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Lower Limb Reconstruction

Lower limb reconstruction is most commonly required following compound fractures of the leg. These traumatic injuries often result in damage not only to the long bones of the lower leg but also significant skin and soft tissue injury.

Without adequate skin coverage the orthopaedically corrected fracture is prone to infections and non-union of fractures. Plastic surgeons are frequently required to reconstruct the skin and soft tissue following such injuries using skin grafts, local flaps and free flap reconstruction. Dr Mayuresh Deshpande has a particular interest in microsurgical reconstruction and thus can offer the full complement of reconstructive surgery techniques to his patients.

Varicose Veins/Vascular Malformations

Varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

Congenital Anomalies

(a) Cleft Lip -Cleft lip repair (cheiloplasty) is surgical procedure to correct a groove-like defect in the lip.A cleft lip does not join together (fuse) properly during embryonic development. Surgical repair corrects the defect, preventing future problems with breathing, speaking, and eating, and improving the person's physical appearance.

(b) Cleft Palate -The presence of cleft palate has both aesthetic and functional implications for patients in their social interactions, particularly on their ability to communicate effectively and on their facial appearance with or without involvement of the lip. Midfacial skeletal growth may be affected by the surgical repair of the palate. The treatment plan focuses on two areas: speech development and facial growth. Speech development is paramount in the appropriate management of cleft palate.

Many surgical techniques and modifications have been advocated to improve functional outcome and aesthetic results. The most controversial issues in the management of cleft palate are the timing of surgical intervention, speech development after various surgical procedures, and the effects of surgery on facial growth. The major goals of surgical intervention are normal speech, minimizing growth disturbances, and establishing a competent velopharyngeal sphincter.

(c) Hypospadias -Hypospadias repair is surgery to correct a defect in the opening of the penis that is present at birth. The urethra (the tube that carries urine from the bladder to outside the body) does not end at the tip of the penis. Instead, it ends on the underside of the penis. In more severe cases, the urethra opens at the middle or bottom of the penis, or in or behind the scrotum.

(d) Microtia -Microtia can have a significant physical and psychological impact on your child. A missing or malformed outer ear can affect their appearance and self-confidence, and a narrowed or nonexistent ear canal can have more far-reaching effects on their hearing, speech patterns, and language processing skills.

(e) Vaginal Agenisis -Congenital vaginal agenesis is a rare malformation with an incidence of one in 4000 to 5000 female newborns. The purpose of vaginal agenesis treatment is not only to create an adequate passageway for penetration but also to facilitate satisfactory sexual intercourse.

Diabetic Foot/Chronic Wounds

A diabetic foot ulcer is an open sore or wound on the foot of a person with diabetes, most commonly located on the plantar surface or bottom of the foot. Diabetic foot ulcers occur in approximately 15% of persons with diabetes. Of those who develop a foot ulcer, 6% will be hospitalized due to infection or other ulcer-related complication. The risk of foot ulceration and limb amputation increases with age and the duration of diabetes.

Diabetes is the leading cause of non-traumatic lower extremity amputations in the U.S. Between 14-24% percent of patients with diabetes who develop a foot ulcer will require an amputation and foot ulceration precedes 85% of diabetes-related amputations. In the U.S., 82,000 amputations are performed each year on persons with diabetes, half of those age 65 or older.

The good news is that a foot ulcer is preventable if the underlying conditions causing it, diabetic peripheral neuropathy and/or peripheral arterial disease, are appropriately diagnosed and treated.

Causes

Peripheral neuropathy (nerve damage) and lower extremity ischemia (lack of blood flow) due to peripheral artery disease are the primary causes of diabetic foot ulcers.