Islanded greater palatine artery flap for anterior oronasal fistula repair

Objective: To describe the usefulness of islanded greater palatine artery flap for repair of anterior oronasal fistula

Study design: Descriptive case series

Place and Duration of study: Plastic and Reconstructive Surgery Department, Bahawal Victoria Hospital, Bahawalpur, from January2013 to January 2015

Methodology: Five patients were selected for the study who had history of cleft palate repair. Selection was based on location and size of fistula and amount of residual palatal mucosa. Assessment was done for postoperative wound complications, postoperative speech and swallowing and donor site morbidity

Results: All the patients underwent islanded greater palatine artery flap. One patient was operated with bilateral islanded flaps. Postoperative diet started between 1[st] to 3[rd] day [mean 2 days]. Patients were discharged on 3[rd] -5[th] [mean 4[th] day] postoperative day without any postoperative donor site or recipient site complications. Donor site re-epithelialized within 4 weeks in all patients

Conclusion: The islanded greater palatine artery flap offers a reliable method of primary reconstruction of anterior oronasal defects

experience with the surgical management of pressure ulcers around pelvis at Bahawal victoria hospital, Bahawalpur

Background: Pressure ulcers remains a major problem in bed ridden patients, due to many diseases

Objective: To determine the outcome of surgery in the management of pressure ulcers in paralyzed patients

Patients and Methods: Study design: This was a cross-sectional study. Duration and place of study: The study was conducted from 1[st] June 2007 to 30[th] June 2013 in the Department of Plastic and Reconstructive Surgery, Bahawal Victoria Hospital, Bahawalpur. After following inclusion and exclusion criteria patients were admitted. Their serum chemistry was sent. Patients with uncontrolled diabetes, anemia and improper care were excluded. Patients and their attendants were educated about the proper care of patient and send to home for a month. After one month they were called for follow-up and patients who followed directions were selected for surgery. After surgery, the outcome was measured in terms of recurrent infection. The data was entered and analyzed by using SPSS version 10

Results: Twenty-three patients were selected for surgical management. Most common pressure ulcers were sacral sores [47.8%] followed by ischial [34%] and trochanteric ulcers [17%]. Ischial Ulcers were most difficult one to treat with 37% recurrence. Pressure ulcers have high overall recurrence rate of 26%. Different types of musculocutaneous flaps were used

Conclusion: All types of flaps used for reconstruction have comparable results

Pectoralis major myocutaneous flap for reconstruction of major neck defects

To analyze results of pectoralis major myocutaneous flap used for reconstruction in massive neck trauma patients. Descriptive case series study. Plastic and Reconstructive Surgery Department Bahawal Victoria Hospital Bahawalpur, from April 2010 -April 2014. Patients who were brought with major tissue defects in neck either due to trauma or surgeries done due to malignant lesions were enrolled. Patients with diabetes mellitus, renal or hepatic dysfunction were excluded. Those with active infection were also not subjected to this surgical procedure. Pectoralis major flap was taken based on longitudinal artery for reconstruction of neck. In those cases where history of extensive trauma or neck dissection was present, flap was based on thoracoacromial vessel. Complications during hospital stay and at follow up were recorded. Aesthetic and functional assessments of the patients were done at each follow up. Twelve patients were selected for the procedure. The age ranged from 15 year to 55 year. In six cases the soft tissue loss was due to electric burns while three were victims of road traffic accidents. Three [25%] patients developed complications including flap necrosis and hematoma of donor site in one case each. Three patients were able to speak normally and four had no problem with swallowing. Three patients attained good color match while two patients attained good neck contour. Pectoralis major myocutaneous flap is simple, easy, variable and a life saving flap for coverage of major head and neck defects with minimal complications

Lower eye lid reconstruction using single stage Mustarde' cheek rotation flap

To determine the functional and cosmetic outcome of Mustarde' cheek rotation flaps performed for reconstruction of large lower eyelid defects. Bahawal Victoria Hospital, Bahawalpur from August 2003 to March 2006. All those patients in whom Mustarde 'cheek rotation flap was done for the reconstruction of large lower eyelid defects, were included. Follow up included assessment of position of eyelid, closure, presence of epiphora, aesthetic balance, and donor-site morbidity. Thirty patients, aged 2 year to 70 years, have been operated with this technique for total or sub total defects of the lower eyelid. Two patients received an auricular chondro-cutaneous graft. Rest of them received a nasal chondro-mucosal graft for inner lining. The flap remained viable in every patient, without total or partial necrosis. Mustarde cheek rotation flap is very reliable procedure that provides complete reconstruction and can be used with good functional and cosmetic results in patients with total and sub-total lower eyelid defects

Maxillofacial trauma: Current practice in management at Pakistan institute of medical sciences

This study was carried out to determine the aetiology, pattern and management of maxillofacial injuries at PIMS, Islamabad. This descriptive study was conducted at Plastic Surgery Department, PIMS Islamabad from 1st February 1998 to 30th April 2002. All the adult patients presenting with maxillofacial injures were included where as patients less than 12 years of age and only facial lacerations were excluded. Similarly isolated nasal bone fractures were also excluded because these patients were routinely managed by ENT department. Age, sex, presentation, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. In 164 patients 254 fractures were noted. Most were male [86%], ranging in age from 13'71 years with a male to female ratio of 6:1 respectively. The most frequent [48%] cause noticed was road traffic accidents followed by assault. Mandible was the commonest to be involved in such injuries followed by maxilla. Most of the patients [32%] had associated facial injuries. Various treatment modalities were practiced. Maxillofacial fractures should be managed by open reduction and internal fixation as early as possible

Intramuscular benign lipoma of the temporalis muscle

Lipoma within the musculature of the head and neck is rare. Most of them are infiltrating lipomas. There is no report of a well circumscribed lipoma of the temporalis muscle. We present a 58-year old man who had a non-pulsatile soft mobile mass in the right temporal fossa extending down in the cheek. The lesion was 15x7x3cm in size. Patient recovered well after surgery with a good cosmetic result