Management of postburn digital flexion contractures

To determine the outcome of plantar/palmer skin graft for the management of postburn digital flexion contracture in terms of functional and cosmetic improvements. Interventional quasi-experimental study. Department of Plastic and Reconstructive Surgery, PGMI, Hayatabad Medical Complex, Peshawar. The duration of the study was 1-1/2 years [from January 2001 to June 2002]. Fifty patients with postburn digital flexion contracture were recruited in the study. Patients with posttraumatic and postinfective contractures were excluded from the study population. The contracture was released and the deficit produced was replaced by plantar/palmer split skin graft. Active range of motion [ROM] was measured before and after surgery. Postoperative follow-up was done for one year. The outcome measurements were color and texture match of graft with the adjacent palmer skin, sensibility, recurrence rate of contracture and donor site morbidity. The data collected was labeled with the help of statistical package for social sciences [SPSS] and descriptive statistics were calculated accordingly. The graft take was complete [100%] in 48 patients, 50% in one patient [2%] and nil in one [2%] patient. Recurrence of contracture occurred in 5 patients [10%]. Pre-operative median active range of motion [ROM] at proximal interphalangeal [PIP] joint was 60 degree to 90 degree [extension/ flexion]. Postoperatively median active range of motion [ROM] at PIP joint was 0 degree to 90 degree at one year follow-up examination. The healed graft showed good colour and texture match with the surrounding palmer skin. The sensory function return was satisfactory and there was no significant donor site morbidity. The excellent colour, texture match and the functional advantages in terms of active range of motion and sensibility offered by the split thickness palmer/plantar skin grafts exceeded the expected outcome of conventional techniques [thigh, groin and buttock skin grafts]

assessment of incomplete facial basal cell carcinoma excision

To determine the rate and cause[s] of incomplete excision of basal cell carcinoma, occurring on face. Design: A non-interventional, descriptive study. Place and Duration of Study: Plastic Surgery Unit, Hayatabad Medical Complex, Peshawar, from January 2002 to March 2004. Patients and Patients with basal cell carcinoma of the face reporting to the OPD were included in the study and were booked for surgery. After excision, all tumors specimens were marked at 12 o'clock and sent to laboratory for histopathology to confirm the diagnosis and to know the completeness/incompleteness of tumor excision. If biopsy reported residual tumor in any of the margins it was noted and projected as percentage for the purpose of our results. Out of 56 patients, 49 [87.5%] had complete excision of tumor. Six [10.7%] had residual tumor while in one [1.7%] patient, biopsy report failed to mention the involvement/clearance of margins. Six patients with residual tumor were given postoperative radiotherapy. All patients were followed for a minimum of 2-1/2 years [critical period for recurrence] with careful watch on those with residual tumor. So far, only 2 of these 6 had recurrence of lesion. Both of them were greater than 2 cm in diameter and were located on medial canthal and nasolabial region. Chances of incomplete tumor excision are more on the mid face region. Patients with residual tumor are more prone to recurrence