Omental grafting in fore arm

A 45 years old female patient was admitted with extensive fore arm injury after a road side accident. There was loss of skin and muscles of the flexor compartment. Most of the flexor muscles were lost leaving the bones necked. Only a few muscles were left in the extensor compartment but the skin was totally lost. The skin on the dorsum of the hand was also lost. The remaining tendons were left necked. The finger tips were pale and cold. After 48 hours the finger rips became black. The greater omentum was mobilised through a mini lap to cover the extensive raw area to provide coverage to the bones and tendons and to bring nutrition to the ischaemic hand

Smith's mucosal graft operation in a case of external biliary fistula

A patient with external biliary fistula after cholecystectomy was admitted in Surgical Unit-1, Nishtar Hospital, Multan. The patient had fever and jaundice which was obstructive in nature. On exploratory laparotomy, bile was seen coming out of a track lined by fibrous tissue. After a tediouss dissection of the track, we ended up with the finding of the openings of right and left hepatic ducts in the porta hepatis. The common hepatic duct and the common bile duct could not be traced. A short distal stump of common bile duct was found after duodenotomy and probing of the ampulla of Vater. An end to end anastomosis of the duct was not possible. A mucosal graft operation was performed. The problems of management of this complication, are discussed

Smith's mucosal graft operation in a case of external biliary fistula

A patient with external biliary fistula after cholecystectomy was admitted in Surgical Unit-1, Nishtar Hospital, Multan. The patient had fever and jaundice which was obstructive in nature. On exploratory laparotomy, bile was seen coming out of a track lined by fibrous tissue. After a difficult dissection of the track, we ended up with the finding of the openings of right and left hepatic ducts in the porta hepatis. The common hepatic duct and the common bile duct could not be traced. A short distal stump of common bile duct was found after duodenotomy and probing of the ampulla of Vater. An end to end anastomosis of the duct was not possible. A mucosal graft operation was performed. The problems of management of this complication are discussed