Short and long term follow up results of [the versatile] reverse sural artery flap

This study was designed to see the long and short term outcome of the reverse sural artery flap.Case series. From January 2009 to December 2011, data was collected and analyzed for this study. Eighty nine patients with wounds on the ankle, heel, sole, distal leg, and foot were included in the study.they were followed up at 01 week, 02 weeks, and then 4 weekly for 06 months and at one year time from operation. They were examined for necrosis, congestion, surgical site infection, dehiscence of suture line, epidermolysis, donor site infection and functional outcome. Most of the flaps healed nicely but two [2.25%] failed completely. Six flaps were delayed. However early follow up [within 04 weeks] revealed that there was partial loss of the distal 1-1.5 cm of flap in 04 patients [4.50%]. Two patients [2.25%] developed superficial surgical site infection. Six patients [6.74%] developed venous congestion of the flaps which recovered within two weeks. Other minor complications included dehiscence of suture line in 3 patients [3.37%], and superficial Epidermolysis in four [4.50%] [Table-2]. Twenty two patients [24.72%] returned to their work in 12-16 weeks, 31 [34.83%] in 16-20 weeks and 36 [40.45%] in 20-24 weeks. Long term follow-up to 06 months revealed hypertrophic scars at the donor site in three patients [4.91%] and recurrence of ulcer in 2 patients [3.27%]. The sural fasciocutaneous flap provides reliable supple and durable most single-stage coverage of wounds of the distal third of the leg, heel, and foot with the results comparable to free-tissue transfer

Versatality of supraclavicular flap in neck, face, and upper chest region coverage

The objective is to analyze the utility of theisland supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Prospective descriptive study. The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Atotal of 30 patients were included 20 [66.6%] male and 10 [33.3%] were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 [73.3%] while 8 [26.6%] require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4[13.3%] cases. 1 [3.3%] flap failed completely and the defect was covered with a skin graft. We had 01 [3.3%] mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 [60%]. Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap for oral/ facial defects

Reconstruction of non-melanotic facial tumours with local flaps; replacing like with like

To assess the outcome of early skin tumour excision and reconstruction with regards to tumour margin clearance, recurrence and aesthetic results of reconstruction. Quasi experimental. This study was carried in the department of Plastic and Reconstructive Surgery Combined Military Hospital [CMH] Rawalpindi, Pakistan from January 2010 to December 2012. All patients having tumours of the cheek, upper and lower lips, nose and forehead, who underwent primary surgical excision and reconstruction with local flaps, were included in the study. Patients with nodal or distant metastasis were excluded. Tumours were excised with safe margins and defects reconstructed with local facial flaps. Patients were regularly followed up as per protocol for basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]. Eighty nine patients aged between 37-86 years with a mean age of 59.4 years [SD +/- 9.24] were included in the study. There were 58 [65%] cases of basal cell carcinoma [BCC] and 31 [35%] of squamous cell carcinoma [SCC]. Recurrence was seen in 3 [5.2%] cases of BCC and 2 [6.4%] cases of SCC. There was 1 [1.1%] complete and 4 [4.5%] partial flap losses. The follow-up period ranged from 4 months to 3 years with average of 16 months. Local flaps give a simple option for facial reconstruction for postoncological resection defects giving good aesthetic match due to local tissue

Outcome of conservative management in acute pancreatitis

This study was done to evaluate the patients of acute pancreatitis managed conservatively and to review the findings of investigations. A descriptive study. This study was done in Combined Military and Military Hospital Rawalpindi from Nov 2004 to March 2005. This study was carried out from Nov 2004 to March 2005. All Patients presenting with acute abdominal pain and subsequently diagnosed as acute pancreatitis were included in this study. After history general physical and systemic examination was done. All relevant biochemical tests keeping in view Ranson's criteria were carried out. Patients were managed in surgical intensive therapy centre with broad-spectrum antibiotics, somatostatin analogues, intravenous crystalloid infusions, proton pump inhibitor and analgesics. All patients were monitored for complications if any. They were kept hospitalized till their serum amylase level was normal and they were asymptomatic on oral feeding. Ten [33%] of the patients were females and 20[67%] were males. Majority of the patients were between 31 years to 60 years of age. All of them presented with pain epigastrium, 23 [77%] had fever, 21 [70%] had vomiting. Twenty one [70%] had TLC above 16000/mm3. Serum amylase was raised four times in 30 [100%]. While on CT scan abdomen swelling of pancreas was seen in 17 [57%], peripancreatic fluid in 9 [30%] The treatment of acute pancreatitis is primarily conservative. Conservative management results in low rate of complications, mortality and cost, therefore conservative management should be the first option in treatment of acute pancreatitis

Comparison between delayed-absorbable polydioxanone and non-absorbable [prolene] suture material in abdominal wound closure

The objective of this study was to compare Polydioxanone [PDS] and Prolene suture material for abdominal fascial closure regarding morbidity in terms of post-operative wound complications. Cohort comparative ramdomized study. Dept of surgery Combined Military Hospital Rawalpindi from January 2002 to December 2003. A series of 100 patients presenting in the General Surgical OPD and requiring midline laparotomy were studied. In group "A" all the midline abdominal wounds were closed with Prolene 1 and in group "B" PDS 1 was used. In both the groups the data was collected, based on post-operative wound complications including post-operative wound pain, wound infection, wound dehiscence, suture sinus formation, stitch granuloma and incisional hernia. All the post-operative wound complications were then compared between the two groups. Our results show that the post-operative wound infection, wound dehiscence, suture sinus formation, stitch granuloma and chronic wound pain were significantly lower with PDS 1 as compared to Prolene 1, without any significant increase in incisional hernia formation. Slowly absorbable suture material [PDS] appears to be superior than non-absorbable suture material [Prolene] in midline abdominal fascial closure

Acute abdomen; causes

The term [acute abdomen] denotes any sudden spontaneous non-traumatic disorder whose chief manifestation is in the abdominal area. There is frequently a progressive underlying intra-abdominal disorder, the correct early diagnosis and treatment of which is essential for a favorable outcome. [I] To find out the most common causes of acute abdomen. [II] To compare the preoperative assessment with postoperative diagnosis. A Non-interventional Analytical [Comparative] study. Emergency department of Combined Military Hospital Kharian. Oct 2001 to Mar 2002. Total of 220 patients who presented with acute abdomen. The most frequent cause was found to be Acute Appendicitis, followed by Nonspecific abdominal pain, acute cholecystitis, acute intestinal obstruction and perforated duodenal ulcer. Preoperative diagnosis was wrong in 9.5% [n=21] of cases. Acute appendicitis was found to be the most common cause of acute abdomen and the single most important cause of acute abdominal pain causing great diagnostic difficulties, the preoperative diagnostic accuracy can be increased especially in female of child bearing age by using modern diagnostic tools especially laparoscopy