Interview on Plastic Surgery and Burn Reconstruction with Dr. Sameer Prabhakar

Team MediGence: Hello everyone, I have with me Dr. Sameer Prabhakar of Sharda Hospital with me. He is working as Senior Consultant of Burns and Plastic Surgery at the hospital. So Dr. Sameer, thank you very much for joining this session where we are going to specifically discuss burn reconstruction surgery, and also microsurgery of the hand.

This is going to be a very informative session for the candidates who are specifically looking for surgery, and the apprehensions about it. And also you know people who are not very aware of the advances in technology when it comes to burns reconstruction and how does it take place and what to expect out of the procedure.

So starting off with the most basic question, who are the right candidates, and which procedures are more specifically targeted towards the younger crowd in cosmetic surgery?

Dr. Sameer Prabhakar: I think cosmetic surgery has now come out in a very broad way now, and people have started to accept it openly. Earlier it was more of a taboo. People were afraid to go to cosmetic surgery. Now people are ready to get it. Even relatives and society accept the same. It is a very natural feeling to undergo cosmetic surgery. Everyone has a right to be happy, so if someone feels happy while looking good, I think they should definitely go for it.

Age is no bar for cosmetic surgery.  Let me specify there are a few people apprehensive about age. People who are coming to our clinics from the age of 20 years (yes 20 years !!!!) to even patients of 79 years ask for cosmetic surgery of the face and genitalia. Age is no bar to getting cosmetic surgery.

Now coming to the type of procedures, a lot of younger people are going for breast reduction procedure especially for male patients. Those who develop gynecomastia also known as bilateral breast enlargement. For male patients, they are usually in the age group of 18-22 years. They go for the same. Many females have huge breasts, they go for breast reduction procedures. Some young females want a breast enlargement procedure also know a breast augmentation. That is a very common procedure nowadays.

The breast enlargement procedure entails a very broad age group. Some of them are going at a very young age of 20 years, some of them want at the age of 30-35 years. So it all depends on the procedure and what the patient wants.

Some patients post breast cancer, opting for reconstructive surgery with implant or microsurgery (using flap surgery).

People in the age group of 30-40 years, who look a bit older, they want a facelift procedure. Now a less aggressive approach is coming for facelift called thread lifts. We are using PRP (Platelet-rich plasma injection), botox, fillers. So the surgical exposure has reduced, patient satisfaction has improved, the downtime has decreased. Like the patient, con comes to our clinic to get this botox filler injected and join work the next day. So he/she doesn’t have to worry about scar marks, he doesn’t have to worry about the downtime. SO the cosmetic surgery is fairly acceptable.

So people who are as beautiful as you ( Guneet Bhatia, Co-Founder of MediGence) can also go for still fo for cosmetic surgery. Any age group, any people who are beautiful, people who have scars, and those who feel conscious by the scars can undergo Plastic Surgery.

Now coming to the burn reconstruction, I must say that the subject has not been touched much, they are always in the dark. What will happen to them, what will happen about the scars? Whether they will be ok or not, or whether they will be normal or not. It all depends upon the type of work required. The graveness or the seriousness of the work. I seriously feel that if the burns are managed in the 1st stage itself, the results will drastically change.

Earlier the management of burn wounds, burn contracture, if everything is taken in a multidisciplinary fashion, then the results are very good. If done by a good hand, and at a good center. Even those who wish to come for those patients which we call contracture or post-burning scarring, hyperpigmentation, or non-healing woads. Even those if managed by a good plastic surgeon who has a good amount of experience in managing burns, the results are pretty good.

However, the patient still remains in the dark. They keep on going from one place to the other in search of a good treatment. But they usually come out depressed. I can assure you that in our center we are doing a lot of burn-related studies. We are dealing with a lot of burn patients and most of them are satisfied. We send them happy, and we try to incorporate them back to society. That is our basic motto.

Team MediGence: So when it comes to specifically burn surgery, what does it typically involve? If it is only skin grafting, and where is it taken from?

Dr. Sameer Prabhakar: As I told you earlier, burns is a multi-disciplinary team approach. We cannot just focus on the skin, we have to also focus on the joints, we have to focus on the muscles, we have to focus on the soft tissue, and we have to focus on the skin also. There is a common misconception, where everyone thinks about the skin in burn reconstruction. We have to think of the patient as a whole. We have to think of the joints of the hands, whether it will function or not. Just putting the skin is not important. Whether we are rehabilitating the patient, that is more.

So if it requires just the skin graft, we go with a skin graft, if it requires flap surgery we go with flap surgery. And same in the case of joint surgery, tendon release. Sometimes we go for microsurgery. Those who have gross sequelae, severe contracture, those who cannot be managed, just with a skin graft. In those cases, we have to proceed with microsurgery.

So the surgeon who is treating burn patients should be apt in every area, and good in everything, so that depending on the patient’s requirement he can adjust.

Team MediGence: And talking about burn victims, in particular, they are exposed to the outside environment. What are some of the precautions that are taken at the facility to prevent infection?

Dr. Sameer Prabhakar: Good question. If a burn is managed in the early stage, the results drastically change. In the early stage, if the burn wounds are dressed well there are higher chances of infections spreading, and the results definitely improve. A good dressing is the priority of any surgery by a good surgeon with good debridement, in the early stages, the results are definitely in the positive.

Team MediGence: And the extent to which the functional ability or mobility, or functional rehabilitation, does it also depend upon how soon the patient has come for the treatment?

Dr. Sameer Prabhakar: Definitely. I will emphasize this. Early good management, multi-disciplinary management. We just don’t want to treat the burn. We have to treat the patient physically, we also have to treat the patient mentally,we want to treat them occupationally, so that we can rehabilitate. End goal is not just to treat patients.Our aim is that the patient should be incorporated back into the society from where he/she has come.

Team MediGence: What are some of the advances in burn reconstruction?

Dr. Sameer Prabhakar:  In the earlier times, when we were students, skin graft was the only technique for skin deficiency. But now with rise of INTEGRA artificial skin has come up in a big way. It has revolutionized the management in burn patients. Definitely there is a cost factor, but the results are much better.

Then bio-engineered skin is coming. People are coming up with skin banks. All of these techniques have changed the way burn reconstruction was done. Earlier, 50%-60% burns were considered difficult to be managed.

Team MediGence: According to the degree of the burn, what is the hospital stay which is required, and how long does the treatment last?

Dr. Sameer Prabhakar: Any 1st degree or 2nd degree burn, within 21-30 days(that is the average), he/she should heal within the mentioned timeframe. But any burn which is 3rd degree burn, then it would depend on the extent of the burn, and what is the level of management we require. So that may require multiple settings.

Whenever the full thickness burn is there, sometimes it may heal within 2 weeks time after the operation, and if it is extensive then we can do it in a stage procedure. We have to see the patient as a whole. Whether they can tolerate such procedures. Or whether we have to do it in stages for the patient’s benefit. That timeframe depends upon the extent of the burn.

Team MediGence: Suppose we have a burn victim, and they are exploring treatment options that are available. So what is the basic information that you will need from the patient to be able to assess what kind of treatment they would need? Physical assessments is important, but apart from that what else is required like the photo of the burned area, what kind of medical reports are required?

Dr. Sameer Prabhakar: General medical fitness is required, like their complete blood counts, renal function, liver function. If they are having any viral diseases, that also has to be ruled out. Apart from this no other special information is required. No other investigations are required.

Team MediGence: So I have one more surgery related plastic surgery, a question about breast reduction, and breast augmentation. We receive a lot of requests from patients who have undergone mastectomy to get breast reconstruction and breast augmentation. So I just want you cover about the implants, saline implants or silicon implant, which one is more suitable for patients?

Dr. Sameer Prabhakar: Patient who are coming for secondary breast reconstruction, those who have undergone mastectomy due to cancer or for other reasons. I think, now the armamentarium which we have, some patients go for free flap surgeries, they want the natural breasts. We take skin from abdominal region and restructure the breast using TRAM flap (TRAM stands for transverse rectus abdominis)

Or if they say that we want the implants to be done, then there are saline filled implants, they are mainly used as temporary implants. They are just to make the pockets, to make the space. So we have to expand the skin, and they act as a tissue expander. And now with the coming up of silicon implants, I think they are very safe now. The amount of capsular contracture has reduced. So people have started going for these implants.

Some patient want to go for primary reconstruction of the implants. They have to be counseled well in advance, before the mastectomy procedure itself. Then we can we have to breast reconstruction in the same seating.

Team MediGence: And the way in which the patient heals, would the patient receive primary reconstruction or secondary reconstruction differently on that basis?

Dr. Sameer Prabhakar: Usually in the latest studies, they say there is not much of a difference. The only thing is the cancer surgeons confidence. Whether he is confident of the margins. Whether the tumor needs remove TOTO.And if he is confident we can go for the primary reconstruction. If the tumor is in an advanced stage and the surgeon is doubtful that another surgery is required.

Or he might requires some radiotherapy or chemotherapy. Then we prefer to the the reconstruction in secondary to latter stage.

Team MediGence: And when it comes to cosmetic surgery, face-lift or eye lid surgery, or any other procedure like breast augmentation, when can the results be visualized.

Dr. Sameer Prabhakar: Very good question! All cosmetic patients should know about this. For procedures like botox, the results are immediate, or maybe sometimes 2-3 days for the toxin to give its result. Now coming to the facelift, 80% of the result is visible immediately. Definitely there is a mark, a redness. So I think anywhere from 6 weeks to 6 months. Patient should be patient enough for the result to come.

Many cosmetic patients, they get restless. That depends on how you have managed the patient during pre-surgery. If you have counseled the patient well, I think they will understand that we have to wait uptown 6 months, then we can decide on the results.

Team MediGence: Thank you for the very informative session. And especially about divulging information on burn reconstruction. Patients are not aware of the all the techniques, and developments to be able to witness the improvement. Thank you so much Dr. Sameer again and hopefully we will be back again for another session.

Dr. Sameer Prabhakar: Thank You!