Juniper Publishers Journal of Orthopedic and Orthoplastic Surgery

Juniper Online Journal of Orthopedic & Orthoplastic Surgery  Introduction Increasing the healing rate of a wound by applying an externally controlled negative pressure is known as Negative Pressure Wound Therapy (NPWT). Negative pressure drains serve as an excellent atmospheric bandage [ 1 , 2 ] and NPWT can be used for treating wounds which usually take a long time to heal or do not heal at all when treated using conventional treatment methods [ 3 ] and also diabetic foot disease which has become a major global burden [ 2 ]. Though, international organizations have already developed NPWT machines, their cost is around 7 to 8 thousand [ 4 ], which is unbearable to a developing country like India. Increasing healthcare costs and the growing burden of non-healing wounds is a challenging issue in India. Due to their high cost, NPWT devices are not available in Indian civil hospitals [ 5 - 7 ]. As a result, the patients with non-healing wounds Increases the...

Juniper Online Journal of Orthopedic & Orthoplastic Surgery Post-operative infection of the implant is one of serious complications of knee arthroplasty and may lead the removal of the implant to eradicate the infection. The most common causative agents are reported to be Gram positive such as Staphylococcus aureus and Staphylococcus epidermidis [ 1 ] and less commonly Streptococci but Gram negative bacterial infection by Escherichia coli, Pseudomonas and Proteus are also frequently reported [ 2 ]. The discrepancy started with the demonstration of increase in the frequency of infections in the perioperative antibiotics administered group when compared to controls [ 3 ], the demonstration of effectiveness of antibiotic administration before exposure and leading to decrease in the infection frequency [ 4 ] but at the same time an alarming increase in the incidence of antibiotic resistant bacterial infections in the hospital setting [ 5 ]. Thus, t...

Juniper Online Journal of Orthopedic & Orthoplastic Surgery  Introduction Osteoradionecrosis is the long term and most serious side of radiotherapy. The definition of osteoradionecrosis is generally accepted as presence of exposed bone in an irradiated field, which fails which to heal within a three-month a period [ 1 ]. Treatment of osteoradionecrosis is a challenging problem. There is a variety of treatment options and no universal approach to management, as this depends on institutional or individual experiences. Early case of osteoradionecrosis treated with hyper baric oxygen therapy, antibiotics, tocopherol and pentaxyphyllin [ 2 ]. Conservative debridement may be necessary to remove spicules of devitalised bone particularly if the adjacent tongue is abraded. Patients who have osteoradionecrosis are traditionally treated with HBO alone or combined with debridement. Segmental mandibulectomy and reconstruction are necessary in patient with severe ost...

Juniper Online Journal of Orthopedic & Orthoplastic Surgery  Introduction A diabetic foot is a non-healing ulcer due to the presence of diabetes in a patient. [ 2 ] The most important and serious foot complications in diabetes are: a) Ulceration (an estimate shows lifetime incidence of foot ulcers among people affected by diabetes is around 15-25%] “A Diabetic foot ulcer (DFU] affects around 15% of all the people suffering from diabetes along the course of their life and is a major factor in predisposing amputations in almost 15% of all cases [ 3 - 6 ]. b) Neuropathic osteoarthropathy. These are the significant risk factors for lower extremity amputation. Administration of antimicrobial agents, to which they are sensitive to, is very important part of the management of these patients. “Of all the methods that are proposed for the prevention of DFU, the only beneficial therapy in RCTs was foot temperature-guided avoidance therapy “a meta-analysis s...

Juniper Online Journal of Orthopedic & Orthoplastic Surgery  Case History Patient aged 34 years reported to the department of Periodontology with the complaint of long corner tooth with sensitivity. On clinical examination, gingival recession was observed on maxillary right canine ( Figure 1 ). Diagnosis was made as Miller's Class I gingival recession with 13. Coronally advanced flap with alloderm with microsurgical approach was planned. Patient's consent as well as ethical clearance was obtained prior to the surgical intervention. Following administration of local anesthesia, the tooth with the recession was root planed. A split-thickness flap with two vertical releasing incisions with micro scalpels was raised with microelevaters, and the papillae were de-epithelialized ( Figure 2 ). Alloderm was measured, cut and rehydrated before suturing it with chromic gut 5-0 covering the defect as shown in Figure 3 . The flap was coronally moved and secured...

Juniper Online Journal of Orthopedic & Orthoplastic Surgery    Case Presentation A 50-year-old female diagnosed an advanced carcinoma of the right breast. After four cycles of neoadjuvent therapy, tumour size was decreased but still it was 15* 10 cm in dimension, free from chest wall, multiple ulcerations with foul smelling discharge with liver metastasis. Patient underwent a right sided total paliative mastectomy and immediate breast reconstruction with a right sided latissimus dorsi (LD) myocutaneous flap, but the defect was very large, flap and skin was opposed under tension. On seventh post operative day, it was noticed that upper flap was not apposed, there after patient was subjected for skin graft. Post operative period was uneventfull. Patient is sent into radiotherapy department for further managment. Discussion The latissimus dorsi (LD) flap was first described in the seventies for breast reconstruction [ 1 ]. Early attempts to i...