History of the Department

DEPARTMENT OF PLASTIC & RECONSTRUCTIVE SURGERY AND BURNS

Dr CJT Pinto
(7.10.16-9.9.1970)

Dr CJT Pinto
(7.10.16-9.9.1970)
“It is one of the lessons of history of science that each age steps on the shoulders of the ages which have gone before. The value of each age is not its own, but is in part, in large part, a debt of its forerunners”

– Michael Forrester

The Beginning

The Plastic Surgery Department at Seth G.S.Medical College and K.E.M.Hospital was inaugurated on December 1961 on the initiative of Dr. C.J.T. Pinto, the active support of Dr. S.V.Joglekar, the then Dean and the participation of Mr. Eric Peet of Oxford who was actively involved during the first three months of its existence and for a month each during the next two years. Dr. AnantaPuranik and Dr. DeoduttBendre were the first Surgical Registrar and House Surgeon respectively. We had about 30 dedicated beds and a dedicated operation theatre. The last was a gracious gesture of Dr. H. N. Dastur, the then Professor and Head of the Department of Neurosurgery. The OT was shared between the two departments at this stage, but as soon as the Neurosurgery OT Complex was commissioned, we were vested with the exclusive use of this OT complex.

The OT Complex

The OT complex occupies the centre of our department and our growth has been centered around it. The large window occupying its northern wall provides a soothing background of greenery and of bird activity. Two decades later the theatre was renovated and air-conditioned. From the very inception, we were well equipped. We obtained an electric dermatome in 1965 and we were the first to have a flash sterilizer and an operating microscope and power instruments for craniofacial surgery.

The Building Of A Team

In April 1962, less than four months after its inception, Dr. Goleria joined the unit as Honorary Assistant Professor. On the same day on which Dr Goleria joined, Dr. MrsDivekar, with experience in Plastic Surgery Anaesthesia, joined our OT and remained with us as a dedicated anaesthetist for years to come. Sister Solomon, trained abroad in Plastic Surgery, assumed the charge of our OT from its very inception. A few years later Mrs. Sheth, who not only had the skills of a dedicated Speech Therapist but also a special concern for our Cleft patients, joined us. Dr C.V.Mehendale, after a long stint in UK joined our department, as a ‘Pool Officer’ in 1966 and after a short while was absorbed in the Faculty.

Individuals, Leadership And Contributions

Dr. Charles J. T. Pinto

The speed and the methodical manner of the establishment of this department, speak volumes for the vision, dedication and tenacity of its founder. Dr. Pinto was a kind person, a compassionate human being, a loyal friend and an ever-willing fighter for justice. He was widely loved and respected. His memory lives not only in the department that he founded, but also in the Dr. Charles Pinto Centre dedicated to the treatment of Cleft lip and palate, founded by Dr. HirjiAdenwalla at Trichur, Kerala and in the CME programme of the Association of Plastic Surgeons of India which was dedicated to him years after he passed away. He had an abiding interest in the management of cleft lip and palate. The workload of clefts was heavy. Following cleft lip repair, to ensure timely repair of the palate and to cope with non-compliance they began doing both lip and palate simultaneously. Dr. Pinto using the golf terminology called this a ‘Hole-in-one Repair’, a concept that became dear to the heart of his successor. Along with Dr.Peet he described a procedure for urethroplasty in Hypospadias which was widely used in the department till early seventies. Realizing the importance of exposure to trauma management in the training of a Plastic Surgeon, the management of hand and maxillofacial trauma was brought within the purview of our department in 1965.

Dr. Pinto’s love for the department was unlimited. He passed away on 9th September 1970 , at the age of 54 – as he would have wished – in harness and within the department, soon after completing an operation.

Dr. Kuldip Singh Goleria (Prof and Head 1970 to 1989)

Shortly after Dr.Pinto’s death the mantle of heading the department fell on Dr. Goleria. Dr. Goleria’s interest in the ‘Hole-in-one repair’ of cleft lip and palate has been an abiding interest for over 40 years. In the initial stages it was the socio-economic need. Today it is the dictate of the local morbid anatomy. In 1980, part of the plastic surgery ward was converted to a 12-bedded Burns Unit for adult female patients with or below 50% burns. The aim was to do early grafting so as to prevent the development of deformities and contractures in females. This is the only plastic surgery department in BMC to have a Burns unit attached to it. The work of Tessier on Craniofacial surgery witnessed at the 5th IPRS had aroused a desire to establish this specialty in the department. The advent of craniofacial surgery in 1983 – even then, a pioneering venture as far as our country was concerned was possible with the co-operation of the departments of Neurosurgery, Anesthesiology and Paediatric Surgery.

Dr. Chintamani V. Mehendale

Dr. Mehendale’s association with our department had spanned two decades, when he retired in 1986. Essentially, an individualist, he was a dedicated personality, intense in whatever he did and totally devoted to the welfare of the patients under his care. Improvisation and a quest for technical perfection were inbuilt in his personality. Endowed with a scientific mind and a fund of scientific knowledge, his inputs were wide ranging, from creating awareness of the requirements of Medical photography to the development of Surgical Instrumentation. He devised a collapsible vaginal mould for Vaginoplasty both for intra-operative and post-operative use. He also developed a “harness” for facial fractures, a pencil wire twister for jaw wiring, a needle holder for palate repair, a dynamic jaw exerciser, an adjustable skin grafting board and a blade guard. He mastered and developed the art of making facial moulages and photography. His interest in the Indian classical music and his knowledge of the physics of sound production was unique and manifested itself in developing “Anil Vadyam” a new musical instrument.

Dr. Suresh R. Tambwekar

Dr.Tambwekar’s interest in micro-vascular surgery precipitated the acquisition of an operating microscope. Re-plantations and free-flaps began to appear on our operation list in increasing numbers. Dr. Tambwekar is one of the pioneers of Microvascular surgery in India and he has also been the leading force in the establishment of an organised training program at the Ethicon Institute which attracts trainees from all over the country. A visit to China aroused his interest in the management of filarial lymphedema. Under his leadership the ovens used to provide the treatment in China were evolved into special chambers for providing heat therapy. In intractable cases, MRI venography led him to observe perivenous fibrosis in some cases. These improved after venolysis. A joint study was carried out by Dr. Tambwekar with Professor Edwin Turkof of Vienna , on the identification of the level of nerve blocks in Leprosy (for the purposes of selecting the site for nerve decompression) by the use of intra-operative evoked potential studies.

Dr. Roshani E. Rana (Prof and Head 1989 to 2006)

Dr. Rana, an alumnus of this institution, had joined the department as a postgraduate student in 1976. After her post-graduation she continued in the department as a Lecturer, and in 1989, on the retirement of Dr. Goleria assumed the responsibilities of Professor and Head of the department. Her interest in the treatment of vascular malformations has been enriched by the support of an excellent interventional radiology department. Pre-operative embolization of vascular malformations of head and face has made surgery almost bloodless. Availability of fibre-optic bronchoscope has enormously helped the work on Temporo-mandibular joint ankylosis. The covering of the new articular surfaces with fascia lata on either side after release of ankylosis has made the post-operative course pain free. The department continues to attract patients from other parts of India for the management of Mullerian agenesis and other intersex problems.

Dr. Vinita Puri (Prof and Head since 2008)

Dr. Vinita Puri, an alumnus of LTMC and JJ group of Hospitals, joined the department as Lecturer in 1996. After the retirement of Dr. R.E.Rana in 2006, the department did not have a designated head. But the responsibilities of running the department were jointly managed by Dr. Vinita Puri and Dr. Amresh.S. Baliarsing who were both then Associate professors. A gifted surgeon, Dr. Puri pursued her interests in Cleft surgery, Hand Surgery ,management of Vascular Malformations and Maxillofacial surgery and has set a benchmark in these fields with numerous indexed publications and presentations in conferences . Dr. Baliarsing concentrated his efforts in Microvascular surgery and has gained formidable reputation in this field. They jointly conducted the Cadaveric flap dissection course in 2006 and 2007 which was attended by plastic surgeons from all over the country. Dr. Vinita Puri assumed the mantle of Professor and Head of the department in Oct 2008 and is taking the department to new heights in step with progressing times. She conceptualized and began the Aesthetic CME series, under the purview of which was conducted an invited lecture and workshop on Botox, fillers and Live operative Liposuction workshop in July 2009. Dr. Puri has also commenced the Hand clinic in coalition with the occupational therapists and physiotherapists and Maxillofacial follow up clinic to improve patient care. The department is undergoing civil renovation and will soon have state of the art inpatient wards, Ot complex and a Microvascular animal lab. Dr. Puri’s dedication to patient care, empathy towards patient suffering, sincerity and openness to new ideas and innovations make her popular with peers and students alike.

3 generations of HOD with current team….APSICON-15

Upper Row(R to L) – Dr. AnupSarda, Dr. Manoj Bachhav,

Dr. Kapil Agrawal, Dr. RaghavShrotriya, Dr. KumailSayyed

Lower Row(R to L) – Dr. Roshani Rana, Dr. K.S. Goleria, Dr. Vinita Puri

90^th Year celebration of KEMH,Mumbai.

DSr. No.	DName	Designation	Photograph
1	Dr. Vinita Puri	Professor and Head
2	Dr. Kapil Agrawal	Professor (Additional)
3	Dr. Venkateshwaran N	Honorary Visiting Consultant
4	Dr. Chandrashekhar Chalwade	Associate Professor
5	Dr.Nilesh Shende	Assistant Professors
6	Dr. Raghav Shrotriya	Assistant Professors
7	Dr. Akshay Anchan	Assistant Professors (Bonded)
8	Dr.Aniruddh Gupta	Assistant Professors (Bonded)
9	Dr. Brahma Duth B.L.	Associate Professor
10	Dr. Alok Patil	Senior Clinical Occupational Therapist
11	Dr. Rupali Devanand Borkar	Clinical Occupational Therapist
12	Dr Nishant Sadhanala	Resident
13	Dr Sudesh Wankhede	Resident
14	Dr Ashish Vyas	Resident
15	Dr.Makrand Thakre	Resident
16	Dr Armaan Khosa	Resident
17	Dr Pavan Shekhar	Resident
18	Dr Raghav Mago	Resident
19	Dr Joseph Francis	Resident
20	Dr Shubhanshu Gaurav	Resident
21	Dr.Vamsee Krishna	Resident
22	Dr. Vidhi Mehta	Resident
23	Dr.Samyak Kucheria	Resident
24	Dr. Sweta Salgaonkar	Professor-Anaesthesia
25	Dr.Shilpashree Palsule	Professor – Occupational Therapy
26	Dr. Vaijayanti Jain	Professor – Occupational Therapy

Additional staff

Location: Ward & Operation Theatre, Old Building, 2nd floor (Gynaecology Wing)

Department consists of 52 beds (40 Plastic Surgery,12 Female & Pediatric Burns)

OT Complex :

2 Major Theatres & 1 minor Theatre
Routine Surgeries : Daily (Except Tuesday & Sunday). Tuesday – OT Washing Day
Emergency Surgeries : 24 x 7

Research Lab :

• § Micro Lab for experiments on animal models.
• § Hands on training for microvascular surgery on models.
• § Any other experimental clinical work.

Library

Apart from central library, the department houses books on various subjects of Plastic Surgery for ready reference — 24 X 7
KEM intranet library facilities: for online journals, books.

OPD:

Venue: OPD 11 ( Multistorey Building, Ground floor)
Day/ Time: Tuesday & Thursday → 1:30 pm to 3:30 pm

Speciality Clinic:

Hand Clinic → Thursday 1:30 pm to 3:30 pm
OPD 11 ( Multistorey Building, Ground floor)
Attended by Plastic Surgeon, OT & PT

BPI Clinic→ 4^th Tues of every month 8:00am to 9:30 am

OT 260 (Old Bldg, 2 nd Floor)
Attended by Plastic Surgeon, OT & PT

Maxillofacial Clinic → Monday 1:30 pm to 2:30 pm
Ward 16 (Old Bldg, 2 nd Floor)
Attended by Plastic Surgeon & Maxillofacial Surgeons.

Breast Clinic →Friday 1:30 pm to 3:30pm
OPD 11 ( Multistorey Building, Ground floor)
Attended by General Surgeons (Under Dr. ShilpaRao, Professor and Unit Head, General Surgery) + Plastic Surgeons

Birth defect clinic→ Tuesday 3.30pm-5pm

Pediatric surgery board room (Old Bldg, 3rd Floor)

Attended by various specialties (under Dr. SandeshParelkar, Prof and Head, Pediatric Surgery)

OPD References :

Routine :

• Ambulatory indoor patient are seen in OPD. Discharged patients are asked to follow up in routine OPD.

Emergency :

• Hemodynamically stable patients can be sent to OPD, during OPD timings for assessments.
• Emergency patients/ Polytrauma patients/Unstable patients are to be assessed by the residents in emergency room or respective wards. Ward/OPD.

Do’s& Don’ts for referrals(Intrahospital):

• § Written calls preferable.
• § Write – Urgent / Routine

Definitive Plastic Surgical role.
Reason for urgency for urgent call
Telephonic calls can be done in an emergency BUT these should be followed by written calls also as all these calls are logged in our register kept in ward 16.

Ward Referrals :

Routine :

After receiving written calls patients are attended within 24 hours.

Emergency :

For indoor patients → Emergency/Urgent written calls to be sent with the reason ; Plastic Surgical intervention required.
For Casualty Patients →Hemodynamically stable patients can be sent to ward 16 for assessment.
DO NOT send polytrauma/ Hemodynamically Unstable patient/ Bleeding patients /Burns patient directly to ward 16 (Emergency written calls should be sent & patients will be attended in casualty itself).
If possible please do basic investigations/X-rays plates/3 D CT Scan plate as required in meantime.
Intra-operative references for Routine/Emergency should preferably be AVOIDED.
Please inform us Pre-operatively for stand by calls.

Maxillofacial Injuries:

• § Initial management of A, B, C.(Airway, Breathing, Circulation) is done in Casualty.
• §References for primary assessment, preferably with X-Rays & 3D- CT Scan Facial Bones in addition to CT Scan Brain are given.
• §Opinion of Neurosurgery, Ophthalmology, ENT services is taken as required.
• §Plastic Surgical intervention is mandatory within 1-2 weeks after trauma, before fibrous malunion occurs (provided patient is fit for elective surgery).

Acute Burns:

Separate Burns ICU for paediatric and female burns

• § Males patients to be referred for opinion.
• § Functional Position Splints to be given to avoid contractures.
• § All patients needs Physiotherapy even during acute treatment of Burns.

Replantation :

• § Control Bleeding from amputed stump by pressure dressing/ limb elevation/ vascular clamps.
• § Establish hemodynamic stability of patient.
• § Transport of amputed part is very important from site of injury.
  • Wrap the part in saline-soaked gauge pieces.
  • Transfer this into a clean/sterile plastic bag & fill with air & seal with thread/rope.
  • Immerse this bag in a closed container or Bag containing ice.
  • Amputed part should NOT BE IN DIRECT CONTACT WITH ICE, as it causes freezing injury.
  • Patient should be referred at the earliest to any tertiary institute for assessment & micro-vascular replantation.
  • Clean sharp cut injuries have better prognosis. However decision of replantation can be done only after assessment.
  • Hand & finger replantation have functional significance hence Re-implantation is highly required.

Cleft Lip &Palate :

• § OPD reference after birth should be sent, if KEM Hospital delivery.
• § Advice regarding –
  • Frequent, small feeds with spoon, in propped-up position to avoid nasal regurgitation.
  • Adequate weight charting.
  • Elastic traction band cap (for B/L cleft lip babies with protruded prolabium).
  • Obturator plates for wide cleft palate to prevent nasal regurgitation
• § Surgery :
  • 4 – 6 months: For Cleft Lip.
  • 9 – 12 months: For Cleft Palate. (Late surgery leads to abnormal & unintelligible speech).
  • Corrective/Revision surgeries required as child grows to correct the deformities.
  • Dental Arch Alignment
  • Rhinoplasty for Cleft Lip Nasal Deformity at 17 – 18 yrs age

Congenital Hand, Limb/Anomalies:

• § Case to be referred to OPD for preliminary counseling at birth.
• § Along with X-rays.
• § Child should be operated at age of 1 year preferably, to give best dexterity during growth.

Vascular malformations / Hemangiomas:

• § Patients to be referred to Plastic Surgery or Paediatric Surgery for assessment.
• § AVM cases to be referred for angiography/venography, MRI Scans to Plastic Surgery / Radiology dept. for assessment.
• § Avoid FNAC/Biopsy if AVM is suspected, as it may be catastrophic.

Burns Contractures :

• § Patient referred to OPD for assessment.
• § Contracture release with skin graft & Z-Plasty or skin flaps are done.
• § Post-operatively : Pressure Garments, Splintage, Massage Therapy, Physiotherapy is mandatory for 9 – 12 months period.
• § Multiple contracture requires Staged Release Surgeries.
• § Long standing ulcer in burn contracture require 4 quadrant Edge-biopsy to rule out Marjolin”s ulcer (SCC), as management requires WLE + Contracture release + STSG /Flap.
• Department has partnered with “RESURGE International” to providefree treatment to economically weaker patients of post Burn Contracture.

Flap Surgeries:

• § For exposed vital structure (Bones, Tendons, Joint, Vessels, Nerves).
• § Preliminary flap cover for reconstruction of tendons, Bones, Nerves, Vessels).
• § Reconstruction of defect post-cancer excision
• § Brachial Plexus Injuries & peripheral nerve injuries (upper limb).
• § Closed wounds/ suspected nerve injuries should be sent for preliminary assessment & further EMG-NCV studies.
• § Open wound with nerve injuries needs primary repair/reconstruction with sural nerve graft.
• § Acute injuries needs primary repair/ delayed preliminary repair.
• § Late injuries needs workup & secondary reconstruction.

Reconstructive Surgeries:

• § HFN – Reconstruction of defect following Wide Local Excision of Oral malignancy using Pedicled / Microvascular Free Flaps.
• § Occuplastic Surgeries – Ptosis, Ectropion, Eyelid reconstruction, Socket reconstruction.
• § Ear & Nose reconstruction.
• § Neck – Post burn contracture, Torticollis, Pharyngo-esophageal reconstruction.
• § Breast reconstruction, Chest/Abdominal wall reconstruction.
• § Brachial Plexus/ Peripheral Nerve Injuries reconstruction – Myo-neurotisation, Tendon Transfers, Free Functional Muscle Transfer.
• § Flaps for Lower Limb Trauma +/- Bone loss.
• § Vaginoplasty for agenesis, coverage for closure during vesico-vaginal fistula, recto-vaginal fistula

Cosmetic Surgeries :

• § Hair Treatment(Alopecia)
  • Surgical (Hair Transplantation)
  • Non-Surgical (Medical Therapy)
• § Facial Rejuvenation ( Face Lift, Neck Lift, Forehead Lift, Blepharoplasty, Brow Lift)
• § Rhinoplasty –( For post-traumatic deviated nose, cleft lip nasal deformity)
• § Lip Augmentation ( Fillers, Auto Fat Grafting)
• § Chin Augmentation (Implants, Genioplasty, Autografts using Cartilage, Fat)
• § Ear Lobe Repair, Keloid Excision
• § Botox , Fillers
• § Gynecomastia(Male Breast Reduction)
• § Breast Augmentation ( Silicone Implants, Fat Grafting)
• § Breast Reduction
• § Breast Hypoplasia ( Poland”s Syndrome)
• § Liposuction: ( For excessive fat deposits, Gynecomastia, Body contouring , Double chin)
• § Abdominoplasty (TummyTuck) for post pregnancy pendulous abdomen, Incisional hernia rectus divarcation.
• § Fat grafting for hollow cheeks, depressed scars, lip augmentation, nasolabial folds.
• § Brachioplasty (Arm Lift), Thigh plasty (thigh lift).
• § Scar revision
• § Dermabrasion for post-acne scar
• § Genital rejuvenation
  • (For Females – Hymenoplasty, Clitoroplasty, Vaginal Tightening)
  • (For Males – Penile Lengthening, Fat grafting, Testicular Implants)

For suggestions:

infoplasticsurgery@kem.edu

Department has actively participated in organizing following events:

• World Society of Reconstructive Microsurgery 8th Congress held at Mumbai, in 2015

• 50th Golden Jubilee annual conference national APSICON,held in Mumbai in 2015

• Celebrated World Transplant week with Urology department in 2015