HOLI AND THE SKIN SPECIALIST

Holi and the Skin Specialist

Holi, also known as Dhuli in Sanskrit, celebrated by people throwing scented powder and perfume at each other. Originally, it was a festival that commemorated good harvests and the fertile land. In addition to celebrating the coming of spring, Holi has even greater purposes. Hindus believe it is a time of enjoying spring's abundant colors and saying farewell to winter. Furthermore, Holi celebrates many religious myths and legends.

As the spring-blossoming trees that once supplied the colors used to celebrate Holi have become more rare, chemically produced industrial dyes have been used to take their place in almost all of urban India.

Not to deter the enthusiasts from using these, below is the list of chemicals that are used in off the shelf local colours available:

·         Gulals (red): Contains asbestos/ silica (can cause asthma, skin diseases and temporary blindness).

·         Black powders: Contain lead oxide (which can result in renal failure with chronic exposure).

·         Silver: Contains aluminium bromide (carcinogenic)

·         Red: Contains mercury sulphide (carcinogenic).

·         Blue: Contains prussian blue (contact dermatitis, skin allergies)

·         Green: Contains copper sulphate (eye allergies, puffiness of the eyes, or temporary blindness).

·         The wet colors might lead to skin discolouration and dermatitis due to their use of color concentrate gentian violet

 A natural Holi with:

HERBAL COLOURS,

FLOWER PETALS,

HALDI,

MULTANI MITTI

is the healthy alternative to synthetic colors giving the same feel and thrill as that of any coloured powder.

The biggest deterant to people not playing this wonderful festival is that they don’t have control over what the person infront of them is using and hence the Diaspora……

Here are a few home remedies that our grannies used to tell us and we failed to imbibe and suffered the consequences. These hold good to the scientific reasoning as well.

1.    Apply oil or moisturiser all over your skin and allow it to be absorbed by the body for 15 minutes. Next smear waterproof sunscreen on your skin.

2.    Soak your hair liberally with hair oil so that all colours slide away when you sit down to remove them after the day is over.

3.    Wear clothes that can cover maximum part of the body. A swimsuit or waterproof tights under your clothes would protect your body from the harmful effects of chemicals in colours.

4.   You can also apply foundation just before playing Holi. This will protect your skin from dry colours

5.   Use Vaseline for your nails. Apply it beneath the nails and also over it. This prevents permanent staining of your nails and adjacent area.

6.   Other than oil, you can also apply lip balm for extra protection of your lips.

7.   Use Vaseline for your nails. Apply it beneath the nails and also over it. This prevents permanent staining of your nails and adjacent area.

8.   Staining of nails can be prevented by using nail paint before playing with colours. Nail paint can be easily removed with the nail varnish.

9.   Prefer red or pink colours because they can be easily removed as compared to colours like yellow, green, orange or dark purple as they have comparatively more harmful chemicals in them.

10.                While playing with colours, ensure that your eyes are protected all the times. If any colour happens to get into your eyes, do not take it lightly and keep washing with tap water till the irritation subsides. Seek medical advice from a doctor.

11.              Avoid running over wet surfaces, can lead to falls and subsequent injury.

12.                Kids are vunerable to injury as they are largely unattended for majority of the time.

What the doctor suggests as

“Tips for skin care when removing colour”:

1.   Wash the colours off from your skin with luke warm water and lemon wedges.

2.   Avoid hot water as it fixed the colour to the skin. Add a few lemon drops to the bathing water and use mild soap. Rub the skin gently to wash off the colours.

3.   For getting rid of traces of colour left, use the paste of gram flour (besan) with milk on the skin

4.   Avoid removers such as strong soaps, petrol and kerosene for removing colour because they can cause skin irritation

5.   Apply moisturizer on the entire body immediately after the bath as the skin gets dehydrated and dull after washing off the colour.

6.   Do not rub the skin vigorously. It does more damage to the skin.

7.   Keep your skin well hydrated by drinking fluids.

8.   Avoid rubbing your skin with a hard and rough brush as it can cause exfoliation and erythema.

9.   If you are planning a bleach or facial then wait for atleast a week.

The advice that you need to follow most is, "There will always be proponents and opponents to the celebrations of this festival; Do not let data dampen your spirits, have a Happy Holi!!!!!!!!!!!!!" 

DR ASHISH GUPTA
COSMETIC SURGEON
PEDIATRIC PLASTIC SURGEON
TEL: 977977-1111

SCARS NEED A SUPERSPECIALIST’S TOUCH

SCARS NEED A 

SUPERSPECIALIST’S TOUCH

WHAT IS A SCAR?

A scar is the fibrous tissue (thick, firm, red) laid down by the body as a natural process of biological healing at any site that sustains injury.

IS SCAR FORMATION PREVENTABLE?

The following factors determine scar formation: Size and depth of the wound; Location of the injury on the body; Blood supply to the area; Age of the person; Thickness, type and colour of the person's skin; Direction of the scar & Duration of the wound. Some of these factors can be modified to reduce scar formation.

CAN SCARS BE COMPLETELY REMOVED?

“Once A Scar, Always A Scar. We Can Improve The Quality Of The Scar.” A skilled PLASTIC SURGEON can definitely improve the appearance of the scar by disguising it, relocating it, or minimizing its prominence, by surgical and non-surgical means.

ARE THERE ANY TYPES OF SCARS?

Scars can be good scars or bad scars but scientifically they are classified into various type: Keloids, Hypertrophic scar, Hypo or Hyper-pigmented scar, Pitted/ depressed acne scars, Stretch marks (striae).

HOW DO I ENSURE THAT I GET A GOOD SCAR?

Follow the instructions given by your PLASTIC SURGEON properly and for the entire duration as directed. Regular follow up visits are necessary to assess the response of the body towards the treatment and if any change is required can be instituted at the earliest.

WHAT ARE THE NON- SURGICAL OPTIONS FOR IMPROVING MY SCAR?

Pressure garments and silicone gel/sheet (medical grade as advised by the PLASTIC SURGEON) has been the mainstay in the treatment of scars. Other options are: Chemical peels (by the Skin Specialist); Fractional Lasers or Nd:YAG laser therapy  (by the Plastic Surgeon); Intra-lesional injection of Steroids (by the Plastic Surgeon); Fillers

WHAT ARE THE SURGICAL OPTIONS?

The type of surgery may range from a simple dermabrasion (surgical peeling of outer layer of skin); micro-dermabrasion (does not require anaesthesia); Z- Plasty; scar excision; serial excision; scar revision; skin grafting or tissue expansion (in large scars).

IS SCAR SURGERY A MAJOR SURGERY?

Usually Scar revision surgeries for small scars can be done under local anaesthesia which do not require admission. Some larger scars or scars in sensitive areas like near the eyes, nose etc may require general anaesthesia and a day care admission in which the patient is sent home in the evening. Complex scars may constitute a major surgery and require admission for more than a day.

WILL INSURANCE COVER MY EXPENCES FOR SCAR SURGERY?

If the scars are causing functional problems like contractures, limiting ones daily activity, or hindering ones social interactions; such scar revisions are likely to be covered under the Insurance act. But a prior approval from the company is helpful. Cosmetic surgery is not covered under the gamut of health insurance.

HOW LONG AFTER THE SURGERY WILL MY SCAR LOOK BETTER?

The biological process of healing in a scar usually subsides by 6-9 months. It is by that time the final results can be commented upon.

DO HOME REMEDIES HELP?

People have tried lemon juice, shea butter, cocoa butter, honey, sun exposure for scar reduction but with inconsistent results. But application of Vit E, Aloe Vera creams, massage and avoiding sun exposure do facilitate better scarring.

DR. ASHISH GUPTA

ASSOCIATE CONSULTANT

S.P.S. APOLLO HOSPITALS, LUDHIANA

SAFETY WITH KITES & STRINGS (DOR)

SAFETY WITH KITES & STRINGS (DOR)

The festivals of Lohri and Vasant Panchami are synonymous with kite flying in the northern states of India. Lohri is celebrated for numerous reasons one among them is that it falls on the eve of winter solstice, that is the longest night of the winters and as the beginning of a financial new year for the Punjabi farmer. Over time, people have associated Lohri to the tale of Dulla Bhatti. The central character of most Lohri songs, who lived in Punjab during the reign of Emperor Akbar. He was regarded as a hero in Punjab for he rescued Hindu girls being forcibly sold in the slave market of the Middle East. He arranged their marriages to Hindu boys with rituals and provided them with dowries. So every other Lohri song has words to express gratitude to Dulla Bhatti. For Punjabis, this is more than just a festival, it is also an example of a way of life. Lohri celebrates fertility and the spark of life.

           

Vasant Panchami too is a famous festival that marks the end of the winter season and ushers in the springtime. Goddess Saraswati is the one who gives the essence (sara) of our own self (swa). She is considered the personification of knowledge. Vasant Panchami has a specific meaning, Vasant means Spring, whereas Panchami means the fifth day of the spring. It falls on Panchami - on the Waxing Moon. The color yellow celebrates the brilliance and the vibrancy of life.

           

The vibrance of these two festivals is witnessed in the sky filled with innumerable shapes and colors of KITES.  The history of kite flying is equally engrossing as is the recreation itself. Kites were used approximately 2,800 years ago in China, where materials ideal for kite building were readily available: silk fabric for sail material; fine, high-tensile-strength silk for flying line; and resilient bamboo for a strong, lightweight framework. The kite was said to be the invention of the famous 5th century BC Chinese philosophers Mozi and Lu Ban. Ancient and medieval Chinese sources list other uses of kites for measuring distances, testing the wind, lifting men, signaling, and communication for military operations. The earliest known Chinese kites were flat (not bowed) and often rectangular.

After its introduction into India, the kite further evolved into the Fighter kite known as the PATANG in India. In India annual kite running competitions are held every year in the month of January. Lohri & Vasant Panchami are the times when the skies are filled with hues of different colors and forms of kites.

The science behind these graceful flybys presented us with a volte face (the darker side) in the form of the glass laced, polyethylene fiber blended with the metal zinc thread; in common verbatim labeled as “The Chinese Dor”. The accurate constituents of the string are still not known. It was January of 2012 that the Indian people had a taste of its true potential; a kite string that would cut all Indian threads that were hand woven called “Manjha” but also have property to stretch without breaking leading to extensive cuts on people caught in its tangles; leading to partial amputations and injuries to the face and neck as populace of Amritsar found out the hard way; Electrocution, an unheard entity, but the metal content would transmit current in the vicinity of high voltage wires or when wet leading to fatalities in the states of Punjab and Jammu in the year 2011.

The newsprints were full of incidences of fatalities resulting from the string that had created ripples in the kite flying ways. The infamous Chinese Dor was then banned in Punjab, Gujrat & Maharashtra; but it still finds favor with the ill-informed and the un-repenting. Even with its fatal outcomes, traders are stock piling it as the demand fuels its sales.

Human nature is to strive for material things that are forbidden and the tragedy is that we find what we are looking for and are left to fend ourselves while facing the consequences of our selfish actions.

The Chinese Dor is not to be blamed in its entirety as it was intended to be used to fly large kites for Kite flying Competitions not the usual “duels” that we witness in our skies during Lohri and Vasant Panchami. The polyethylene fiber used in making the string has a large breaking load and stretches before breaking giving it a unique nature to resist all attempts of the Indian made Dor to break it. The lacing of glass adds the teeth to the Dor.

Year after year we read in the newspapers about accidents occurring on roads due to children running after kites, kids falling off the roof during kite flying, injuries to fingers leading to minor cuts which would actually quantify the zeal of kite flying. But the rules of endearment changed with the arrival of the Chinese Dor. Kite lovers faced the risk of amputation of fingers’ while flying heavy kites with laced Chinese dor; a sure recipe for loosing ones fingers. The commuter on two wheelers face a double dilemma of an unruly traffic and the risk of sustaining injuries from the string on their neck and arms as few of the residents of Amritsar experienced, especially travelling on the bridges/ flyovers. Rampuraphool, a small town in District Bhatinda shot to lime light when a boy got electrocuted while flying his kite over high voltage electric wires.

Accidents happen when we are not careful. A learned decision as to which string (dor) you will buy might make a difference of life and death for you, your family member and/ or for an unknown passerby who was just admiring the view. As a doctor, I would say, “If you have a bleeding wound, give pressure over the part from where it is bleeding and rush to the nearest hospital.” But as a concerned citizen, I would say, “Prevention is better than cure. Make a wise decision and keep the playing field even.”

Have a Happy Lohri and a joyous Vasant Panchami.                 

DR. ASHISH GUPTA

ASSOCIATE CONSULTANT

DEPT. OF PLASTIC & MICROVASCULAR SURGERY

SPS APOLLO HOSPITALS , LUDHIANA

KEEP YOUR FEET IN DIABETES!!!

THE DIABETIC FOOT

INTRODUCTION

Diabetes Mellitus is a fast growing pandemic afflicting people of all age groups. The disease affects all the systems of the body and all the tissues also. Numerous patients come to realize that they are suffering form this disease when the small ulcer on their foot does not heal and starts to make the foot look black (gangrene).Diabetic patients have 15– 40 times higher risk of under going amputation (cutting of the dead limb/foot) than normal population.

HOW DOES A DIABETIC FOOT OCCUR?

High blood glucose levels lead to nerve damage causing a significant decrease in the sensation of the feet. So any trauma, nail prick, ill fitting shoe, heat or cold; leads to formation of ulcers/ blisters on the feet which are ignored as the patient does not check the condition of his/her feet everyday. As the skin also becomes dry, the cracks that appear on the skin start harboring bacteria which increase the risk of ulceration.

Diabetics have a propensity to accelerated atherosclerosis (occlusion of blood vessels) of the limbs which reduces the blood flow and makes the foot susceptible to ulceration. These factors together can lead to abnormal pressure on the skin, bones, and joints of the foot during walking and can lead to breakdown of the skin of the foot. High blood sugars also have a detrimental effect on the immune system leaving the body susceptible to infections.

WHAT SHOULD I DO EACH DAY TO STAY HEALTHY WITH DIABETES?

• Follow the healthy eating plan that you and your doctor or dietitian have worked out.
• Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
• Take your medicines as directed.
• Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
• Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
• Don't smoke.

HOW DO I KNOW THAT I HAVE A DIABETIC FOOT?

• Persistent pain.
• Redness.
• Swelling of the feet or legs can be a sign of underlying inflammation or infection, improperly fitting shoes, or poor venous circulation.
• Other signs of poor circulation include the following:
• Pain in the legs or buttocks that increases with walking but improves with rest (claudication)
• Hair no longer growing on the lower legs and feet
• Hard shiny skin on the legs
• Localized warmth.
• Any break in the skin is serious. Calluses and corns may be a sign of chronic trauma to the foot. Toenail fungus, athlete's foot, and ingrown toenails may lead to more serious bacterial infections.
• Drainage of pus from a wound is usually a sign of infection. Persistent bloody drainage is also a sign of a potentially serious foot problem.
• A limp or difficulty walking can be sign of joint problems, serious infection, or improperly fitting shoes.
• Fever or chills in association with a wound on the foot can be a sign of a limb-threatening or life-threatening infection.
• Red streaking away from a wound or redness spreading out from a wound is a sign of a progressively worsening infection.
• New or lasting numbness in the feet or legs can be a sign of nerve damage from diabetes, which increases a persons risk for leg and foot problems.

WHAT ARE COMMON DIABETES FOOT PROBLEMS?

Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.

• Corns and calluses are thick layers of skin caused by too much rubbing or pressure on the same spot. Corns and calluses can become infected.
• Ingrown toenails happen when an edge of the nail grows into the skin. The skin can get red and infected. Ingrown toenails can happen if you cut into the corners of your toenails when you trim them. You can also get an ingrown toenail if your shoes are too tight. If toenail edges are sharp, smooth them with an emery board.
• A bunion forms when your big toe slants toward the small toes and the place between the bones near the base of your big toe grows big. This spot can get red, sore, and infected. Bunions can form on one or both feet. Pointed shoes may cause bunions. Bunions often run in the family. Surgery can remove bunions.
• Plantar warts are caused by a virus. The warts usually form on the bottoms of the feet.
• Hammertoes form when a foot muscle gets weak. Diabetic nerve damage may cause the weakness. The weakened muscle makes the tendons in the foot shorter and makes the toes curl under the feet. You may get sores on the bottoms of your feet and on the tops of your toes. The feet can change their shape. Hammertoes can cause problems with walking and finding shoes that fit well. Hammertoes can run in the family. Wearing shoes that are too short can also cause hammertoes.
• Dry and cracked skin can happen because the nerves in your legs and feet do not get the message to keep your skin soft and moist. Dry skin can become cracked. Cracks allow germs to enter and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse.
• Athlete's foot is a fungus that causes itchiness, redness, and cracking of the skin. The cracks between the toes allow germs to get under the skin and cause infection. If your blood glucose is high, it feeds the germs and makes the infection worse. The infection can spread to the toenails and make them thick, yellow, and hard to cut.

TELL YOUR DOCTOR ABOUT ANY FOOT PROBLEM AS SOON AS YOU SEE IT.

WHAT CAN I DO TO TAKE CARE OF MY FEET?

Look at your feet every day to check for problems.

• Wash your feet in warm water every day. Make sure the water is not too hot by testing the temperature with your elbow. Do not soak your feet. Dry your feet well, especially between your toes.
• Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. Checking every day is even more important if you have nerve damage or poor blood flow. If you cannot bend over or pull your feet up to check them, use a mirror. If you cannot see well, ask someone else to check your feet.
• If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
• File corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower.
• Cut your toenails once a week or when needed. Cut toe nails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
• Always wear slippers or shoes to protect your feet from injuries.
• Always wear socks or stockings to avoid blisters.
• Wear shoes that fit well
• Before putting your shoes on, feel the insides to make sure they have no sharp edges or objects that might injure your feet.
• Eliminate obstacles: Move or remove any items you are likely to trip over or bump your feet on. Keep clutter on the floor picked up. Light the pathways used at night - indoors and outdoors.
• Having a doctor examine the patient's feet at least once a month.

WHAT CAN I DO TO TAKE CARE OF MY SKIN?

• After you wash with a mild soap, make sure you rinse and dry yourself well especially between the toes.
• Keep your skin moist by washing with a mild soap and using lotion or cream after you wash.
• Check your skin after you wash. Make sure you have no dry, red, or sore spots that might lead to an infection.
• Tell your doctor about any skin problems.
• Prevention & good control of blood sugar level - remains the best way to prevent diabetic complications.

                      

HOW CAN SPECIAL SHOES HELP MY FEET?

Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Talk with your doctor about how and where to get them.

WHAT INVESTIGATIONS WILL I NEED?

Medical evaluation includes a thorough history and physical examination and may also include laboratory tests, x- rays (angiogram) studies of circulation in the legs, and consultation with specialists. Ideal Fasting blood glucose is <120 mg/dl and Ideal HbA1c <7% (which denotes the long term diabetic control).

WHICH DOCTOR SHOULD I CONSULT?

Management of a patient with a diabetic foot requires a team of doctors out of which any one can be the first contact:  

• Physician: Family doctor is usually the first referral.
• Endocrinologist: Medical management of Diabetes.
• Plastic Surgeon: Wound management, soft tissue coverage and microvascular bypass surgeries.
• Vascular Surgeon: Management of blocked major arteries.
• Physiotherapist: Rehabilitation of patients.
• Dietician: Proper diet is the backbone of management of diabetes.

THE PATIENT IS THE MOST IMPORTANT MEMBER OF THE TEAM. No matter how qualified the other members are, if the patient does not believe they can master the problem and keep their own two feet intact for the rest of their lives, everything else will be a failure.

      

BE SAFE THIS DIWALI

BE SAFE THIS DIWALI

Diwali, the festival of lights, imparts diverse meanings to the various elements of nature. The delight is in the exquisite beauty of the firecracker as it lights up the sky, the thunder of the firecrackers that give language to the diyas, the enchantment lies in the wall of sparkles thrown up by the flowerpots (annar), the ground smiles when the chakkri turns its hypnotizing circles.  

As the month of October rolls towards the cooler month of November; the fervor of festivals rises to a crescendo. With the festival of lights “Diwali” drawing near, the days start becoming darker and the nights become brighter, lit by the magnificent lights in the bazaars and homes. Even though the hysteria created behind excessive air pollution by firecrackers rises to a higher pitch every year, the number of burn injuries also keeps pace. The reasons are numerous; faulty firecrackers, faulty igniting techniques. But the real factor is IGNORANCE.

Kids get cracking with the crackers, mothers get busy in the kitchen for guests and treats, fathers’ are fumbling with the gift lists. With the festivities in the air, a few safety measures can keep you and your family safe and usher in the prosperous New Year with smiles.

SAFETY TIPS WHILE BURNING FIRE- CRACKERS:

1. Keep the pile crackers away from the area where they are being lit.
2. Keep a bucket full of mud and another full of water nearby.
3. Avoid wearing long dresses/ kurtas lest they catch fire from the ground chakkar
4. Avoid wearing synthetic clothing (they catch fire faster).
5. Discard used sparkles in a bucket.
6. Always look around before lighting up a fire cracker; the other person may not know what you are up to.
7. Light the Annar (flower-pot) with a sparkle (phooljhari) keeping it at an arms length. Do not bend over it while lighting it.
8. Do not hold the annar/ fire cracker in your hand to light it.
9. Let the flames die out completely before you place another one in its vicinity.
10. While lighting a ground chakkar make sure your clothing is not touching the ground.
11. Let the fuse of the bombs be long so you have enough time to move away.
12. Light the firecrackers with a candle or sparkle as it increases the distance between the firecracker and your hand.
13. Avoid putting boxes over lit bombs they become projectiles when the bomb goes off.
14. Always keep the rockets in a tall bottle with wide base so that it doesn’t topple over when you light it.
15. Wear footwear while lighting fireworks
16. Light only one firework at a time, by one person. Others should watch from a safe distance.
17. An adult should always supervise the use of fireworks by children
18. Never carry fireworks in your pocket.

WHAT TO DO IN CASE OF BURN INJURY:

1. Remove burnt clothing as it stops the burning process.
2. Remove all constricting clothing/ jewelry immediately.
3. Place the burnt part under running tap water for 10min.
4. Avoid putting a blanket to stop the burning.
5. Avoid putting ice over the burnt part.
6. Eat a pain killer
7. Consult your doctor/ plastic surgeon

            Don’t let ignorance rule your actions; Be aware, Be safe and Enjoy a prosperous new year.

                                                                       Happy Diwali!!!!

DR. ASHISH GUPTA

ASSOCIATE CONSULTANT

DEPT. OF PLASTIC & MICROVASCULAR SURGERY

S.P.S. APOLLO HOSPITAL,

LUDHIANA

DO YOU KNOW A PLASTIC SURGEON..........

DO YOU KNOW A PLASTIC SURGEON..........

When a doctor introduces himself as a plastic surgeon, momentarily beautiful faces of Bollywood starlets flash in front of one’s eyes and the image of a jet setting doctor sets in. Over the last few decades the plastic surgeon has become synonymous with a cosmetic surgeon. My kid had a fall and sustained a cut wound over the eye; I would rush to the nearest hospital and ask for a Plastic Surgeon! My belief, there is no scarring in the hands of the plastic surgeon. You may be able to relate to many such parents. My friend is overweight and wants to go figure size zero; who do we consult, the Plastic Surgeon. My mother spilt scalding hot milk on her hand; whom to consult, the Plastic Surgeon.

                Is the speciality of Plastic Surgery limited to making scars disappear or make people look young and beautiful? Is this field limited to slowing the natural process of ageing? Is this field limited to the glamorous world of actors and models? Is this field affordable only by the super- rich? Hair Transplant found the fancy of the masses seeing their on screen balding actors suddenly supporting wavy locks of hair. Face transplant has been a fantasy of many since Poonam Dhillon changed to Tina Munim in a blockbuster Bollywood movie in the 1980s. Skin rejuvenation and tightening with botox & lasers has vaporized a decade of wrinkles. This brings us to the core issue of DO YOU KNOW A PLASTIC SURGEON.... does much more than just hair transplants, nose jobs, tummy tucks.........

                The locale of a plastic surgeon is not limited by anatomical barriers on the human body, nor is confined to one single organ system; but encompasses all medical and surgical specialities.  It was in 300BC, when Sushruta laid down the foundation of Plastic Surgery in India by performing forehead flaps for reconstructing the nose. His techniques are embalmed in his literature entitled, “Sushruta Samhita” and are still followed around the globe. Rhinoplasty commonly known as Nose Job, both as a cosmetic and reconstructive procedure has been our heritage.

                It was Dr. Capt. Balakrishnan, in India who brought the services of the Plastic Surgeon to the masses by envisaging the first Dept. of Plastic and Reconstructive Surgery in Nagpur and PGIMER, Chandigarh in India. It was his ideology that a child should not grow up with the deformity of a cleft lip & palate, a child should not be disabled due to birth defects of hands and feet, a labourer not left in the lurch to fend for himself with burns contractures, a skilled labourer left impoverished due to hand injury involving tendon and nerve, a housewife facing a decision to have her limb amputated due to crush injury, a youngster be left with terrifying scars of faciomaxillary injury sustained in a road traffic accident. He was a teacher of teachers and his ideologies still reverberate through those hallowed halls.

                The words Trauma and Trauma Surgeon are synonymous with a Plastic Surgeon. It may be a small laceration on the face or a gaping hole in the leg with multiple fractures and bleeding vessels; No wound, be it small or big is out of the preview of the Plastic Surgeon. According to a survey there are 14 deaths per hour due to road traffic accidents involving trucks and two wheelers on Indian Roads. Shattering the myths, the maximum number of accidents occur in the afternoons and evenings. In the absence of stringent laws and non- cooperative drivers who shun the protective equipment like helmets and safety belts, these numbers continue to grow. Split open faces with shattered facial bones are a common sight in the casualty being examined by a Plastic Surgeon.  The neurosurgeon and the plastic surgeon are usually the first ones to operate on such a patient as these injuries are in >45% of times associated with head injury.

Glass cut injuries over the wrist or hand by suicidal or homicidal intent not only cuts the arteries as is glorified in the movies but also disrupts the tendons moving the fingers, the nerves providing sensation to the hand.  Such gashes though look docile on the outside are amongst the most challenging for the plastic surgeon to restore the structures to their functional state. Repairing the tendon, the nerve and the blood vessel requires skill, patience and persistence for desired results.

                In patients who sustain fractures of limbs due to violent accidents with bone ends jutting out of the skin usually require a team of orthopedicians and plastic surgeons to fix the bone and cover the splintered bone with healthy skin, so that the person may be able to walk at the earliest. Many a times this bone becomes non viable and requires transplant of healthy bone from other parts of the body to be placed in the fracture site to help close the fracture. Many times these fractures have associated injury to the blood vessel which may lead to fatal blood loss or loss of the limb if not repaired within 6-8 hours. This repair of the peripheral vessels is a component of the armamentarium of the plastic surgeon.

                Human rage respects no boundaries and sometimes we are faced with a sword wielding felon intent on chopping off one’s head or limb; and unfortunately do succeed in some instances. In the 80’s & 90’s when the Toka machines were in vogue in the heartlands of Punjab and Harayana, trauma surgeons were faced with the unique dilemma of witnessing numerous amputations on hands, arms even avulsion injury of scalp which got caught in the wheel of the infamous Toka Machine. It was during those times the Plastic Surgeons took upon themselves to restore these limbs by reimplanting them. Surgical techniques and equipment has seen revolutionary change since the turn of the century with the Plastic Surgeon at the helm of all affairs. State of the art equipment is available in the premier institutes like S.P.S. Apollo Hospital, Ludhiana and other tertiary care centres along with availability of Plastic Surgeons trained to perform these surgeries akin to heroic acts seen on the silver screen.

                This all brings us back to the same pertinent question; “DO YOU KNOW A PLASTIC SURGEON...........” does much more than just trauma surgery?

DR. ASHISH GUPTA (ASSOCIATE CONSULTANT)

DEPT. OF PLASTIC & MICROVASCULAR SURGERY

S.P.S. APOLLO HOSPITAL, LUDHIANA

EMAIL: docashish2001@gmail.com

DO THOSE DARK SPOTS ON YOUR FACE BOTHER YOU???

Melasma Treatment and Cure

(MASK OF PREGNANCY)

         Melasma is a common ailment affecting females causing brown discolouration of skin of the face. It is exacerbated by sun exposure, pregnancy, oral contraceptives, and certain anti-epilepsy drugs. Sun exposure would appear to be a stimulating factor in predisposed individuals. Although a few cases within families have been described, melasma should not be considered a heritable disorder.

        Melasma is common, especially in women of child-bearing age. Melasma is more apparent during and after periods of sun exposure and less obvious in winter months, when sun exposure is lacking. Melasma is the most common pigmentary disorder among Indians.

        Melasma most commonly presents itself over the cheeks, forehead, upper lip, nose, and chin. Melasma also occurs on the forearms, but this is rare.

        Melasma is curable. Persistence on the part of the plastic surgeon and patience on the part of the patient is a sure remedy for cure. Successful treatment of melasma involves three pronged approach: SUNBLOCKS, BLEACH AND TIME.

1.       Sunscreen, however, is the most important factor. Without daily use of opaque sunscreen, treatment will fail (a broad-spectrum formulation with an SPF over 30 plus cover up is necessary).

2.       Bleaching preparations include 2 or 4% hydroqyinone containing creams or gels and 3% hydroquinone solution hasten the recovery of skin.

3.       Time for your body to adjust to the treatment and trust on your doctor are as vital as the other two modalities.

4.       Laser therapy with Intense Pulsed Light and to some extent Nd:YAG lasers are helpful in early return of normal colour of skin..

        It takes approximately 2 months to initiate response and up to 6 months to complete the process. Once epidermal melasma is cleared, the hydroquinone and tretinoin should be discontinued; But the  sunscreen should be continued through at least one summer season to reduce the risk of recurrence. Often, melasma will slowly resolve following childbirth or upon discontinued use of oral contraceptives.

        In all of these treatments the effects are gradual and a strict avoidance of sunlight is required. This is because UV-A, UV-B and visible lights are all capable of stimulating pigment production.

FOR FURTHER DETAILS CONTACT:

DR. ASHISH GUPTA
ASSOCIATE CONSULTANT
SPS APOLLO HOSPITAL,
LUDHIANA
(M): +91-9779771111