Letters to Editor fascia lata as a pedicled flap. Surg Gynecol Obstet 1934;59:766-80. Nahai F, Hill L, Hester TR. Experiences with the tensor fascia lata flap. Plast Reconstr Surg 1979;63:788-99. 3. Gupta AK, Kingsly PM, Jeeth IJ. Groin reconstruction after inguinal block dissection. Indian J Urol 2006;22:355-9. 2.
Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146693
Figure 5: Post-operative day 12 following surgery
Our Flap dimensions ranged from 16 cm × 8 cm to 22 cm × 10 cm and all the donor defects were closed primarily. All the flaps did well without any complications [Figure 5]. A superiorly based “V” flap to provide a stable soft tissue cover over the femoral vessels reduces the risk of wound dehiscence and lymphatic drainage problems with minimal donor site morbidity when compared with other flaps. The technique is simple, with lesser operating time (50-60 min). It is a reliable flap for covering femoral vessels and groin with good tolerance to radiotherapy. Moreover, no muscle is sacrificed, [1,2] and donor site is closed primarily. Superiorly based “V” flap being a single staged procedure meets the criteria formulated by Gupta et al.,[3] with the blood supply of precisely known anatomy, with arterial base out of the field of resection or radiation. However, assessment of aesthetic and functional outcomes of this flap over other flaps and the “ideal” form of reconstruction for groin defects needs additional investigation with more number of patients and longer follow-up.
Vinoth Kumar Dilliraj, Pradeoth Korambayil Mukundan1 Departments of Plastic Surgery and Burns, Vijaya Hospital, Vadapalani, Chennai, Tamil Nadu, India 1Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India Address for correspondence: Dr. Vinoth Kumar Dilliraj, Departments of Plastic Surgery and Burns, Vijaya Hospital, No. 434, N.S.K. Salai, Vadapalani, Chennai - 600 026, Tamil Nadu, India. E-mail: [email protected]
REFERENCES 1. 475
Wangensteen OH. Repair of recurrent and difficult hernias and other large defects of the abdominal wall employing the iliotibial tract of
“Bottle cap as bite block”: An innovative intraoral splint Sir, Bite blocks[1] are commercially available devices, which can be used to prop open a patient’s oral cavity during a prolonged treatment session. After certain surgeries on the mouth such as temporomandibular joint (TMJ) ankylosis or cases of submucosal fibrosis release the jaw needs to be kept in the open position by using bite blocks. We have devised a simple technique of creating bite blocks using the rubber caps of the glass bottles used for intravenous (IV) infusion. The material is pliable, easily available with a wide range of innovative options as per the case demands. After the desired intraoral procedure has been performed (free flap for intraoral reconstruction or release of TMJ ankylosis/submucosal fibrosis), a cap from the intravenous glass bottle which is readily available in the operation theatres is removed after breaking the seal. The inner rim of the cap that fits into the mouth of the bottle is fashioned in such a way to accommodate the maxillary and mandibular molars by cutting two small semicircles of the rubber at 6’O clock and 12’O clock positions [Figure 1]. Then, pack gauze is threaded through the IV set insertion holes and knotted outside and hence that once fitted in the mouth it can then be strapped to the cheek to prevent it from accidental slippage [Figures 2 and 3].
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Letters to Editor
in decreasing both the cost factor as well as the preparation time in devising them. These blocks are also easy to maintain and do not break due to their pliability, but at the same time providing the necessary rigidity.
Figure 1: Fabrication of biteblock
Figure 2: Intraoral view of the biteblock
Figure 3: Biteblock fastened to the cheek
We have used this technique in various patients who include; patients undergoing surgeries for intraoral reconstructions, TMJ ankylosis and to those patients with restricted mouth opening following buccal mucosa fibrosis due to soft tissue involvement for whom release with grafting has been done but require postoperative splintage. In all these cases, the method proved effective
Bite blocks fall in the category of removable passive appliances in the orthodontic management.[2] These bite blocks are commercially available in normal and also reflect in the total cost of the procedure for the patient. Most techniques that have been described in the making of these bite blocks have used some form of dental amalgam that are cumbersome to prepare. Though elastic rubber tubes have been described in their usage as elastic activators for treatment of anterior open-bites,[3] these are normally not readily available in today’s theatres, which depend more on portex and other tubes. Moreover, they are generally available with the anaesthetists and problems with sterility are in plenty. The IV glass bottle caps that are used by us are most often discarded after the use of the fluid within them and hence they are readily available. The rubber can also be easily cut and modified according to the demands of the procedure. The technique of using IV glass bottle rubber cap for splintage after TMJ surgeries is very cost-effective as patients can be sent with them at no extra expense. These caps have the advantage of providing a wide spectrum for usage due to the immense ease with which these materials can be modified according to the surgical condition. These caps are made of simple rubber material which makes them very pliable and can be modified as required for the case that might not be possible with the readily available bite blocks. They are also more tissue friendly for the same reasons. The range of the spectrum in which they can be put to use varies from cases of temporomandibular ankylosis to cases where free flap reconstruction of intraoral cavity has been attempted which demands constant Doppler monitoring. These blocks can be used as props to keep the mouth open. They can be placed on the opposite side of the flap and do not cause pressure related problems especially in these cases. They can also be modified to accommodate the uneven dentition by modifying the slices that are cut from the inner rim so as to accommodate the unevenly placed tooth in certain patients. The bite blocks that are described here by no means are meant to surpass the already available commercial blocks. But these blocks due to their ability to be modified in a
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
476
Letters to Editor
number of ways and being pliable, can be a useful adjunct in complicated cases, such as free flap, in some cases of TMJ ankylosis and submucosal fibrosis release where the release might not be complete and the usually available commercial splints might need modification.
Madhubari Vathulya1,2, Prateek Arora2, Raghav Mantri2, Sunil Choudhary2 Department of Plastic Surgery, 1Coronation Hospital, Dehradun, 2Max Super Speciality Hospital, Saket, New Delhi, India Address for correspondence: Dr. Madhubari Vathulya, Coronation Hospital, Dehradun, India. E-mail: [email protected]
REFERENCES 1.
Dellinger E. A clinical assessment of the Active Vertical Corrector. A nonsurgical alternative for skeletal open bite treatment. AM J Orthod 1986;89:428-36. 2. Iscan HN, Sarisoy L. Comparison of the effects of passive posterior bite-blocks with different construction bites on the craniofacial and dentoalveolar structures. Am J Orthod Dentofacial Orthop 1997;112:171-8. 3. Stellzig A, Steegmayer-Gilde G, Basdra EK. Elastic activator for treatment of open bite. Br J Orthod 1999;26:89-92. Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146694
Taking the next step in documentation: Why and how?
pace. The concept has changed from academic learning to experiential learning[2] and soon we can hope that the concept of documentation will also be incorporated. An interlinked chain of events needs to be understood in this aspect. Previously, it was learning and doing only, then came learning by doing and now the mantra is learning by doing followed by documentation so that others can learn and integrate the existing knowledge with their clinical expertise to innovate newer techniques, which again need to be documented, to continue the education cycle. Another important issue is exposure/interest/ experience of our teachers. Owing to lack of teachers’ initiative the young generation is not being trained in documentation. The documentation strategy should also be made an integral element of teachers’ training. To continue the education cycle, we need to have a fair idea of how to start, from where to start and what are the available resources. World-wide-web services are indispensable in this regard, and there are many databases such as COCHRANE database of systematic reviews[3] available free to the researchers belonging to the developing countries. In addition to this, renowned universities conduct online research methodology learning courses from time to time, which can be accessed through COURSERA[4] etc. Knowing about the various categories/types of manuscripts is also important. We, as surgeons mostly talk of clinical documents, e.g., case series, reviews, case reports, new technique or innovations. However, there are many more ways of writing papers such as web search, embryology, anatomy, community care, public education, prevention and many more. We need to motivate our colleagues to think in this direction and prepare manuscripts on various such issues as well. Now, the time has come to get rid of anxiety about documentation and to take the initiative of documenting quality and not quantity research papers.
Himanshi Aggarwal, Pradeep Kumar Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India
Sir Apropos the editorial entitled “Let’s take the next step in the documentation,” recently published in your esteemed journal.[1] We commend Bhattacharya for very interesting and highly informative write up on the changing global trends in documentation strategy. The impetus on high-quality documentation has been greatly underemphasised in the existing medical education system. However fortunately, medical education system is transforming albeit at a slow 477
Address for correspondence: Dr. Pradeep Kumar, Room No. 404, E Block, Gautam Buddha Hostel, King George’s Medical University, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
REFERENCES 1.
Bhattacharya S. Let’s take the next step in documentation. Indian J Plast Surg 2014;47:157-8.
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146693
Figure 5: Post-operative day 12 following surgery
Our Flap dimensions ranged from 16 cm × 8 cm to 22 cm × 10 cm and all the donor defects were closed primarily. All the flaps did well without any complications [Figure 5]. A superiorly based “V” flap to provide a stable soft tissue cover over the femoral vessels reduces the risk of wound dehiscence and lymphatic drainage problems with minimal donor site morbidity when compared with other flaps. The technique is simple, with lesser operating time (50-60 min). It is a reliable flap for covering femoral vessels and groin with good tolerance to radiotherapy. Moreover, no muscle is sacrificed, [1,2] and donor site is closed primarily. Superiorly based “V” flap being a single staged procedure meets the criteria formulated by Gupta et al.,[3] with the blood supply of precisely known anatomy, with arterial base out of the field of resection or radiation. However, assessment of aesthetic and functional outcomes of this flap over other flaps and the “ideal” form of reconstruction for groin defects needs additional investigation with more number of patients and longer follow-up.
Vinoth Kumar Dilliraj, Pradeoth Korambayil Mukundan1 Departments of Plastic Surgery and Burns, Vijaya Hospital, Vadapalani, Chennai, Tamil Nadu, India 1Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India Address for correspondence: Dr. Vinoth Kumar Dilliraj, Departments of Plastic Surgery and Burns, Vijaya Hospital, No. 434, N.S.K. Salai, Vadapalani, Chennai - 600 026, Tamil Nadu, India. E-mail: [email protected]
REFERENCES 1. 475
Wangensteen OH. Repair of recurrent and difficult hernias and other large defects of the abdominal wall employing the iliotibial tract of
“Bottle cap as bite block”: An innovative intraoral splint Sir, Bite blocks[1] are commercially available devices, which can be used to prop open a patient’s oral cavity during a prolonged treatment session. After certain surgeries on the mouth such as temporomandibular joint (TMJ) ankylosis or cases of submucosal fibrosis release the jaw needs to be kept in the open position by using bite blocks. We have devised a simple technique of creating bite blocks using the rubber caps of the glass bottles used for intravenous (IV) infusion. The material is pliable, easily available with a wide range of innovative options as per the case demands. After the desired intraoral procedure has been performed (free flap for intraoral reconstruction or release of TMJ ankylosis/submucosal fibrosis), a cap from the intravenous glass bottle which is readily available in the operation theatres is removed after breaking the seal. The inner rim of the cap that fits into the mouth of the bottle is fashioned in such a way to accommodate the maxillary and mandibular molars by cutting two small semicircles of the rubber at 6’O clock and 12’O clock positions [Figure 1]. Then, pack gauze is threaded through the IV set insertion holes and knotted outside and hence that once fitted in the mouth it can then be strapped to the cheek to prevent it from accidental slippage [Figures 2 and 3].
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Letters to Editor
in decreasing both the cost factor as well as the preparation time in devising them. These blocks are also easy to maintain and do not break due to their pliability, but at the same time providing the necessary rigidity.
Figure 1: Fabrication of biteblock
Figure 2: Intraoral view of the biteblock
Figure 3: Biteblock fastened to the cheek
We have used this technique in various patients who include; patients undergoing surgeries for intraoral reconstructions, TMJ ankylosis and to those patients with restricted mouth opening following buccal mucosa fibrosis due to soft tissue involvement for whom release with grafting has been done but require postoperative splintage. In all these cases, the method proved effective
Bite blocks fall in the category of removable passive appliances in the orthodontic management.[2] These bite blocks are commercially available in normal and also reflect in the total cost of the procedure for the patient. Most techniques that have been described in the making of these bite blocks have used some form of dental amalgam that are cumbersome to prepare. Though elastic rubber tubes have been described in their usage as elastic activators for treatment of anterior open-bites,[3] these are normally not readily available in today’s theatres, which depend more on portex and other tubes. Moreover, they are generally available with the anaesthetists and problems with sterility are in plenty. The IV glass bottle caps that are used by us are most often discarded after the use of the fluid within them and hence they are readily available. The rubber can also be easily cut and modified according to the demands of the procedure. The technique of using IV glass bottle rubber cap for splintage after TMJ surgeries is very cost-effective as patients can be sent with them at no extra expense. These caps have the advantage of providing a wide spectrum for usage due to the immense ease with which these materials can be modified according to the surgical condition. These caps are made of simple rubber material which makes them very pliable and can be modified as required for the case that might not be possible with the readily available bite blocks. They are also more tissue friendly for the same reasons. The range of the spectrum in which they can be put to use varies from cases of temporomandibular ankylosis to cases where free flap reconstruction of intraoral cavity has been attempted which demands constant Doppler monitoring. These blocks can be used as props to keep the mouth open. They can be placed on the opposite side of the flap and do not cause pressure related problems especially in these cases. They can also be modified to accommodate the uneven dentition by modifying the slices that are cut from the inner rim so as to accommodate the unevenly placed tooth in certain patients. The bite blocks that are described here by no means are meant to surpass the already available commercial blocks. But these blocks due to their ability to be modified in a
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
476
Letters to Editor
number of ways and being pliable, can be a useful adjunct in complicated cases, such as free flap, in some cases of TMJ ankylosis and submucosal fibrosis release where the release might not be complete and the usually available commercial splints might need modification.
Madhubari Vathulya1,2, Prateek Arora2, Raghav Mantri2, Sunil Choudhary2 Department of Plastic Surgery, 1Coronation Hospital, Dehradun, 2Max Super Speciality Hospital, Saket, New Delhi, India Address for correspondence: Dr. Madhubari Vathulya, Coronation Hospital, Dehradun, India. E-mail: [email protected]
REFERENCES 1.
Dellinger E. A clinical assessment of the Active Vertical Corrector. A nonsurgical alternative for skeletal open bite treatment. AM J Orthod 1986;89:428-36. 2. Iscan HN, Sarisoy L. Comparison of the effects of passive posterior bite-blocks with different construction bites on the craniofacial and dentoalveolar structures. Am J Orthod Dentofacial Orthop 1997;112:171-8. 3. Stellzig A, Steegmayer-Gilde G, Basdra EK. Elastic activator for treatment of open bite. Br J Orthod 1999;26:89-92. Access this article online Quick Response Code:
Website: www.ijps.org DOI: 10.4103/0970-0358.146694
Taking the next step in documentation: Why and how?
pace. The concept has changed from academic learning to experiential learning[2] and soon we can hope that the concept of documentation will also be incorporated. An interlinked chain of events needs to be understood in this aspect. Previously, it was learning and doing only, then came learning by doing and now the mantra is learning by doing followed by documentation so that others can learn and integrate the existing knowledge with their clinical expertise to innovate newer techniques, which again need to be documented, to continue the education cycle. Another important issue is exposure/interest/ experience of our teachers. Owing to lack of teachers’ initiative the young generation is not being trained in documentation. The documentation strategy should also be made an integral element of teachers’ training. To continue the education cycle, we need to have a fair idea of how to start, from where to start and what are the available resources. World-wide-web services are indispensable in this regard, and there are many databases such as COCHRANE database of systematic reviews[3] available free to the researchers belonging to the developing countries. In addition to this, renowned universities conduct online research methodology learning courses from time to time, which can be accessed through COURSERA[4] etc. Knowing about the various categories/types of manuscripts is also important. We, as surgeons mostly talk of clinical documents, e.g., case series, reviews, case reports, new technique or innovations. However, there are many more ways of writing papers such as web search, embryology, anatomy, community care, public education, prevention and many more. We need to motivate our colleagues to think in this direction and prepare manuscripts on various such issues as well. Now, the time has come to get rid of anxiety about documentation and to take the initiative of documenting quality and not quantity research papers.
Himanshi Aggarwal, Pradeep Kumar Department of Prosthodontics, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India
Sir Apropos the editorial entitled “Let’s take the next step in the documentation,” recently published in your esteemed journal.[1] We commend Bhattacharya for very interesting and highly informative write up on the changing global trends in documentation strategy. The impetus on high-quality documentation has been greatly underemphasised in the existing medical education system. However fortunately, medical education system is transforming albeit at a slow 477
Address for correspondence: Dr. Pradeep Kumar, Room No. 404, E Block, Gautam Buddha Hostel, King George’s Medical University, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
REFERENCES 1.
Bhattacharya S. Let’s take the next step in documentation. Indian J Plast Surg 2014;47:157-8.
Indian Journal of Plastic Surgery September-December 2014 Vol 47 Issue 3
Copyright of Indian Journal of Plastic Surgery is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
