Peer-reviewed research and clinical studies authored and co-authored by our surgical team — contributing to the advancement of plastic, reconstructive and aesthetic surgery.
A Fortuitous Anatomical Variant ‘Sternalis’
The sternalis muscle is a rare anatomical variant of the chest wall, present in only 3–8% of individuals. It runs vertically along the sternum, parallel to the pectoralis major, and has been debated in anatomical literature since its first recorded description in 1604. Unlike most chest wall muscles, the sternalis lacks a consistent origin, insertion or innervation — making each encounter with it a genuinely unique surgical finding.
This study documents the incidental discovery of the sternalis muscle during a routine plastic surgery procedure. Such chance encounters hold important clinical significance: an unrecognised sternalis can be mistaken for a soft tissue mass on mammography or MRI, potentially leading to unnecessary investigations. Surgeons performing breast augmentation, reduction or reconstruction must be aware of its existence to avoid inadvertent injury and to consider its potential use as a vascularised pedicle flap.
The case highlights how rare anatomical variations continue to present themselves in modern surgical practice. Documenting and sharing these findings contributes to the collective surgical knowledge base, ensuring that future surgeons are better prepared when they encounter this fortuitous — and occasionally useful — variant in the operating theatre.
Quaba Flap Cover for Dorsal Digital Defects
Soft tissue defects on the dorsum of the fingers — often resulting from trauma, burns or tumour excision — represent a significant reconstructive challenge. When bone, tendon or neurovascular structures are exposed, simple dressings or skin grafts are inadequate. The Quaba flap, formally known as the Dorsal Metacarpal Artery Perforator flap, offers an elegant local solution: a distally based island flap harvested from the dorsum of the hand that brings well-vascularised tissue directly to the defect with minimal donor site morbidity.
This study evaluates the Quaba flap as a reliable reconstructive option for dorsal digital defects. Its design is based on a direct cutaneous branch of the dorsal metacarpal artery, making it an axial pattern flap with predictable vascularity. The technique allows resurfacing of web spaces, metacarpal and phalangeal defects while preserving the main digital arteries and maintaining hand function. Compared to alternatives such as the reversed cross-finger flap, studies demonstrate a statistically significant reduction in complications in favour of the Quaba flap.
The flap is technically straightforward, achieves good aesthetic outcomes on the dorsal hand, and can be performed even in previously skin-grafted or burned areas. This research reinforces its role as a first-line reconstructive option for the hand surgeon facing complex dorsal digital defects, particularly in a trauma setting where speed and reliability are paramount.
Efficacy of Scratch Test in Free Flap Monitoring
Free flap reconstruction — where tissue is harvested from a donor site and transplanted to a distant defect using microsurgical vessel connections — is one of the most technically demanding procedures in plastic surgery. The success of the flap depends entirely on the patency of these microvascular anastomoses. Any compromise in blood flow, if undetected for more than a few hours, leads to irreversible flap failure. Early and accurate monitoring is therefore critical to achieving salvage rates that justify the procedure.
The scratch test is a simple, low-cost bedside technique: a superficial scratch is made on the flap surface and the response — brisk bleeding indicating arterial perfusion, or dark sluggish blood suggesting venous congestion — is observed. This study, authored by Dr. Sumedha Wadhwa, evaluates the diagnostic accuracy of this clinical test against other monitoring modalities. The research examines sensitivity and specificity across a series of free flap cases, establishing evidence-based guidelines for when the scratch test is most reliable.
In resource-limited settings, where implantable Doppler probes or near-infrared spectroscopy devices may not be available, a validated clinical test such as the scratch test has immense practical value. This work contributes to making free flap reconstruction more accessible and safer, offering a standardised, reproducible monitoring protocol that can be applied in any surgical centre worldwide.
Descriptive Study on Imperiled Cochlear Implant Salvage Using Double Flap Cover — What We Learned in Six Years
Cochlear implant surgery is the gold standard treatment for severe sensorineural hearing loss. While the procedure has a high success rate, a small percentage of patients develop post-operative infections leading to implant exposure and extrusion through the scalp. The conventional management — explantation and reimplantation — is expensive, surgically demanding, and may result in poor speech reception outcomes. In developing countries, the prohibitive cost of a replacement implant makes this approach particularly untenable.
This descriptive study, co-authored by Dr. Sumedha Wadhwa and conducted over six years at a tertiary care hospital, analysed 303 cochlear implant surgeries, of which 12 patients experienced implant exposure or extrusion. The team developed a double flap salvage technique: a pericranial flap (innermost layer, providing robust vascularised coverage directly over the implant) combined with a scalp rotation flap (outer layer for final skin closure). The average operating time was 2.17 hours. Eleven of twelve implants were successfully salvaged and remained functional at one-year follow-up.
The study concludes that implant salvage is feasible, durable and effective in appropriately selected patients — excluding those with meningitis or systemic sepsis. The technique has a short learning curve, brings a rich blood supply to the compromised area, and avoids the morbidity and cost of explantation. Published in the Indian Journal of Otolaryngology and Head & Neck Surgery (2024), this research represents a meaningful contribution to cochlear implant management in resource-limited settings.
Mesenchymal Chondrosarcoma of the Foot Salvaged by Sensate Chimeric Anterolateral Thigh Free Flap
Mesenchymal chondrosarcoma is a rare and aggressive malignancy arising from bone or soft tissue, accounting for fewer than 3% of all chondrosarcomas. It carries a poor prognosis and demands wide surgical excision with tumour-free margins. When it occurs in the foot, the resulting defect after oncological resection is often so extensive — involving skin, deep tissue and potentially bone — that conventional reconstruction fails, and amputation has historically been the outcome for many patients.
This case report documents the successful limb salvage of a foot affected by mesenchymal chondrosarcoma using a sensate chimeric anterolateral thigh (ALT) free flap. A chimeric flap combines multiple tissue components — in this case skin, muscle and a sensory nerve — harvested on a single vascular pedicle from the anterolateral thigh. The inclusion of a nerve component allows restoration of protective sensation in the reconstructed foot, which is critical for weight-bearing and long-term limb viability. Without sensation, patients are at high risk of repetitive pressure injuries and secondary amputation.
This complex microsurgical reconstruction demonstrates that even in the setting of aggressive malignancy, thoughtful surgical planning can achieve both oncological clearance and functional limb salvage. The case adds to the limited but growing literature on sensate free flap reconstruction of the foot and supports the use of chimeric ALT flaps as a versatile option in challenging lower extremity oncoplastic surgery.
Glomus Tumor of Face: A Case Report and Literature Review
Glomus tumours are rare, typically benign vascular neoplasms that arise from the glomus body — a specialised thermoregulatory structure found in the dermis. They are classically described in the subungual region of the fingers, where they present with the triad of localised tenderness, cold sensitivity and intense paroxysmal pain. Extra-digital glomus tumours are uncommon, and their occurrence on the face is exceptionally rare — with fewer than 30 cases documented in English-language literature at the time of writing.
This case report presents a facial glomus tumour, describing its clinical presentation, diagnostic workup and surgical management. Because facial glomus tumours lack the pathognomonic pain triad of their digital counterparts — and because they are rarely considered in the differential diagnosis of facial soft tissue masses — they frequently present as a histological surprise following excision of what appeared to be a more common lesion. High-frequency ultrasound and MRI can aid pre-operative diagnosis, but tissue histology remains the gold standard.
Surgical excision is curative in the vast majority of cases, with low recurrence rates when complete margins are achieved. This report and its accompanying literature review serve to raise awareness of extra-digital glomus tumours among plastic and maxillofacial surgeons, ensuring that this rare diagnosis is included in the clinical evaluation of facial nodular lesions — and that patients receive timely, appropriate treatment rather than prolonged diagnostic uncertainty.
To Evaluate the Efficacy of Early Treatment with Botulinum Toxin in Reducing Long Term Sequelae of Frostbite
Frostbite causes direct cellular injury through ice crystal formation and, critically, triggers sustained vasospasm — severe constriction of the small blood vessels supplying the digits and extremities. Even after rewarming, this vasospasm persists, leading to ischaemic injury, tissue necrosis and a constellation of long-term sequelae: chronic cold sensitivity, neuropathic pain, digital gangrene, joint stiffness and hyperhidrosis. In high-altitude environments and cold climates, these sequelae represent a significant source of long-term disability, particularly among military personnel and mountaineers.
Botulinum toxin type A, known primarily for its cosmetic applications, has a well-established mechanism of action on the autonomic nervous system: it inhibits the release of neurotransmitters responsible for smooth muscle contraction in vessel walls, producing chemical sympathectomy and vasodilation. Its use in Raynaud’s phenomenon — a condition of recurrent digital vasospasm — has shown clear benefits in improving blood flow and relieving pain. This study evaluates whether early administration of botulinum toxin following frostbite injury, before permanent vasospastic changes are established, can reduce or prevent the development of long-term sequelae.
The findings contribute to an emerging body of evidence supporting Botulinum toxin as a therapeutic tool beyond aesthetics. By intervening early in the pathophysiological cascade of frostbite, there exists a window of opportunity to preserve tissue viability and prevent chronic disability. This research is particularly relevant to armed forces medical practice in high-altitude postings, where frostbite is an occupational hazard and access to specialist vascular intervention is often limited.
