some of the commonly amputated parts are Fingers, Thumb,
Hand from wrist or whole of the arm. Some times other parts of body like
the, Hairs of head get entangled in drive belts and get detached, these also
can be put back by Microvascular surgery.
First aid and preservation is very important for the success of such
Any part that is totally amputated from the body should be sealed in a
clean polythene bag, within 2 hours of amputation. This polythene should be
kept over ordinary ice. Once preserved in this way the patient can be
transported to the hospital. Replantation can be successfully done even upto
24 hours. We have successfully replanted more than 300 such cases and the
longest duration after which replantation has been successful was 22 hours.
Even if the amputation is not complete in sever injuries the blood supply
to the limb may be severed. Partial or completed severance of blood Supply
to a part of the body requires plastic surgeons to perform Micro vascular
Repair and thus salvage the body part. Injury to hand is complex and
requires the careful & delicate repair under magnification thus are best
performed by Plastic Surgeons trained in Micro vascular surgery. It is
advised not to even put one stitch over injured hand without using
Injury to nerves gives best results when repaired under magnification. Old
injuries to nerves can also be repaired or nerve grafts put to bridge the