Frequency of sensory deficit in terms of two point discrimination in split thickness skin grafts and local flaps for soft tissue defects of fingers

The minimum distance between two stimulus points on the skin, which are perceived as distinct points, is defined as two point discrimination [TPD]. Among the two types of TPD, i.e., static and dynamic, static two-point discrimination [STPD] is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two-point discrimination in contrast to split thickness skin grafts [STSG]. Aim was to determine the frequency of sensory deficit in terms of Two Point Discrimination [TPD] in Split Thickness Skin Grafts [STSG] and local flaps for soft tissue defects of fingers three months postoperatively. Thirty-five patients underwent local flap coverage and other thirty-five had split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. TPD, measured at 3 months of follow-up, of 7 mm was considered normal [no sensory deficit] and TPD of 8mm or more was considered as sensory deficit. The sensory deficit observed at the end of 12[th] week post operatively was 8.6% in the patients with local flap coverage [3 patients] and 45.7% with STSG [16 patients]. Patients with no sensory deficit were 91.4% [32 patients] in the local flap coverage and 54.3% [19 patients] in the STSG at 12th week of follow up. The relative ratio [RR] of sensory deficit in local flaps and STSG was 5 [>2]. Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers.

Local flaps and split; Sensory deficit in term of two point discrimination [TPD] thickness skin grafts [STSG]

Two point discrimination [TPD].is the minimum distance between two stimulus points on the skin, which are perceived as distinct points, Among the two types of TPD i.e., static and dynamic, static two-point discrimination [STPD] is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two point discrimination in contrast to split thickness skin grafts [STSG]. The objective of this study was to determine the frequency of sensory deficit in terms of TPD in STSG and local flaps for soft tissue defects of fingers after three months. It was a Quasi experimental study. Patients admitted in the indoor of Plastic surgery department, Services Hospital Lahore. February 2009 to January 2010. Thirty five patients underwent local flap coverage and other thirty five underwent split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. The sensory deficit observed at the end of 12th week post operatively was in 8.6% of the patients with local flap coverage [3 patients] and 45.7% of those with STSG [16 patients]. Patients with no sensory deficit were 91.4% [32 patients] in the local flap coverage and 54.3% [19 patients] in the STSG at 12th week of follow up. The relative ratio of sensory deficit in local flaps and STSG was 5 [>2]. The results of this study show that Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers

Comparison of tapp and open mesh hernioplasty

Background: The objective is to determine the outcome of TAPP and Open Methods [Lichtenstein] for inguinal Hernia repair in terms of post operative pain, hospital stay, wound infection and recurrence. TAPP technique is newer modality in the treatment of laparoscopic hernia repair. With advantages over open methods of repair and various potential complications along with greater learning curve it has point of interest for various studies. This study focuses on 100 patients undergoing hernia repair by either method, and elaborating the outcome in terms of pain, operative time, wound infection and recurrence

Materials and Method: Atotal of 100 patients were operated on between July 2005 and August 2010. They were divided into group A for TAPP mesh hernioplasty and group B for Lichtenstein tension free mesh hernioplasy, 50 patients in each group. All the patients were followed up at 1,6, 12 and 24 months for outcome measures

Results: Atotal of 100 male patients with mean age 50.4 underwent hernia repair. There were 58 indirect, 31 direct and 11% mixed types of inguinal hernias. The mean operating time for TAPP was 104.7 higher than in the open technique Mean=35.7 minutes. Post operative pain in majority of TAPP group was mild in 40 [80%] patients and for open technique was moderate in 27 [54%]. The infection rate for the Open technique was 10%. Of the TAPP group 4 patients [8%] had early recurrence, and 1 [2%] patient in the open technique presented with recurrence after 12 months follow up

Conclusion: TAPP technique for inguinal hernia repair is better than Open repair with regards to less pain and early mobilization of patients. The rate of infection is also less. The disadvantages include longer learning curve but it tends to vary in various centers. So the emphasis remains on the need for developing a learning environment for such techniques in order to provide better patient care

Effects of summer and winter on blood picture among young adults

To find out the effects of summer and winter seasons. The blood pictures of 252 healthy students were studied in the last week of June, 2006 and the last week of January, 2007. Total leucocyte, absolute neutrophil, absolute lymphocyte and red blood cell counts and hamemoglobin concentration were highly significantly [P < 0.001] higher in the summer than in the winter. Packed cell volume was also significantly [P < 0.01] higher in the summer. Mean corpuscular volume [MCV] mean corpuscular haemoglobin [MCH], mean corpuscular haemoglobin concentration [MCHC] and platelet count showed a non-significant [P > 0.05] difference between the two seasons. It is concluded that there are significant seasonal variations in the blood picture of healthy young adults

Assessment of health services provided to the prisoners with pulmonary tuberculosis at central jail hospital, Multan

Prisoner department of the Punjab consist of 28 jails, out of which two are situated in Multan. Currently 52,596 prisoners confined in a space with official accommodation capacity of 17,413. To assess, health services provided to the prisoners with pulmonary tuberculosis at central jail hospital Multan, a descriptive cross sectional study was conducted involving 35 prisoners. A semi structured interview questionnaire was designed to determine client's satisfaction. A checklist was designed to assess health facilities and TB case management. Study was conducted in December 2000. All patients who were present at the time of interview were included in this study. Thirty-five prisoners were included in the study and were interviewed. Health facilities being provided to the inmates were assessed to study the current practices and factors affecting the management of sick inmates confined in the jail. Almost 65.7% of the prisoners belonged to the age group ranging from 21-40. Only male prisoners were included in the study. Majority of these prisoners 78% were facing still trials in their concerned courts. Majority belonged to labour and fanner's class and 51.3% were held under section 302. According to conservative estimates one third of the world's Population is infected with the T.B. Bacillus. There are 15 - 20 millions cases of infectious tuberculosis in the word. This infectious pool is maintained by the occurrence of 4 - 5 million new cases[1]. The magnitude of the problem is such that WHO declared it a global emergency in 1993. More recently during 1996, estimated 7.4 million people developed tuberculosis bringing the global suffers to about 22 millions[2]. La Pakistan out of approximately 130jnillion Populations, about 15 millions suffer from T.B. More than 210,000 new cases occur each year[3]. Tuberculosis affects almost every stratum of the society including prisoners visiting the Jails. Due to some unavoidable circumstances prisoners carry a much greater burden of various diseases than other members of society. Like other developing countries prisoners in Pakistan are suffering from a lot of health and social problems. The incidence of T.B. among prisoners has long been recognized as a significant problem. Since 1985 the problem of active T.B. has been exacerbated by the increasing prevalence of HIV. The prevalence tuberculosis of prisoners was 30% and the incidence of new infection attributable to incarceration was 5.9 per 100 inmates per year[4]. The basic health facilities such as adequate supply of essential medicines, necessary diagnostic facilities, provision of specialized care to the needy prisoners and their timely referral to the tertiary care facility, are not upto the required standard to maintain harmony in the prison health services. At times, the prisoners are not being provided with the proper emergency care[5]