Browsing by Author "Lohani, Ishwar"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Publication Cleft Lip and Palate Repair Surgeries in a Tertiary Care Center: A Descriptive Cross-Sectional Study(Institute of Medicine, 2023) Rai, Sushant; Niraula, Himalaya; Sharma, Samit; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: The burden of cleft lip and palate in Nepal is high. Surgeries should be performed at the right age and weight for the safety and optimal development. We aimed to identify the socio-demographic and peri-operative attributes of cleft lip and palate patients. Methods: A descriptive, cross-sectional study of cleft lip and palate surgeries conducted in Tribhuvan University Teaching Hospital, over a two-year period. Variables studied include age and weight at the time of surgery, gender, ethnicity, type of repair, other congenital defects, the length of stay, and complications. Results: Overall, 28 cleft lip and palate surgeries were performed. The median age at operation of cleft lip patients was six months and of cleft palate patients was 20.5 months. The median weight in kilograms of cleft lip patients was six, whereas of cleft palate patients was 10. The male-to-female ratio among all the patients was 1.2:1. The patients hailed from all seven provinces of Nepal. For cleft lip, Millard technique 13 (93%) was most commonly performed and for cleft palate, the Bardach repair 10 (71.4%) was mostly preferred. Only two patients suffered from peri-operative complications. Conclusion: Millard technique and Bardach repair were the most commonly performed surgeries for cleft lip and palate respectively. Two peri-operative complications were encountered. Keywords: Cleft lip; cleft palate; socio-demographic profilePublication Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal(Institute of Medicine, 2021) Niraula, Himalaya; Rajbhandari, Bikesh; Devkota, Manish; Sharma, Samit; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Lower limb defects are caused by trauma, chronic ulcers or oncological resection. Being a large and varied area of the body, lower limb reconstruction is challenging. This study analyzed clinical presentation of such defects, surgical management and outcomes in Nepalese context. Methods: Single-center retrospective study of flap reconstruction of lower limb defects conducted in Tribhuvan University Teaching Hospital, Kathmandu over a two years period (April 2019-March 2021). Demographics, clinical presentation, comorbidities, treatment and complications were recorded and analyzed. Results: A total of 53 flaps were performed on 47 patients with 50 defects (35 males and 12 females). Road traffic accidents (38.3%) and pressure ulcers (17.02%) were common causes. Ankle-foot was the most affected site (48%), followed by leg and thigh (18% each). Defect size ranged from 3 cm2 to 396 cm2. Surgery consisted of 46 pedicled and seven free flaps. Reverse sural artery flap was the commonest flap performed (30.2%). All free flaps were performed on defects larger than 100cm2. Overall complication rate was 30.2%, partial flap loss being the commonest (15.1%). Total flap loss occurred in one pedicled and one free flap. Eleven pressure ulcers were operated on, with 36.4% complication rate. Average hospital stay was 33.5±26.88 days. Conclusion: Multiple surgeries, comorbidities and high complication rates with hospital stay of more than a month reflect the difficulties encountered in lower limb reconstruction. Despite these challenges, majority of our patients were discharged with stable wound coverage. Keywords: Lower limb reconstruction, pressure ulcers, reverse sural artery flapPublication Experience in Oral Cancer Reconstruction in a Tertiary Care Center of Nepal(Institute of Medicine, 2022) Pradhan, Rohan; Rayamajhi, Sangam; Sharma, Samit; Rai, Sushant; Rajbhandari, Bikesh; Niraula, Himalaya; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Oral cancer is one of the most common malignancies in Nepal. Most patients have locally advanced disease during their initial presentation, necessitating substantial resection and leaving significant deformity. Functional and anatomical restoration of these defects is crucial. This study analyzed the clinical presentation of oral cancer, surgical management, and encountered complications in the Nepalese context. Methods: This was a single-center retrospective study of oral cancer reconstruction performed at Tribhuvan University Teaching Hospital, Kathmandu over four years period (September 2018 - September 2022). Demographics, clinical presentation, comorbidities, treatment, and complications were recorded and analyzed. Results: Out of the analysis of 36 cases of oral cancer, most of the patients were in the fifth decade of life with male to female ratio of 3:1. The most common primary site involved was buccal mucosa (38.88%). Twenty-two cases (61.11%) were in the locally advanced stage. Tobacco chewing was a common entity in personal habits. Surgery consisted of eighteen pedicled, sixteen free flaps, and five local flaps. Pectoralis major myocutaneous flap was the commonest flap performed (38.46%). The overall complication rate was 58.33%. Orocutaneous fistula was the commonest (22.22%). The partial flap loss occurred in 8.33% (15.1%) and the total flap loss occurred in three free flaps. Conclusion: The difficulties experienced in OC reconstruction were high complication rates, multiple redo surgeries, and extended hospital stays. Despite these challenges, all of our patients were released from the hospital with stable wound coverage. Furthermore, the study will provide a platform for a better understanding of the oral cancer reconstruction scenario in the context of Nepal. Keywords: Free flaps, oral cancer; pedicled flaps, reconstructionPublication Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal(Institute of Medicine, 2020) Devkota, Manish; Sharma, Samit; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal. Methods: This is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018. Results: Out of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%. Conclusion: Adult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries. Keywords: Acute burn, burn injury, burn outcome, epidemiologyPublication Split Thickness Skin Grafting With and Without Surgical Removal of Granulation Tissue in Granulating Wounds: A Single Blinded, Randomized Controlled Trial(Institute of Medicine, 2021) Sharma, Samit; Pokhrel, Biraj; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Split thickness skin graft (STSG) is a commonly carried out procedure in granulating wounds. The graft may be applied directly on the granulation tissue (without scrapping) or it may be applied after complete removal of the granulation tissue (after scrapping). Surgeons are divided on this issue. Methods: A single blinded, randomized, controlled trial was carried out between November 2017 and December 2018 in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The study consisted of 62 patients who were divided into two groups. Group A consisted of patients undergoing removal of granulation tissue and Group B included patients on whom the skin graft was directly applied on the granulation tissue. On the 10th post-operative day, assessment of the graft take was done. Results: There was no statistically significant difference in graft take between group A and group B (p=0.59). The average drop in hemoglobin levels after the surgery was 1.6 gm% in group A and 0.4 gm% in group B and this difference was statistically significant. Also, the drop of serum protein after surgery was 8.6% gm/dl in group A and 1.0 gm/dl in group B and this difference was significant. Conclusion: There was no significant difference in the take of skin graft with or without removal of granulation tissue in our study. However, with lesser blood loss, lesser protein loss and lesser operative time, this study favours skin grafting without the removal of granulation tissue. Keywords: Graft take, granulation tissue, split thickness skin graft