Children have a tendency to try on anything and everything and one
such object is a colourful and innocently docile looking RUBBER
BAND.
In children less than 4 years old it has been seen to cause
Catastrophic damage as it burrows through the skin, cutting across
the nerves and tendons causing loss of function of the hand.
Unfortunately the child cannot give a reliable history and in this
growing phase the skin grows over it leaving behind a circular scar
which may pour out pus at various intervals.
Total of 15 cases are reported in literature and we have been able to
restore function in two such children.
1.
Circular
scar across the wrist of the child.
2.
Child
keeps complaining of pain in hand.
3.
Child
stops using one hand and does not allow anyone to touch it.
4.
Frequent
ulcers or pus discharge from the scar around the wrist.
5.
Paralysis
of the hand.
1.
High
degree of suspicion is needed for making a diagnosis of Rubber band Syndrome.
2.
MRI
is Gold Standard Investigation of Choice.
3.
Surgical
Exploration and removal of the Rubber band.
4.
Exploration
and repair of the Nerves to prevent residual neurological deficit.
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WHY NOT STITCH (SUTURE) A CUT?
We witness and experience numerous injuries during our lifetime
but the ones that leave us in a dilemma are the ones that our little
angles get during their endless sessions of mischief.
Then the Dharm-Sankat starts, whether to get the CUT stitched or
NOT.
Wounds that are not long, not
gaping; not bleeding; not near joints; not on scalp, face, hands and feet can
and shall heal without suturing. But the decision should be taken with the
Plastic Surgeon’s opinion.
2. DISSOLVING STITCHES
(SUTURES) ALSO LEAVE SCARS
It’s the injury that leaves a scar.
When the cuts are in the skin creases and are sutured by an expert the
resulting scar is almost invisible. Use of Fine Sutures and their early removal
hold more importance than Dissolving vs Removable Sutures.
3. SCARS IN
CHILDREN STRETCH WITH TIME
With the growth of the child the
cells in the skin multiply but the scar stretches. It makes it more
important to suture the wound so that there is minimal stretching over the
years till child is 16 -18 years of age.
4. STITCHED (SUTURED)
CUTS SCAR BETTER THAN GLUE
An invisible scar depends on the
accurate approximation of the cut ends of the skin which can best be achieved
by Suturing. In selective cases where skin is not gaping; the wound is small
and superficial; skin glues too give good results.
5. AFTER CARE
IS MOST IMPORTANT
Treatment does not end with removal
of bandages, it Starts from there. Avoiding sun exposure, religiously massaging
of the scar and regular follow up with your Plastic Surgeon gets you the best
possible results.
Coming up next : THE GOOD, THE BAD, THE UGLY ABOUT SCARS
DR. ASHISH GUPTA
SENIOR CONSULTANT PLASTIC SURGEON
LUDHIANA
+91-977977-1111
DOCASHISH2001@GMAIL.COM
Q. How are Dog Bites Different?
A. Dogs tend to shake their heads around during an attack. It causes tearing of skin, loss of soft tissue, and crushing damage to the surrounding skin.
Q. How are Dog Bites more dangerous than normal cuts?
A. The Dog’s mouth is full of bacteria which enter deep in the wound with the teeth and cause damage to vital structures like nerves, tendons, blood vessels leading to deformity as well as BAD SCARRING.
Q. What are the common areas of Dog Bite?
A. Most common areas involved are face, lips, ears, nose, neck, hands and legs.
Q. What to do Immediately in case of Dog Bite?
1. Wash the wounds with soap and water for 15 minutes by watch.
2. Cover the wounds with a clean cloth or Gauze piece.
3. Apply direct pressure over actively bleeding wounds.
4. Elevate the part where Dog Bite has happened
5. Report to the nearest hospital.
Q. Should the Dog Bite wounds be left open or Sutured?
A. To prevent infection and for regular monitoring daily dressings have to be done. In case the wounds involve vital areas like Face, Hands or Injury to blood vessels, nerves the wounds have to be surgically cleaned and then repaired.
Q. What to do for Scars of Dog Bite?
A. A lot can be done to reduce the scarring:
Early and proper suturing of the wounds gives Best Results
Medical Management by silicon gels, coconut oil massage with avoidance of sun exposure
Microneedling, Microdermabrasion, CO2 Laser Ablation
Scar Revision Surgery
domestic Dog bite
Q. What the
complications of Dog Bite?
A. The
common complications of Dog Bite are;
a)
Infection
b)
Damage
to important structures
c)
Deformity:
Functional and Cosmetic
Q. Why go to
A Plastic Surgeon?
A. A
plastic surgeon is specialty trained to take care of wounds, which means being
able to properly debride a wound free of dead tissue and foreign bodies, which
would inhibit healing and cause infection. Although an important goal is to
reduce deformity from the injury, the primary goal in treating dog bites is to
prevent infection and promote good healing functionally and cosmetically.
DR ASHISH GUPTA
Senior Consultant Plastic Surgeon
Ludhiana
9779771111
docashish2001@gmail.com
Insta: docashish2001
Q. What
are signs of ageing in Hands?
A. Thin Skin, Wrinkles, Age spots,
Excessive show of Veins and tendons,
Loss of Shine
and Tone.
Q. Who should not get it done?
A. People who are Smokers, with Allergies, Bleeding disorders,
Women who are Pregnant and Breast feeding and
People with Unrealistic goals
Q. What are the procedures to slow/ conceal the
ageing process?
A. There are
numerous procedures for delaying ageing of hands and each has to be
individualized according to the needs of the patient. The procedures are
1.
Microdermabrasion
2.
Dermapen
4 (Microneedling)
3.
Chemical
Peels
4.
Fillers
and Fat Injections
5.
Lasers:
IPL, Fractional CO2
6.
Sclerotherapy
or Vein Removal
7.
Surgical
excision of excess Skin
Q. Are
they safe?
A. These procedures are time tested and safe provided they are done by a specialist
and
at a medical facility.
Q. Do I
need to get them regularly?
A. Few of these procedures like Microdermabrasion, Dermaapen4, Laser resurfacing require multiple sittings.
The Surgical procedures like fat grafting, skin excision are usually single
step procedures.
Q. Is
Admission required for these procedures?
A. Majority
of these procedures are office procedures and with minimal downtime. For details
consult your Plastic Surgeon.
DR.
ASHISH GUPTA
Senior
Plastic & Microvascular Surgeon,
Ludhiana
M:
9779771111
Email:
docashish2001@yahoo.com
