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ROLE OF EMERGENCY P DEBRIDEMENT) ON CELL TO NIJA Jadh 1 PG Final Year, 2 M D, Sha S.S.A.M. INTRODUCTION Vranashopha [wide spre lulitis] is very common among th of diabetes, hypertension, ob systemic diseases and to the pe are susceptible to external tra heavy workers and carpenters. N of which leads to spreading of with necrotizing fasciitis. a. If diseases are not treated pro jaVranashopha) b. Professions like carpentry, fa etc, are more prone to trauma. M vere trauma may leads to cellul treated conditions may land the p Research Article Internati Today’s lifestyle is caus disorders. This is resulting in in conditions in the society. Along The people working in garages trauma. They do have tende (Vranashopha).It is observed tha the start of winter as climatic Staphylococcus, Streptococcus very similar to Cellulitis with ne is Fasciotomy, Debridement & Compartment syndrome with sev Hospital OPD & IPD, more than mild to severe symptoms of V Fasciotomy& Debridement [Pra patients were treated with con Pracchan, Lekhan karma (Fas fasciitis w.s.r. to Nija& Aagantuj Keywords:Pracchankarma: Fasc PRACCHAN, LEKHAN KARMA (FASCIO LULITIS WITH NECROTIZING FASCIIT A &AAGANTUJ VRANASHOPHA hav Swapnil R 1 , Kale Rashmi2 alyatantra; Associate Professor, Department of S ., Hadapsar, Pune, Maharashtra, India eading cel- he patients besity like eople who auma like Negligence f cellulitis operly (Ni- abrications Mild to se- litis & un- patientinto life threatening conditions (Marmopaghat), compartme with multi organ failure. It ca more serious consequences of the affected part (in both gantujVranashopha) and deat Sushrutacharyaquotedthat tr Aatyayikawasthashould be d emergency management house.It is can be correlated chhan, Lekhan, Karma, etc helpful to improve patient’s dition like hypotension, deh decreased urine output, urem ional Ayurvedic Medical Journal ISSN ABSTRACT sing many diseases which come under umbrell ncreasing incidences of DM, HTN, and IHD & g with these, external trauma to the body may ca s, painters, carpenters and hard workers are m ency to neglect the trauma, which leads at occurrence of Cellulitis is more seen in summ c conditions are more favorable for micro-or etc.Signs& symptoms of Pakwavastha of Vra ecrotizing fasciitis. Emergency management of t & antibiotics. In spite of this,many patients vere septicemic shock and multi-organ failure. In n 30 patients of Cellulitis [Vranashopha] were ex Vranashopha. These patients were treated wit acchan, Lekhan karma] with concomitant the nservative treatment.In this study, the Role o sciotomy & Debridement) on Cellulitis with jVranashopha is discussed. ciotomy,Lekhanakarma: Debridement OTOMY & TIS W.S.R. Surgery, like shock ent syndrome an result in like sacrifice h Nijaand Aa- th. reatment for done like an of burning d With Prac- c… which is general con- hydration and mia, multi or- N:2320 5091 la of lifestyle & Obesity like ause cellulitis. more prone to to Cellulitis mer & during rganisms like anashophaare this condition s land in to n Sane Guruji xamined with th emergency erapy & few of Emergency h Necrotizing

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ROLE OF EMERGENCY PRACCHAN, LEKHAN KARMADEBRIDEMENT) ON CELLULITIS WITH NECROTIZING FASCIITIS W.S.R.

TO NIJA &AAGANTUJ VRANASHOPHAJadhav

1PG Final Year, 2M D, Shalyatantra; Associate Professor, Department of Surgery, S.S.A.M., Hadapsar, Pune, Maharashtra, India

INTRODUCTION Vranashopha [wide spreading cel

lulitis] is very common among the patientsof diabetes, hypertension, obesity like systemic diseases and to the people who are susceptible to external trauma like heavy workers and carpenters. Negligence of which leads to spreading of cellulitis with necrotizing fasciitis.a. If diseases are not treated properly (jaVranashopha)b. Professions like carpentry, fabrications etc, are more prone to trauma. Mild to severe trauma may leads to cellulitis & untreated conditions may land the pa

Research Article International Ayurvedic Medical Journal ISSN:2320 5091

Today’s lifestyle is causing many diseases which come under umbrella of lifestyle disorders. This is resulting in increaconditions in the society. Along with these, external trauma to the body may cause The people working in garages,trauma. They do have tendency to neglect the trauma,(Vranashopha).It is observed that occurrence of Cellulitis is morethe start of winter as climaticStaphylococcus, Streptococcus etc.Signs& symptoms of very similar to Cellulitis with necrotizing fasciitisis Fasciotomy, Debridement & aCompartment syndrome with severe septicHospital OPD & IPD, more than 30 patients of Cellulitis mild to severe symptoms of VranaFasciotomy& Debridement [Pracchan, Lekhan karma]patients were treated with conservative treatment.In this study, the Role of Emergency Pracchan, Lekhan karma (Fasciotfasciitis w.s.r. to Nija& AagantujVranaKeywords:Pracchankarma: Fasciotomy,

PRACCHAN, LEKHAN KARMA (FASCIOTOMY & DEBRIDEMENT) ON CELLULITIS WITH NECROTIZING FASCIITIS W.S.R.

NIJA &AAGANTUJ VRANASHOPHAJadhav Swapnil R1, Kale Rashmi2

M D, Shalyatantra; Associate Professor, Department of Surgery, S.S.A.M., Hadapsar, Pune, Maharashtra, India

[wide spreading cel-lulitis] is very common among the patientsof diabetes, hypertension, obesity like systemic diseases and to the people who are susceptible to external trauma like heavy workers and carpenters. Negligence of which leads to spreading of cellulitis

reated properly (Ni-

Professions like carpentry, fabrications are more prone to trauma. Mild to se-

vere trauma may leads to cellulitis & un-treated conditions may land the patientinto

life threatening conditions like shock(Marmopaghat), compartment syndrome with multi organ failure. It can result in more serious consequences like sacrifice of the affected part (in both gantujVranashopha) and death.Sushrutacharyaquotedthat treatAatyayikawasthashould be done likemergency management of burning house.It is can be correlated With chhan, Lekhan, Karma, etc…helpful to improve patient’s general condition like hypotension, dehydration and decreased urine output, uremia, multi or

International Ayurvedic Medical Journal ISSN:2320 5091

ABSTRACTToday’s lifestyle is causing many diseases which come under umbrella of lifestyle

increasing incidences of DM, HTN, and IHD & Obesity like ty. Along with these, external trauma to the body may cause

working in garages, painters, carpenters and hard workers are more prone to ey do have tendency to neglect the trauma, which leads to

that occurrence of Cellulitis is more seen in summer & during the start of winter as climatic conditions are more favorable for micro-organisms like

cus etc.Signs& symptoms of Pakwavastha of Vranashophavery similar to Cellulitis with necrotizing fasciitis. Emergency management of this condition is Fasciotomy, Debridement & antibiotics. In spite of this,many patients land in to

ment syndrome with severe septicemic shock and multi-organ failure. In Sane Guruji more than 30 patients of Cellulitis [Vranashopha] were examined

Vranashopha. These patients were treated with emergency [Pracchan, Lekhan karma] with concomitant therapy & few

patients were treated with conservative treatment.In this study, the Role of Emergency (Fasciotomy & Debridement) on Cellulitis with Necrotizing

AagantujVranashopha is discussed.asciotomy,Lekhanakarma: Debridement

(FASCIOTOMY & DEBRIDEMENT) ON CELLULITIS WITH NECROTIZING FASCIITIS W.S.R.

M D, Shalyatantra; Associate Professor, Department of Surgery,

life threatening conditions like shock, compartment syndrome

with multi organ failure. It can result in more serious consequences like sacrifice of the affected part (in both Nijaand Aa-

) and death.quotedthat treatment for

should be done like anemergency management of burning house.It is can be correlated With Prac-chhan, Lekhan, Karma, etc… which is helpful to improve patient’s general con-dition like hypotension, dehydration and decreased urine output, uremia, multi or-

International Ayurvedic Medical Journal ISSN:2320 5091

Today’s lifestyle is causing many diseases which come under umbrella of lifestyle & Obesity like

ty. Along with these, external trauma to the body may cause cellulitis. painters, carpenters and hard workers are more prone to

which leads to Cellulitis mer & during

organisms likePakwavastha of Vranashophaare

ent of this condition ts land in to

organ failure. In Sane Guruji examined with

treated with emergency with concomitant therapy & few

patients were treated with conservative treatment.In this study, the Role of Emergency Debridement) on Cellulitis with Necrotizing

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

996 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015

gan failure(signs & Symptoms of septice-mia). These surgical procedure described in Ayurvedic text constitute a significant contribution to existing knowledge. More than 30 patients visited at Sane Gu-rujiRugnalaya in the last three months. These patients were treated with Prac-chhan&Lekhana Karma. Very encour-aging results were observed with healthy & improved wound healing [Shuddha-vrana]. In this research paper, role of the-Pracchan, Lekhana karma [Fasciotomy& Debridement] in Pakwavastha of Nija and AagantujVranashopha[spreading cellulitis with necrotizing fasciitis] is discussed.1

AIM: Study the role of emergency Pracchan, Lekhan, karma [Fasciotomy& Debridement] on Nija&AagantujVranashopha[Cellulitis with necrotizing fasciitis].OBJECTIVE: Study the role of Emergency Prac-

chan, Lekhan karma [Fasciotomy& Debridement] on Nija&AagantujVranashopha[Cellulitis with necrotizing fasciitis].

To study Marmopaghat i.e. Septicemic Shock & Life threatening condition due to septicemia.

To re-establish ancient principles of surgery in present contest.

MATERIAL & METHODOLOGYA] Literature review:-Fasciotomy (Pracchankarma):- Accord-ing to Sushrutacharya,Raktavistravan is done by two methods i.e. with the help of Shastra& without help of Shastra. Rakta-vistravanwiththe help ofShastrais subdi-vided in two types - Pracchan and Sira-vyadha.2 DushitRaktadhatu located at any part of body superficially is treated by Pracchan karma, clotted blood is drained by Shrungadi and dushitRaktadhatu is

treated bySiravyadha. A Pracchan karma must be straight (saral), appropriately incised(asamkirna), (sukshma),equal(Saman), naati-gambhir or naati –uttan.3

Draining of dushitRaktadhatureleases the pressure of tissue exerted by imflamatory, ischaemic changes andimmidiate im-provement in symptoms like pain, disease intensity is seen.4

Instruments used in Emergency Prac-chan karma: [ Fasciotomy] Needle, Hawk bill scissors, Scissors, Curved bistoury, Pagets knife.Debridement (Lekhana karma):-Su-

shrutacharyadescribed sixtyVranaChikit-saUpakarminDwivraneeyaChikitsaAd-hyaya. Lekhana karma can be used in a rough, irregular hyper granulated tissue over affected area.5

Instruments used in Emergency Lek-hana karma [Debridement]:Round handed knife, Curette, Scalpel.Incision: Sushrutacharyastated that the width of incision over muscle should be thin like Yava& at other parts it must be half of Yava or Yavamatra. For this Vrihi-mukhayantra (Thin Trocar & Cannula) should be used. On the bony area, it must be done by Kutharika(Axed shaped knifeor chisel).B] Clinical study:Study design:

Simple, random open clinical study of 30 patients of AagantujVranasho-pha[cellulitis] in last 3 months, visited to our OPD & IPD basis, irrespective of gender, religion, occupation & economic status. Informed written consent is taken prior to treatment.Age group- above18 yearsInvestigations:Haemogram, BSL [R], Urine, Wound C/S [sos] ,RFT ,HIV &HbsAg, BT,CT.

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

997 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015

ECG, Chest X-Ray.Place of work: MAM’S SGAK, MAL-WADI HADAPSAR, PUNEPrevious Work: No reference of previous study found.Material &Methods:Inclusion criteria:Size of cellulitis area- more than 15 cmAge – Above 18 YearsAll cases of spreading cellulitis which shows life threatening signs & symptoms.Exclusion criteria:Size- less than 15 cm

All cases ofVranashopha [cellulitis in early stage] i.e.AmavasthaProcedure- Pracchankarma -11 no blade

on scalpelDirectly on affected part, straight, deep up to fascia or drainage of collected dis-charge. Necrosed area is completely part is excised.This is extended to healthy tissue. Debridement was done with curette of af-fected part and all unhealthy tissue was removed.ASSESSMENT CRITERIA

Vedana (Pain): Grade 0: NoVedanaGrade 1: Mild Grade 2: ModerateGrade 3: Severe intolerance.Strava(Discharge): Present or AbsentAkruti(Size in length):1] More than 15 cm 2] Less than 15 cm. Gandha (Odor) : Present or Absent.Sparsha(Local hyperemia): Ushna(present) or Sheeta(not present).Jwara(Fever):Present or Absent. Observation &Result:In thirty Patient treated with Prac-

chhan&Lekhan, Darankarma[Fasciotomy& Debridement] significant improvement was observed. The life threatening conditions were managed well. Amongst 30 patients- 20 patients found

significant relief by emergencyPrac-chan, Lekhan, Daran (Fasciotomy&

debridement) with concomitant ther-apy.

5 patients got relief from conservative treatment.

4 patients were drop out. 1 patient died due to complication with

severe septicemia and multi organ fail-ure.

Table No .1: Statistical analysis of patient data for Vedana

Vedana Mean % Relief Wilcoxon Signed Rank Z Statistic

P-Value Result

B.T A.T

2.72 0.04 98.52941 -4.620a <0.001 HS

Using Wilcoxon Signed Ranked Test, Since P-Value is less than 0.001 the effect of treatment on Vedana is Highly Signifi-cant.

Graph No. 1: Graphical presentation of patient data forVedana

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing

998 www.iamj.in

Table No .2: Statistical analysis of patient

Graph No. 2: Graphical presentation of data for

Before treatment strava was present in 20 patients and absent in 5 patients, while after treatment strava was present in only 1 patients and was absent in 24 patients

0

20

Absent

No.

of P

atie

nts

Strava_BT

Absent

Present

N

P-Value

Significance

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

IAMJ: Volume 3; Issue 3; March- 2015

Statistical analysis of patient data forStrava in Tabular form.

Graphical presentation of data forStrava.

Before treatment strava was present in 20 t in 5 patients, while

treatment strava was present in only 1 patients and was absent in 24 patients

hence significant result in strava after treatment were observed.

Absent Present

Strava_AT

50

19

1

Strava

Absent Present

Strava_AT

Absent Present

5 0

19 1

Strava_BT&Strava_AT

25

<0.001

HS

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis

hence significant result in strava after

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing

999 www.iamj.in

Using McNemar’s Test, Since Pless than 0.001 the effect of treatment onStravais Highly Significant.Table No .3: Statistical analysis of patients data forJwara in Tabular form.

Before treatment jwara was present in 25 patients and absent in 0 patients, while after treatment jwara was present in 0 patients and was absent in 25 patients hence

Using McNemar’s Test, Since Pless than 0.001 the effect of treatment on Jwarais Highly Significant.

0102030

No.

of P

atie

nts

Jwara_BT Jwara_AT

Absent

Absent 0

Present 25

N

P-Value

Significance

Procedure

Emergency PracchanLekhanDaran Karma

Relief from conservative treatment

Drop Out

Death

TOTAL

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

IAMJ: Volume 3; Issue 3; March- 2015

Using McNemar’s Test, Since P-Value is less than 0.001 the effect of treatment on-

Statistical analysis of pa-form.

was present in 25 patients and absent in 0 patients, while af-

was present in 0 pa-tients and was absent in 25 patients hence

we can observe significant result in after treatment.Graph No. 3: Graphical presentation of patient data forJwara

Using McNemar’s Test, Since P-Value is than 0.001 the effect of treatment on

Table No .4:Statistical analysis of patientdata – result.

Absent Present

Jwar_AT

0 0

25

0

Fever(Jwara)

Absent Present

Jwara_AT

Absent Present

0

0

Jwara_BT&Jwar_AT

25

<0.001

HS

Frequency Percentage

Emergency PracchanLekhanDaran 20 66.7%

treatment 5 16.7%

4 13.3%

1 3.3%

30 100%

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis

we can observe significant result in jwara

Graphical presentation of

Statistical analysis of patient

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing

1000 www.iamj.in

Graph No. 4: Graphical presentation of treated patients .

DISCUSSIONAccording to Sushrutacharya, Rak

tavistravan is done by Shastra (Pracchan)which is helpful for drainage oftRaktadhatu at affected part of bodyWhen all dushitRaktadhatu is drained out, pressure of collected sero-sangeious or serous or blood below the fascia or in muscle plane or in subcutaneous level is released. This reduces chances of anaerobicother infection and regain of healthy tissue, there was immediate relief in pain & decrease in disease intensity were noticed.

Lekhana karma is one amongShashthiUpakramadone in grossly vrana with irregular margins and surface, discharge with unpleasant odoLekhana karma all dead part was removed.

If Cellulitis is not treated early may result into necrosis of tissue & several other hazardous complications mentioned above. In the procedure Fasciotomysure of inflammatory exudates were drained out, which improves cellular proliferation and healthy tissue regeneration. Wound healing occurs rapidly and irreversible. Cell injury was minimal & necrosis of tissue was prevented.

In the procedure Debridemencrotic tissue & slough was removed till the appearance of fresh bleeding. After re

0

10

20

Emergency Pracchan Lekhan Daran KarmaRelief from from conservative treatment

20

No.

of P

atie

nts

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

IAMJ: Volume 3; Issue 3; March- 2015

Graphical presentation of treated patients .

Sushrutacharya, Rak-Shastra (Pracchan)

which is helpful for drainage ofDushi-at affected part of body.

is drained out, sangeious or

serous or blood below the fascia or in muscle plane or in subcutaneous level is

s reduces chances of anaero-infection and regain of healthy

tissue, there was immediate relief in pain & decrease in disease intensity were no-

is one among-done in grossly dushit-

and surface, discharge with unpleasant odour. After

karma all dead part was removed.If Cellulitis is not treated early may

result into necrosis of tissue & several other hazardous complications mentioned above. In the procedure Fasciotomy, pres-ure of inflammatory exudates were

drained out, which improves cellular proli-feration and healthy tissue regeneration. Wound healing occurs rapidly and irre-versible. Cell injury was minimal & necro-

In the procedure Debridement ne-crotic tissue & slough was removed till the appearance of fresh bleeding. After re-

moving slough with daily dressing and high protein diet resulted in early wound healing and healthy granulation.

When wound became healthy and cherry red colored with granulation, skin grafting were done ( Sandhan karmatwakpratyaropanchikitsa). Rapid were noticed of these patient. Rate of complications were prevented by early Pracchan (Fasciotomy) andLekhabrigement) in Cellulitis w.s.r.Nija&AagantujVranashopha.

Shodhanchikitsa in Aatyayikchikitsa of Ayurveda is more effective & lifesaving treatment as compared to chikitsa in Pakwavastha of Nija&AagantujVranashopha. Thus it was found that ancient principles of surgery are still compatible and helpful in contemporary era.

CONCLUSION: Emergency Pracchan, Lekhan,

etc…karma [Fasciotomy& Debridement] was significantlyPakwavastha of Nija&AagantujVranashopha[Spreading cellulitis with necrotizing fascitis].

Fast improvement in patient’s general condition.

Grafting is required for better outcome.

REFERENCE

Emergency Pracchan Lekhan Daran KarmaRelief from from conservative treatmentDroup Out Death

20

5 41

Line of Treatment

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis

moving slough with daily dressing and high protein diet resulted in early wound healing and healthy granulation.

When wound became healthy and cherry red colored with granulation, skin

Sandhan karma-apid recovery

patient. Rate of complications were prevented by early

Lekhana (De-brigement) in Cellulitis w.s.r. to

Shodhanchikitsa in Aatyayikchi-is more effective & life-

ompared to Shaman chikitsa in Pakwavastha of

. Thus it was that ancient principles of surgery are

still compatible and helpful in contempo-

Pracchan, Lekhan, sciotomy& Debride-

effective in Pakwavastha of Nija&AagantujVranashopha.

cellulitis with necrotizing

Fast improvement in patient’s general

Grafting is required for better outcome.

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

1001 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015

1. Sushrutasamhita of MaharsiSushruta-Sutrasthan- in edited with Ayurveda TatvaSandipika By KavirajAmbika-duttaShastri, AampakwaishaniyaAd-hyaya-VranashophaNirukti, Vyakhya ,Bheda,Samprapti,Lakshana, Avastha, Sadhyasadhyatwa, Chikitsa Edition Reprinted2010, Choukhamba Sanskrit SansthanVaranasi221001 page no- 96

2. Sushrutasamhita of MaharsiSushruta-Sutrasthan- in edited with Ayurveda TatvaSandipika By KavirajAmbika-duttaShastri,- ShonitVarnaniyaAd-hyaya- RaktaUtapatti,Gun,Karma, Raktadosha,Dushtihetu,Lakshane, Chikitsa, Edition Reprinted2010, Choukhamba Sanskrit SansthanVara-nasi221001 page no- 70

3. AstangaHrdayam of SrimadVagbhata edited with Nirmala Hindi Commen-tary by Dr. BrahmanandTripathi- Su-trasthan-ShastravidhiAdhyaya-Sha-stranirukti,bheda, karmukata.Edition reprinted 2007,Choukhambha San-skrutPratisthan Delhi110007,Page no.292

4. Sushrutasamhita of MaharsiSushruta-Sutrasthan- in edited with Ayurveda TatvaSandipika By KavirajAmbika-duttaShastri,- ShonitVarnaniyaAd-hyaya- RaktaUtapatti,Gun,Karma, Raktadosha,Dushtihetu,Lakshane, Chikitsa, Edition Reprinted2010, Choukhamba Sanskrit SansthanVara-nasi221001 page no- 71

5. Sushrutasamhita of MaharsiSushruta-Chikitsasthan- in edited with Ayurveda

TatvaSandipika By KavirajAmbika-duttaShastri,-DwivraniyaAdhyaya ,Vrana,Bhed, Shashthiupakrama Edi-tion Reprint2010 Choukhamba San-skrit SansthanVaranasi221001 page no- 8-9.

6. Sushrutasamhita of MaharsiSushruta-Sharirsthan- in edited with Ayurveda TatvaSandipika By KavirajAmbika-duttaShastri,-Siravyadhavidhishari-rAdhyaya- Siravyadha, Yogya-ayogya,Vidhi,Vedhapraman,Dushta-vedho, Upadrava, Chikitsa Edition Re-print 2013, Varanasi Page 86.

7. Soman Das- Concise textbook of Sur-gery in Celluitis- Defn, pathology, clinical features, treatment, 5 thEdi-tion, Dr. S. Das 13 Old Mayour’s court Calcutta Page 68.

8. R.Russell, N.Williams& C. Bulstrode, Bailey & Loves Short Practice of Sur-gery – Cellulitis, Necrotising fasciitis, 24 th Edition in 2004 byArnold mem-ber of Holder Headline group338 ,Euston Road, London, NWI3BH. Page 122,123,124.

CORRESPONDING AUHTORDr. Kale RashmiM.D. Shalyatantra, Associate Professor, Department of Surgery, S.S.A.M.,Hadapsar, Pune, Maharashtra, IndiaEmail: [email protected]

Source of support: Nil

Conflict of interest: None Declared

JadhavSwapnil R& Kale Rashmi : Role Of Emergency Pracchan, Lekhan Karma (Fasciotomy& Debridement) On Cellulitis With Necrotizing Fasciitis W.S.R. To Nija&AagantujVranashopha

1002 www.iamj.in IAMJ: Volume 3; Issue 3; March- 2015