Today we have high standard of plastic and reconstructive surgery.But it has gone through many milestones. The earliest milestone is found in Ayurveda since ancient Indian era. Shalyatantra,the main surgical branch of Ayurveda,which is a constant source of surgical knowledge till now. Various plastic and reconstructive surgical procedures are mentioned in Shalyatantra. Almost all the Samhitas described about the methods of Sandhan Karma(Plastic and reconstructive surgery).The plastic operations of ear (otoplasty) and Rhinoplasty (Plastic surgery of nose) are described in the 16^th chapter of first book(Sutrasthan)of the compendium. Dushtavrana is very common problem encounter by surgeons. Healing of vrana is natural process but due to interference of various dosha ,vrana become dushta and  normal healing process gets delayed. In that procedure Pain is the most offensive factor to deal with it. For minimizing pain and infected wound factors as well as we can reduce time to heal wound by Grafting procedure.Skin grafting is an effective management for non healing wound. 

Keywords: Drushta vrana, Non healing wound, Vrana, Skin grafting

Introduction

Plastic Surgery is a specialized branch of surgery devoted to the treatment of deformities of the face and other parts of the body.

 The most ancient literature of the world i.e Rig-veda is full of example of various surgical,plastic surgical,orthopaedic and opthalmological operations done by the Dev Vaidya-Ashwini Kumars.Ashwini Kumar operated and rehabilitated the leg of vishalpa wife of king khel which was cut down by the enemy in war.According to the ‘Upanishad’Ashwini Kumars aslo operated and repaired the excised head of Yaganya by Rudra.They operated the eyes of Reejashva.They aslo implanted the teeth of phushna in his edentulous mouth.From Ashwini Kumars thus of knowledge of Ayurvedic science descended.Samhita,the most ancient and authentic literature on plastic surgery,has described elaborately the plastic surgical operations for deformed,cut ears,lobules,Rhinoplastic operations of cleft lip,cleft palate and injured lip in Samhita chapter 16 of Sutra Sthan.Flap technique of skin grafts described in Samhita is the most successful technique of plastic surgery even now a day.

• A  skin grafting is an effective way to controlled the progression of wound and prevention of infection. It improves the way of wound healing also prevent unsightly scar , contraction and also reduce loss of function due to improper healing. 

  So, skin grafting decision was taken   under local anesthesia to improve healing and prevention of infection 

Indications:

Well granulated ulcer.

   Clean wound or defect which can not be apposed.

   After surgery to cover and close the defect created.

Commonest site of graft:

A) For Partial thickness graft:   Commonly thigh.

                                                     Occasionally Arm,Leg,Forearm.

B) For Full thickness graft: Groin crease area.

                                               Post auricular area.

                                               Supraclavicular area.

Method:

76 yr male patient came to OPD with H/O foreign body insertion into dorsum of right foot one month back but he dint take any treatment. After one month he came with abscess formation at the site. I&D done for abscess pus and F.B. removed. Vrankarma done daily for several days. But healing of wound was not good.  Therefore decision of skin grafting taken for healing of wound.

• No any Known case of Diabetes mellitus, Hypertension.
• History : Foreign body insertion into dorsum of right foot one month back.
• Past medical history– patient received Antibiotics for wound healing from 10 days.
• Current illness– Pain and Swelling over right foot, Abscess formation followed by cellulites.
• Local examination: Size- 3inch*1.5inch – Oval shaped 

                       :Local temperature Present.

                       : Tenderness Present.

                      :Pus discharge Present.

• On examination: Pulse – 86/minute.

          Blood pressure – 130/80 mm/hg.

• Systemic examination: N.A.D
• Investigations

BSL Fasting: 88mg/dl

BSL Post prandial:112mg/dl

Bleeding time:4min.20sec.

Clotting time:5min.30sec.

Diagnosis: -Non healing wound.

According to Ayurveda

Drushta Vrana

• Procedure Of  Skin Grafting:Skin Grafting is being a para-surgical  procedure is performed  under  proper aseptic precaution.
• Incision And Drainage under Spinal Anesthesia.
• Foreign body removed.
• Daily dressing done under aseptic precaution upto 15 days followed by oral antibiotics.
• Still wound is not healed progressively by above treatment.
• Therefore decision to take Skin Grafting under local anaesthesia.

Treatment Outcome:

Before I& D:                                                                                 After I & D:

 

               Post op I &D : Day 5^th                                                                Post op I & D : Day 10^th

 

Graft site-Left sided Thigh region.                                                 Post Operated-Day 3 

 

Post operated-Day 7                                                                        Post operated-Day 10

 

 Observations:

Every day upto 10 days wound was observed before and after the procedure.

Results:

Skin grafting provide significant relief in vedana, vrana, strava, akruti after the treatment.

Findings:

Every day upto 10 days wound was observed before and after the procedure

After I & D:                                                     After Skin Grafting:

 -   Pain during dressing +                                             -Pain

                                                                                  -Swelling         

-    Swelling+                                                               -Discharge

-    Discharge + 

-     Slough+                                                                  -Slough

 Discussion:

The patient’s daily dressing with betadine was on daily basis and other antiseptic medicines for dushtavrana .The study did not used any kwath dravya for shodhan karma for dushta vrana. The  skin grafting was done for dushtavrana to avoid other infections within less time.

After I & D procedure patient c/o pain during dressing+, slough+  and  wound was not healed properly and he was troubled for daily dressings, but after Skin Grafting procedure these symptoms become less than I &D, It provides significant relief in non healing wound after the treatment.

Conclusions:

• Study showed better wound healing effect.
• Cost effective
• Less time required for wound healing.

 *MS,ScholarDept of Shalyatantra

**Guide and Prof of Dept of Shalya

***H.O.D Dept of Shalyatantra, College of Ayurved And Research Centre, Nigadi Pradhikaran                                                              

 Reference:

Acharya Sushruta,Sutrasthan 16/10 (Hindi Translation vol 1)Sushruta Samhita,Kaviraja Ambikadatta Shastri,published by Chaukahbha Sanskrit Sansthan Varanasi,reprint;2007 p 66.

 Acharya Sushruta,Sutrasthan 16/16 (Hindi Translation vol 1)Sushruta Samhita,Kaviraja Ambikadatta Shastri,published by Chaukahbha Sanskrit Sansthan Varanasi,reprint;2007 p 67

A Concise Textbook Of Surgery-S.Das,A manual on clinical surgery 9^th Edition.

Bailey & Love Short Practical Study,Edited by R.C.G.Russell,Williams ,Christopher bulstone ,26 edition.

Sri Ram Bhatt Surgical book.

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