SERVICES

Congenital hand anomalies

Congenital anomalies are hand or finger deformities that are present at birth. Any type of deformity in a newborn can become a challenge for the child as he or she grows. Hand deformities can be particularly disabling as the child learns to interact with the environment through the use of his or her hands.

Depending on the type and extent of a hand malformation, some babies may have little trouble adapting and functioning well. Others, however, may face various challenges as they grow and learn: 

Developmental problems such as delayed or deficient motor skills
Difficulties with activities of daily living activities and basic self-care skills
Limitations on certain types of exercises and sports
Potential emotional and social harm from childhood teasing about appearance
If child is functioning well and is happy, treatment is not always necessary.
If a child is having difficulty doing the things he or she wants to do because of a hand malformation, treatment options may be available.

Treatment Options

At our institute we offer various modalities of treatment and the most important goal of any treatment for hand malformations is to help a child function as independently as possible.

Treatment may involve:

Orthotics (splints or braces)
Prosthetics (artificial limbs)
Physical therapy
Surgery

Common conditions:

Extra Digits (Polydactyly)
Fused Fingers (Syndactyly)
Underdeveloped Hand (Symbrachydactyly)
Club Hand
Cleft Hand (Ectrodactyly)Small (Hypoplastic) Thumbs
Trigger Thumb

Congenital facial anomalies

Cleft lip and Cleft palate is a common birth condition. It can occur alone or as part of a genetic condition or syndrome. Symptoms arise from the opening in the mouth. They include difficulty in breast feeding, physical deformity, baby feeding difficulties, hearing loss, mouth breathing, nasal congestion, or snoring. Speech: speech disorder, stuttering, or impaired voice 
Treatment consists of surgery Surgery restores normal function with minimal scarring.

Lip repair surgery
Palatoplasty
Orthognathic surgery
Other surgeries/procedures
Further surgery may be done to
1) correct speech problems not resolved with speech therapy,
2) improve the appearance of the nose or lip area, and
3) provide support for the teeth where the gum ridge is affected.

Hypospadias

Hypospadias is a birth defect in which the opening of the urethra is on the underside of the penis instead of at the tip. The urethra is the tube through which urine drains from your bladder and exits your body.

Hypospadias is common and doesn't cause difficulty in caring for your infant. Surgery usually restores the normal appearance of your child's penis. With successful treatment of hypospadias, most males can have normal urination and reproduction.

Some forms of hypospadias are very minor and do not require surgery. However, treatment usually involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis. Surgery is usually done between the ages of 6 and 12 months.

The faciomaxillary surgery is a part of Plastic and Reconstructive Surgery which deals with the management of facial trauma, congenital and acquired deformities of the head and neck, diseases like infections, cysts and tumors of the teeth, upper and lower jaw and Temperomandibular joint related disorders. These problems require a multidisciplinary approach and our department works their best in providing wholesome care to the patient.

TRAUMA

Our institute is one of the  referral centre for traumatic injuries. Majority of the injuries to the face result from road traffic accidents, industrial accidents and fall from height. These injuries can be a simple laceration to a major injury involving multiple facial bones.

FACIAL DEFORMITIES

Deformities  of the face can be limited to a particular segment or entire face. These deformities may be due to genetic or secondary to trauma, infection or surgery. They can present at young age or as the patient grows. These deformities can affect both the function and cosmesis of the patients. In our department we provide services for those patients via surgery after proper evaluation, thereby providing both cosmetic and functional improvement along with the help of other specialities.

Aesthetic surgery or more commonly known as cosmetic surgery is a small but nonetheless a significant sub speciality of plastic surgery. Most people believe that it’s only meant for people in the cine media but even the general public can benefit from it.

For instance – the huge relief women gain from getting rid of heavy breasts and associated neck and shoulder pain or men with otherwise normal physique but enlarged male breasts, women who had part of or entire breast removed for cancer surgery and seeking reconstruction, women who can’t have normal sized breasts due to congenital causes or post burns deformity ,men and women who would like to reverse the normal changes of aging, getting rid of stubborn fat that’s resistant to diet and exercise, reversing post pregnancy changes in abdomen and breasts, reshaping a deformed nose to make it more harmonious with rest of the face and also improve breathing or blocked airways are some of the aesthetic surgeries pertaining to general public.

There is a big misconception regarding aesthetic surgery amongst majority of the Indian population, most of them considering it a big taboo and not being the norm in the society, other reasons being the cost factor but here in our department we offer utmost patient confidentiality and free of cost.

If you are interested in undergoing an aesthetic procedure, these are the steps to follow in our department. 

1. Visit our opd between 10am to 12 pm on every Monday.
2. Complete the patient registration formalities
3. A detailed history will be taken from the patient regarding the patient’smain complaints, relevant past history of previous surgeries, personal and family history. This is followed by a physical examination pertaining to the surgery, the patients and his or her close relatives will then be counselled regarding the patients present condition, the nature of surgery, procedure, hospital stay, specific garments or dressing like compression garment or splints to be worn in the post-operative period, cost if any to be borne and all possible complications.
4. The patient may be asked to quit smoking or stop taking herbal medications or blood thinning tablets prior to surgery and optimise modifiable patient conditions like diabetes, nutrition, weight or reduced haemoglobin levels prior to surgery.
5. He or she will have to undergo all basic and specific investigations and also take opinion from other specialities if necessary.
6. Patient will then be asked to meet the anaesthetist for evaluation and fitness for surgery.
7. The patient will then be given a tentative date for admission and surgery.
8. The patient will then have to sign a consent form for the surgery and also consent to being photographed medically for records and post op result evaluation purpose.

Some of the common procedures done in our department include liposuction, gynecomastia (male enlarged breasts) surgery, breast-reduction, breast augmentation, rhinoplasty, blepharoplasty, body-contouring, and breast reconstruction.

Liposuction:

Removal of excess fat from various parts of the body with help of specialized cannula’s after wetting the fat with specific tumescent solution.

Gynecomastia surgery – Webster’s procedure or lipoexcision A combination of liposuction and excision of excess glandular and fatty portion of enlarged male breasts to achieve optimal shaped male breasts.

Breast reduction mammoplasty – reduction surgery of enlarged and ptotic female breasts to achieve breasts of size that’s more comfortable for the patient yet suitable for her height and weight.

Breast augmentation mammoplasty –  Achieving symmetry in breasts post breast surgery for cancer, enlargingthe size of breast for congenitally small breasts, to increase volume of breasts – this can be done with the use of silicone implants inserted either under the breasts or muscle.

Rhinoplasty – reshaping the nose and improving the airways for better breathing.

Kindly visit our gallery for some related imaged of aesthetic surgeries done in our department.

Hand injuries

Hand surgery is a broad term that incorporates a vast array of different types of surgery on the hand. It is to restore not only the function of the hand, but try to maximise the cosmetic appearance of the hand, as well.

Surgery on the hand may be done for many reasons, including, but not limited to, the following

1)Trauma to the hand
2)Rheumatic changes to the structures in the hand
3)Deformities that present from birth(congenital)
4)Infections Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:
• Reconstruction of Skins and soft tissue defects with Skin graft, flaps( loco regional or free tissue transfers) • Fracture fixations
• Tendon repair / reconstruction
• Nerve repairs/ reconstructions
• Correction of post burns and post traumatic deformities
• REPLANTATION& Revascularization.

The Institute for research and rehabilitation of hand and department of plastic surgery has a dedicated hand injury operation theatre complex which runs round the clock on all days. In hand injuries time plays a crucial In role in functional recovery of the patients, our team of surgeons are available round the clock offering timely and best treatment for patients presenting hand injuries.

BRACHIAL PLEXUS INJURY

The brachial plexus is a complex network of nerves between the neck and shoulders. These nerves control muscle function in the chest, shoulder, arms, and hands, as well as sensibility (feeling) in the upper limbs. A brachial plexus injury occurs when these nerves are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord. Brachial plexus birth injury, also known as brachial plexus injury, is an injury to the brachial plexus nerves that occurs in about one to three out of every 1,000 births. Babies with brachial plexus birth injury may be able to recover with no treatment, but it may take several months, and regular check-ups are often recommended. We also recommend physical therapy to help restore function in your arms and hands and improve your flexibility.Severe brachial plexus injuries may require surgery.

Treatment

Treatment depends on several factors including the severity of the injury, the type of injury, the length of time since the injury and other existing conditions.Nerves that have only been stretched may recover without further treatment. Physiotherapy and other rehabilitation plays a crucial role to keep your joints and muscles working properly, maintain range of motion, and prevent stiff joints. Surgery to repair brachial plexus nerves should generally occur within six months after the injury Surgeries that occur later than that have lower success rates.Nerve tissue grows slowly, so it can take several years to know the full benefit of surgery. During the recovery period, you must keep your joints flexible with a program of exercises. Splints may be used to keep your hand from curling inward.

HAND TRANSPLANTATION – “VCA “ VASCULARISED COMPOSITE ALLOTRANSPLANTATION

Reconstructive hand transplants are for adults who have suffered a hand/arm amputation leading to disability.

Eligibility

Following is a general list, you should meet the transplant coordinators in order to determine the full eligibility.

1)18 – 69 years of age
2)Bilateral upper limb amputee below the level of shoulder
3)No history of HIV or hepatitis C
4)Able to take immunosuppressive drugs
5)No history of cancer for at least five years

HAND TRANSPLANTATION PROCEDURES

Procedures for registration

You need to register your name and other details at out institute by visiting our transplant OPD on every Thursdays (10 am to 1 pm ) Following will be needed for registration

1. Patient should be present for examination by the team
2. A full size photograph of the patient covering both the upper limb / amputated limb in a plain background
3. 4 – Passport size photographs
4. Aadhar card
5. Ration card with the patients name in it.
6. You will be asked to give 3 phone numbers.

Waiting period

Once you are approved and registered after examining by our team for a hand transplant, you will have to wait for a matching donor to become available. This can range from a few weeks to several months. The donor must have matching blood and tissue types.

The procedure

Hand transplant surgery is complex and can last from 8-10 hours. It involves bone fixation, reattachment of arteries and veins and repair of tendons and nerves. The human hand consists of 27 bones, 28 muscles, 3 major nerves, 2 major arteries, multiple tendons, veins and soft tissue. Patients waiting for a hand donation can be called into the hospital for surgery at any time. After surgery, you will be placed in transplant intensive care unit for several days. Once the surgical team feels comfortable with you being moved out of the ICU, you will move to a transplant unit, where you will receive care specially designed for all types of transplant patients. You can expect to be in the hospital anywhere from four weeks to three months. The amount of time spent in the hospital depends on a number of factors, including the amount of support and assistance you have at home, the distance from your home to the hospital for follow-up care, and any delays that might occur in recovery.

Immunosuppressive therapy

Following surgery, to prevent rejection, you will be started on immunosuppressive therapy which is mandatory to continue life long. While effective, such drug regimens have caused complications like infection and drug toxicity,cancers among others, jeopardizing the benefits gained from otherwise successful hand/arm transplants. No patient taking his/her immunosuppression drugs on time and as advised has lost a transplanted hand/arm.

Physiotherapy

Hand transplant patients should be prepared for an intensive rehabilitation process. You will be involved in some form of rehabilitation for the rest of your life and patients are educated before surgery on the critical importance of rehabilitation in improving functional outcome after the procedure. All patients will be required to attend directed hand therapy for 6+ hours each day, 5 days a week, for the first 3-6 months after the transplant. Therapy will be tailored to your needs and abilities; however, you should understand that caring for and rehabilitating transplanted hands becomes a full-time job for the first 1-2 years after the transplant.

Post burns complications Management

Burns is a major problem in all developing countries. 95% of burn injuries happen in developing countries and India has a great share of it. The aim is to provide Reconstructive Surgery for the correction of deformities in burn survivors. Due to lack of preventive measures and adequate acute care facilities being very limited, many victims of burns end up with severe deformities. It can cosmetically disfigure an individual and functionally incapacitating.

Adequate acute care can prevent many deformities from occurring, and for people who have been deformed solutions exist. Current Reconstructive Surgery techniques offer them hope. Deformed hands can be made to work, misshapen feet can be made fit to walk and faces can be made presentable.

The challenge is to make it available to the masses who need it.

IRRH Orthotics

For many patients, being fitted for and wearing an orthotic device can be an uneasy experience.  But our patients and families take confidence in the experience of our clinical staff.  Trained to evaluate, design and provide the most appropriate orthotics for you, our team focuses as much time and attention on comfort as they do on the device.

We at IRRH, Orthotics department, custom-fit orthoses for patients of all ages are available.  Our clinicians make sure patients, families and their medical teams are fully informed throughout the entire process.

Custom-Fit

Good enough isn’t good enough. Instead of settling for an off-the-shelf option, we provide our patients with custom-fit orthotic solutions. This ensures the perfect fit along with any other personalization needed.

Modifications

Along with a custom-fit, we’re able to provide your little one with several orthotic modifications, as required.

Pain Clinic

We at pain management clinic in IRRH is to treat pain without surgery and help people suffering from chronic pain regain mobility and enjoy life to the fullest. Our experts use modern techniques that help relieve pain without surgery and create awareness about ‘Pain Management’ as a concept in the country. With a team of dedicated doctors, each specialising in their respective fields uses regenerative medicine and radiofrequency ablation to help those living their lives with no resolution to their discomfort. We provide fast, effective care.

Physiotherapy at IRRH

Hand therapy helps you to recover after an accident or injury, and manage longer-term conditions such as carpal tunnel. It is also available if you have had surgery on your hand or wrist, or are suffering from damage to the nerves and muscles

We at IRRH, physiotherapy department offer physiotherapy and occupational therapy to support rehabilitation after an injury or surgery, or manage long-term or work-related conditions such as arthritis and work-related upper limb disorders.

Our hand therapists will assess your hand and wrist movements, and conduct a series of therapy sessions focusing on your weak areas with exercises and working to balance out these weak points with your strengths.

We also offer advice and education on ergonomics, joint protection strategies and energy conservation techniques to manage upper limb pain caused by arthritis, tendinitis or other similar conditions.

If you've had surgery, our hand therapists work closely with your hand and wrist surgeon to care for you after your operation. We will create a  rehabilitation plan for you to follow in clinic and at home and monitor your progress throughout your recovery.

All our hand therapists are accredited physiotherapists or occupational therapists with extended training in the management of upper limb disorders. Their wide range of skills enable them to carry out different assessments, procedures and types of therapy.

This includes:

• exercise therapy and mobilisation techniques
• casting
• scar management
• oedema and wound management
• functional retraining

Reconstructive microsurgery

Microsurgery is one of recent modalities of modern surgery which is any procedure which involve operating with microscope. This helps us in better visualisation and operating in blood vessels upto 1mm in diameter thereby providing better results and providing major help in reconstruction. Reconstructive microsurgery can be done from head to foot which includes joining of the amputated fingers to healing of the wounds caused by various causes from accidents, infections, trauma and cancer. Our department has a good functioning microscope both in the emergency and elective operating theatre thereby providing utmost care to patient at any time via our faculties thereby providing best care to our patients.

The following microsurgical procedures are done in our department.

ONCOLOGIC RECONSTRUCTION

The advent of free tissue transfer and other microsurgical procedures had lead to treat more complex diseases especially in cancer reconstruction. Cancer is devastating for the patient and their family. Early detection and adequate treatment serves as the main factor in determining the prognosis. Equally important is the functional well-being of the patient. Cancers of the head and neck region often lead to major disfigurement and functional loss. We aim at Providing the recent and the best treatment of patients presenting with cancers from head to toe requiring reconstructive and microsurgical reconstruction.

REPLANTATION

Allows us to reattach total amputated parts from finger tips upto arm level.

Toe to Hand Transfers

​This procedure is done for patients who have loss of multiple fingers in hand thereby affecting their function. This involves transfer of the second toe from foot to hand thereby restoring function. 

Microsurgical Free Flaps

Microsurgery plays a great role in the salvage of major crush injuries of the limbs. It is a procedure via tissue  like skin upto bone can be transferred thereby saving the limb from major amputation by preventing the infection from setting in. our department receives patient after management of fractures from orthopedic team and after thorough cleaning of wound, the wound is covered, hence providing a functional limb for the patient.

Functioning Free Muscle Transfer to Restore Hand Function Following Trauma

Restoration of finger flexion or extension following major trauma is a most challenging form of reconstruction. This is done when other mode of treatment is unavailable . this procedure involve transfer of muscle ( gracilis) from leg to forearm which leads to functioning of fingers. This is usually obtained after 1 year post surgery and with rigorous rehabilitation.