Bilateral brachial plexus injury

Brachial plexus injuries can occur as a result of various mechanisms such as stretching, direct and indirect trauma or following childbirth. Bilateral brachial plexus injuries are uncommon and associated with a poor functional outcome. We report a case of bilateral brachial plexus injury resulting from prolonged immobilization of the arms in hyper-abducted position resulting in compression of the brachial plexus on both sides. The injuries were treated conservatively and following 4 months of active rehabilitation in our unit, the patient still had poor arm functions and required care and support in the community on discharge

Bilateral tension pneumothoraces following coronary artery bypass grafting

It is an unusual case of bilateral tension pneumothoraces developing in the postoperative period in a patient who underwent total arterial revascularization for two vessel coronary artery disease. The patient had been a previous heavy smoker and at operation had been noted to have thin walled lung parenchyma with multiple small bullae mainly in the left upper lobe. He suddenly developed bilateral pneumothoraces following intermittent continuous positive airway pressure requiring initially bilateral needle decompression followed by chest drain insertion. He recovered well and the air leak sealed after 3 days

distally based superficial sural artery flap for coverage of calcaneal defects

The reconstruction of soft tissue defects of the lower third of the leg, heel and the calcaneal area has improved considerably as a result of increased popularity of reverse sural flap over the last 20 years. The use of skin grafts, local flaps and free muscle transfer for calcaneal area has numerous limitations. The aim of this study is to evaluate the efficacy of sural artery flap for soft tissue defects cover the calcaneal region. This is a descriptive study which includes 20 patients who presented with soft tissue defect in the calcaneal region. The study was conducted at Plastic and Reconstructive Surgery Department of Federal Postgraduate Medical Institute Shaikh Zayed Hospital Lahore, over a period of 5 years from January 99 to January 2004. A total of twenty patients with soft tissue defects of heel and calcaneal area requiring coverage were included. Preoperative data, the age and sex of each patients, cause and site of defects, the flap dimensions and transposition, postoperative results and complications were recorded. Out of 20 patients, 11 were males and 9 were females with range of age from 8 to 50 years. Road traffic accidents was the cause of the defects in 16 [80%] patients [wheel spoke injury in 6 [30%] patients, Marjolin`s ulcer 4 [20%] patients. The site of 20 defects comprised 12 [60%] heel, 2 [10%] heel+ tendo-Ahilles, 4 [20%] Calcaneum, 2 [10%] heel+ Calcaneum. The flap dimensions ranged from 4 to 15cm in length and 3 to 12cm in width. Postoperatively 19 [95%] flaps survived completely while marginal necrosis with infection was seen in 1 [5%] patient. Among 19 patients, 3 [15%] patients had oedema in initial days. There was no considerable morbidity at donor site and all the patients had satisfactory functional outcome. On the whole the distally based superficial sural artery flap is very useful for lower limb reconstruction, particularly for an area around heel and calcaneum. The surgical technique is safe, shorter duration and technically less demanding as compared to the alternative, i.e. free microvascular flaps