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Reconstructive Plastic Surgery

The incidence of Cancer both benign and malignant is on the rise worldwide. Cancer treatment especially for malignancy can damage or disfigure the body parts function and or appearance. Reconstructive Plastic Surgery helps to repair the damage and restore near normal appearance.

Plastic Surgery Dubai
Anti aging treatment and plastic surgery concept. Beautiful faces of young woman with arrows isolated on white

Unlike Cosmetic Surgery, most insurance companies cover Reconstructive Plastic surgery.

Reconstructive surgery is usually needed after a tumour is removed and there is a defect which needs to be covered. E.g. after Mastectomy ( surgical removal of breast) for cancer- the patient may choose to have the breast volume restored . Or after a jaw tumour when the onco-surgeon has removed one side of the jaw bone and cheek completely and there is a huge open defect.

Plastic Surgery In Dubai
Portrait collage of young, healthy and beautiful woman

Reconstructive Surgery can be performed immediately after removal of the tumour (Immediate reconstruction) or can be performed after completion of other cancer treatments like chemotherapy and radiation therapy (Delayed Reconstruction).

Reconstructive surgery can make use of several body parts solely or in combination to facilitate good reconstruction. Options of reconstruction may include use of only skin (skin graft) or flap surgery ( combination of skin, fat , muscle or bone).

With the advancement in Microsurgery and techniques, single stage reconstruction with good cosmesis is possible.  It works by taking tissue and blood vessels from one part of the patient’s body and placing it over the damaged part and joining the vessels under the operating microscope.

All options of reconstruction are to be discussed with the reconstructive plastic surgeon before surgery.

Reconstructive Surgery is no longer a social taboo, but a way forward to a better quality of life and better future.

Not paying attention to your nasal symptoms may turn your sinusitis chronic

Headache disorders Info Graphics in circle.Vector illustrationsApproximately 20% of the UAE population suffers from Chronic Sinusitis. Symptoms range from stuffy nose, nasal blockage, headache, facial pain, postnasal discharge, cough and bad breath. These are all symptoms of chronic sinusitis. The weather in UAE plays a significant role in the development of these symptoms. Fine sand in the air, humidity, allergies, sudden temperature changes too trigger it. Deviation of the nasal septum and nasal polyps too can lead to chronic sinusitis.

KNOW YOUR SYMPTOMS

When you have chronic sinusitis, the mucous membrane of the nose, sinuses and throat get inflamed, possibly from a pre-existing upper respiratory tract infection or allergies. Swelling obstructs the sinus opening and prevents normal mucous drainage, causes mucous and pressure to buildup.

Symptoms include – thick greenish post nasal discharge, nasal stuffiness, and pain around the eyes, cheeks, nose and forehead. There could be an associated reduced sense of smell and or taste.This condition if not treated on time can lead to Bronchitis, asthma or other respiratory diseases,

Many people with sinusitis either silently suffer or opt for self medication, making the problem worse leading to a chronic ailment. A common cold is usually caused by a viral infection and it gets better in approximately a week’s time. If it lasts for more than that, you need to see a Doctor.

HOW TO GET WELL

sinus-1Visual inspection, nasal endoscopy and CT scan, paranasal sinuses can help screen for chronic sinusitis. A CT scan can accurately diagnose chronic sinusitis. Once diagnosed, it is treated with nasal decongestants, steroid nasal sprays, antihistamines, antibiotics etc.
Sinus surgery may be required when conservative treatment fails. Endoscopic sinus surgery is done under local or general anesthesia. The main aim of the surgery is to enlarge the natural opening of the sinuses and to restore the normal sino-nasal ventilation and drainage.

HOME REMEDIES THAT CAN HELP

  • Steam inhalation
  • Saline spray
  • Pain in the nose and sinuses can be relieved by warm compress.

TIPS TO AVOID SINUSITIS

  • Keep yourself hydrated – Drinking water prevents mucus from thickening and blocking the sinuses.
  • Avoid smoking – Smokers are more prone to suffer from sinusitis.
  • Consult a Doctor if a cold persists for more than 10 days.
  • Complete prescribed course of antibiotics. When indicatedHeadache disorders Info Graphics in circle.Vector illustrations

Pain Management Clinic

Pain is defined by International Association for study of Pain as an unpleasant sensory and emotional experience with actual or potential tissue damage.

Conquering pain has been a major limitation for the more evolved human race. Pain imposes a burden on those who suffer from it and impairs quality of life. Most often, it is the common symptom that brings the patient to see a Physician. Pain most commonly presents as a warning sign for any pathological process in the body nevertheless may also cause agony without a specific purpose. The most common forms of pain encountered in daily medical practice are musculoskeletal pain 30-40 %, neck and back pain 30%, headaches less than 10%, and cancer pain 1-2 %.

            Pain Clinic at International Modern HospitalPain may be classified into different types based on the origin, duration, periodicity and nature of pain. Accordingly, Pain management can broadly be classified as acute and chronic pain management. While acute pain deals with perioperative pain, pain in labour, trauma, burns etc., and the latter includes a diverse group of patients in the outpatient setting. The management of acute pain is primarily therapeutic. Chronic pain management requires various pharmacological and non pharmacological approaches to tackle the multidimensional components of pain. At International Modern Hospital we take a holistic approach so as to not only treat the underlying cause but also provide psychological support and rehabilitation to ailing patient.

Pain Clinic at International Modern HospitalPain management largely comprises of pharmacological and non-pharmacological modalities, commonly being medication, counselling, relaxation techniques, electrical stimulation and local anaesthetics. Few Prescribed medications include anti-depressants and systemic local anaesthetics.

Pain Clinic at International Modern HospitalAt International Modern Hospital we undertake Interventional modalities which include diagnostic and therapeutic nerve blocks, facet blocks, epidural steroids, intra articular injections, trigger point injections for myofacial syndromesetc. Therapeutic adjuvants include Psychiatric counselling, physiotherapy and electrical stimulation. Unrelieved and inadequate relief of pain is continuing to be a global health problem and serious efforts have to be taken to provide pain treatment as it is definitely a basic human right.

Hysteroscopy

What is hysteroscopy?

Hysteroscopy is a procedure that allows a doctor to look inside the uterus in order to diagnose and treat causes of abnormal bleeding. Hysteroscopy is done using a hysteroscope – a thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

hysteroscope

Why is hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal. Hysteroscopy may be either diagnostic or operative.

What is diagnostic hysteroscopy?

Diagnostic hysteroscopy is used to diagnose problems of the uterus such as abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroids, polyps, or to locate displaced intrauterine devices (IUDs). It may also be used to confirm the results of other tests such as hysterosalpingography (HSG). Other instruments or techniques, such as dilation and curettage (D&C) and laparoscopy, are sometimes used in conjunction with the hysteroscopy.

What is operative hysteroscopy?

Operative hysteroscopy is used to correct an abnormal condition that has been detected during a diagnostic hysteroscopy, avoiding the need for a second surgery. During operative hysteroscopy, small instruments used to correct the condition are inserted through the hysteroscope.

When is operative hysteroscopy used?

 Hysteroscopy may be performed to correct the following uterine conditions:

  • Polyps and fibroids – Hysteroscopy is used to remove these non-cancerous growths found in the uterus.
  • Adhesions – also known as Asherman’s Syndrome, uterine adhesions are bands of scar tissue that can form in the uterus and may lead to changes in menstrual flow as well as infertility. Hysteroscopy can help locate and remove the adhesions.
  • Septums ­ – Hysteroscopy can help determine whether you have a uterine septum, a malformation of the uterus that is present from birth.
  • Infertility – tubal blockage at uterine end can be opened through hysteroscopy by cornual cannulation
  • Abnormal bleeding – Hysteroscopy can help identify the cause of heavy or lengthy menstrual flow, as well as bleeding between periods.
  • Postmenopausal bleeding – Hysteroscopy is also performed to determine the cause of unexplained bleeding or spotting in postmenopausal women
  • Removal of foreign body or a missing IUCD

What are the benefits of hysteroscopy?

Compared with other, more invasive procedures, hysteroscopy may provide the following advantages:

  • Shorter hospital stay
  • Shorter recovery time
  • Less pain medication needed after surgery
  • Avoidance of hysterectomy
  • Possible avoidance of “open” abdominal surgery

How safe is hysteroscopy?

Hysteroscopy is a relatively safe procedure. However, as with any type of surgery, complications are possible. With hysteroscopy, complications occur in less than 1 percent of cases and can include:

  • Risks associated with anesthesia
  • Infection
  • Heavy bleeding
  • Injury to the cervix, uterus, adjacent organs
  • Intrauterine scarring

When should the procedure be performed?

It may be recommended to schedule the hysteroscopy for the first week after your menstrual period. This timing will provide the doctor with the best view of the inside of the uterus.

What type of anesthesia is used for hysteroscopy?

Anesthesia for hysteroscopy may be local, regional, or general:

How is hysteroscopy performed?

Prior to the procedure, one may be prescribed a medication to help you relax. You will then be prepared for anesthesia. The hysteroscope is inserted through vagina and cervix into the uterus. Saline is then inserted into the uterus, through the hysteroscope, to expand it and to clear away any blood or mucus. A light shone through the hysteroscope allows the doctor to see inside the uterus and the openings of the fallopian tubes into the uterine cavity. Finally, if surgery needs to be performed, small instruments are inserted into the uterus through the hysteroscope.

The time it takes to perform hysteroscopy can range from less than 5 minutes to more than an hour. The length of the procedure depends on whether it is diagnostic or operative and whether an additional procedure, such as laparoscopy, is planned at the same time.

How will I be prepared for hysteroscopy?

If you are having general anesthesia in the hospital, you will be told not to eat or drink anything for a certain period of time (usually after midnight the night before) before the procedure. Routine lab tests may be ordered as well for women having a hysteroscopy in the hospital. You will be asked to empty your bladder and your vaginal area will be cleansed with an antiseptic

What can I expect after the procedure?

If regional or general anesthesia is used during your procedure, you may have to be observed for several hours before going home. After the procedure, you may have some cramping or slight vaginal bleeding for one to two days. However, if you experience any of the following symptoms, be sure to contact your doctor:

  • Fever
  • Severe abdominal pain
  • Heavy vaginal bleeding or discharge

Will I have to stay in the hospital overnight?

Hysteroscopy is considered minor surgery and usually does not require an overnight stay in the hospital. However, in certain circumstances, such as if your doctor is concerned about your reaction to anesthesia an overnight stay may be required.

Who is a candidate for this procedure?

Although there are many benefits associated with hysteroscopy, it may not be appropriate for some patients. A doctor who specializes in this procedure will consult with your primary care physician to determine whether it is appropriate for you.

Limb Lengthening

How Does It Work?

The limb lengthening process works by gradually growing new bone and soft tissues (skin, muscle, nerves, blood vessels, etc). This new growth is called tissue regeneration.

Bone and soft tissue regenerate when they are distracted (pulled apart) at a very slow rate of approximately 1 mm per day. If the rate of distraction is faster than this, bone may fail to form between the two ends of the bone that are being pulled apart. Then, soft tissues, such as muscle, may experience contracture (get too tight) or nerves may become paralyzed. If the rate of distraction is too slow, premature consolidation may occur (the bone may consolidate too soon), preventing the lengthening device from further pulling it apart.

There are many different lengthening devices used. The most common are external fixators, which are devices that attach to the bone by means of thin wires or thicker pins that have a screw threading at their attachment to the bone. There are also lengthening devices that are fully implanted inside the bone. These devices do not require external pins. The different devices are described separately.

There are two phases of lengthening until the bone is fully healed: the distraction phase and the consolidation phase. The distraction phase is the lengthening phase. After the desired length is obtained, the newly regenerated bone is still very weak because of lack of calcium within it. The hardening and calcification of this new bone is called the consolidation phase.

METHODS OF LENGTHENING:-

A variety of orthopedic devices are used to distract the bone and soft tissues. The decision regarding which device to use is an individualized one dependent upon the desired correction.

There are two general types of devices: external fixators and internal fixators. The external devices attach to the bone from outside the body by means of wires and threaded pins. The internal devices are implanted inside the body and lie on the bone or inside the marrow cavity of the bone.

The best known and most versatile techniques are with monolateral (one-sided or straight bar) external fixators (e.g., Orthofix, EBI) and circular external fixators (e.g., Ilizarov, TSF). External fixators are applicable to almost all cases. To shorten the time in the external fixator, combinations of the external fixator method with an internal nail to perform the lengthening over nail (LON) technique. However, this method is not applicable to all cases.

A fully implantable self-lengthening nail (ISKD) is also used. It has an internal mechanism that performs the lengthening and thereby eliminates the need for an external fixator. This method is available for certain cases.

External Fixation Alone
When only an external fixator is used, the fixator needs to remain in place for both the distraction and consolidation phases. If the fixator were removed at the end of the distraction phase, the new bone would collapse and re shortens. Therefore the external fixator needs to remain in place until the regenerated bone appears solid enough on the radiographs (x-rays). At that point, the device can be removed. Often, a cast is applied to temporarily protect the bone from breakage for an additional short time.

The total time in the external fixator can be estimated to be approximately 1 month for each centimeter lengthened in children and 1.5 to 2 months or longer per centimeter in adults.

Lengthening over Nail
Lengthening over Nail or LON was developed in order to decrease the external fixator treatment time, eliminate the need for post-removal casting, and decrease the risk of breakage of the new bone.

With LON, a metal rod is inserted into the bone along with the external fixator. The rod fits in the marrow cavity of the center of the bone, and the external fixator is applied around the peripheral part of the bone so that the external fixator pins do not come in contact with the metal rod. The bone is lengthened as described above.

After lengthening is completed, the patient goes back to the operating room for the insertion of special screws that lock the rod to the bone. With screws at both ends of the rod on opposite sides of the lengthening zone, the external fixator is no longer needed, and is removed during the same operation.

Therefore, the total external fixation treatment time is much shorter, and is equal to the distraction phase. This usually reduces external fixator time to less than half.

Fully Implantable Lengthening Nails and Prostheses
The most recent development is that of a fully implantable devices that can lengthen the limb from within. There is no need for an external fixator. This has many advantages, including no risk of pin infection, no muscle tethering by the pins, less pain, and better comfort. Unfortunately, , this method is mostly limited to older children and adults. Therefore, many patients cannot be treated by this method.

Leg length discrepancy correction

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Bow leg correction

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