Pearl Plastic And Cosmetic Surgery Clinic, Nagpur (MH): Brachial Plexus Surgery And Hand Surgery

Season's Greetings!

Many of you know me personally, but still let me introduce myself first. I am Dr Amol Kumar Patel, Plastic Surgeon, practising in Nagpur since last four years as a Consultant Plastic Surgeon and in association with senior Plastic Surgeon Dr Shailesh Nisal. If you want to know more about me, you can visit my blog.

My purpose in writing this letter is to brief you about a difficult clinical situation where probably you did not have any satisfactory solution in Nagpur till date, that is, Obstetric Brachial Plexus Palsy (OBPP) and Adult Brachial Plexus injury .

Now concept is changing fast as technology, medical sciences and surgeon's experience are improving in this field.

What we used to do was to put the patients on conservative treatment or refer to other cities and lose the follow-up. Some patients improved clinically, either fully or partially, but the question is whether something can be done if there is no or partial unsatisfactory improvement?

I want to give you a Plan in brief about what we can do in Nagpur at our setup and its cost to the patients.

1. When to operate ?

If patient is not improving satisfactorily after 3 months then refer him to a brachial plexus surgeon for opinion. After clinical examination we Investigate - do the MRI of Brachial Plexus for assessment of lesion. Finding may be neuroma, scar, rupture or root avulsion.

2. What we can do ?

We can plan primary repair, nerve graft to available root stump and in case of avulsion can plan various nerve transfer, at the age of 3 months or after that.

Secondary procedure like tendon transfer, muscle transfer, osteotomy depending on clinical condition may be needed at later age.

3. Results

Children have fairly good results as compare to adults.

4. Cost

We do the anastomosis with Tisseel glue (Baxter) which costs around Rs - 8000=00, approximately 50 to 90 thousand package (depending on Surgical Procedure) is sufficient for initial stage, of course some patients may require second stage or more. Cost would not be a constraint for poor patients, Rajeev Gandhi Yojana also provides good package.

5. Where to operate ?

We need microscope or loupe for nerve anastomosis so it can be possible at your setup if these are available.

I presented my results of adult BPI Patients in plastic surgery meet and I am also keen to discuss Obstetric Brachial Plexus Palsy in your clinical meet.

You can also refer your pediatric patients having Syndactyly , Hypospadias, Cleft lip palate, Hand injury for repair and replantation and patients who need cosmetic suturing of facial wounds. We also do Graciloplasty in adult female with rectal incontinence following degree IV perineal tear or injury for sphincter reconstruction.

Please feel free to discuss your cases whenever convenient.

Regards,

Dr Amol Kumar Patel, MCh Plastic and Reconstructive Surgery

Mobile - 7709493988, Email - dramol_patel@yahoo.co.in

Our Result -

History - 29 years old male sustained Injury over left

shoulder after a RTA 6 months back

Clinical Examination - No clavicle #,

Shoulder Abduction -nt

Elbow flexion – Normal, G-4

Wrist – normal,G-5

Triceps – G-5, Hand function good,

Trapezius and Serratus anterior G-5,