Humanitarian cleft mission to central Africa - experience and suggestions

This paper is to report and share our experience regarding the cleft missions in the developing world. In October 2009, an international organization, Smile Train Italia, helping children with cleft lip and palate, arranged a humanitarian mission to the Democratic Republic of Congo. We operated 93 Patients with Cleft lip and Palate during our stay in the Kinshasa university Hospital Congo. A total of 93 patients were operated in which 70% were with unilateral cleft lip, 6.45% patients were with bilateral cleft lip and 37.6% patients were with cleft palate. It is the right of every child to speak and smile especially those who born with Cleft lip and Palate. This should be the ultimate goal of all humanitarian Cleft missions working in the developing countries

Aplasia cutis congenita scalp: management options

To document the management of aplasia cutis congenita scalp. This descriptive study was conducted in the Department of Plastic and Reconstructive Surgery, Hayatabad Medical Complex, Peshawar from February 2000 to September 2007. Eleven patients with aplasia cutis congenita scalp were referred to our unit. A split thickness skin graft from adjacent healthy scalp or thigh was used for coverage of the scalp wound. Among these eleven patients, seven were males and four females. Two patients were observed with associated congenital anomalies. The ages ranged from 05 days to 04 weeks. Mean age was 12.5 days. Split thickness skin grafts were used in all these patients. About 10% graft loss was observed in one patient. One patient developed CSF leakage after wound healing. This patient expired after 03 weeks. Early surgical intervention in the form of split thickness skin graft for wound coverage is the most favorable treatment for Aplasia cutis congenita

Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery

To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. Quasi experimental study. The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' [bupivacaine] were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' [bupivacaine and tramadol] were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. Mean age of the children was 4.2 +/- 2.35 and 5.5 +/- 1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group [p < 0.0001] postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery

Glomus tumor-a diagnostic dilemma

To see the diagnostic utility of Xrays, MRI and C.T. scan in the diagnosis of glomus tumor. Descriptive study done from 1998 to 2005 at the department of plastic and reconstructive surgery Hayatabad Medical Complex, Peshawar. All cases diagnosed clinically as glomus tumor of the frigers were included in the study. The major presenting features were pain in12 patients and bluish discoloration of nail in 4 patients. On examination local tenderness was present in 9 patients and ice cube test was positive in 7 patients. Confirmation was done by histology in all cases. All patients were subjected to radiological examination while specialized tests like MRI was performed in 10 patients and CT scan in 2 patients. Twelve patients were included in the study. Positive findings on MRI and X-rays were observed in only, three patients and in one patient on CT scan. X-Ray findings were negative in 9 out of 12 patients [75%] while MRI finding were negative in 7 out of 10 patients [70%] and CT scan was done in 2 and was negative in 1patient [50%]. Keeping the high cost of MRI and poor results in small size tumors it is recommended to depend on clinical findings and histology to establish the diagnosis rather than CT and MRI

Speech results of furlow's soft palate repair

To evaluate the speech results of Furlows repair in soft palate repair. Cleft lip and palate is a common and complex disorder. It is relatively more common in Asians. The functional goals of cleft surgery are to improve speech and hearing and avoid retardation of maxillary growth. These goals are achieved by early cleft palate repair. The patients' age at the time of surgery in our series was 6- 18 months. The timing of cleft surgery is very important optimum speech and hearing. We perform Millard's repair for unilateral cleft lip at 3-6 months of age and lip adhesion for bilateral cleft lips. Clefts of the soft palate are repaired by Furlow's double opposing Z-plasty technique at the age of 6-9 months. Hard palate clefts are repaired at the age of 12-18 months by Von Langenbeck's technique. Out of 80 patients 57[71.25%] had unilateral cleft lip and palate where as 23[28.75%] patients had bilateral cleft lip and palate. Although Furlow's repair of the soft palate is considered a difficult technique but we have found that it yields excellent results in terms of speech and hearing, without interfering much with maxillofacial growth. We achieved normal speech results in 78.75% [n=63] cases and normal articulation in 93.75% [n=75], after treatment with Furlow's double opposing Z-plasty of the cleft soft palate. The fistula rate in our series is 2.26%. Furlow's repair is technically difficult procedure, but it yields excellent speech results

Treatment of necrotizing fasciitis with quinolones

To evaluate the effect of high dose quinolones therapy in patients with necrotizing fasciitis. Design: descriptive analytical study. Place and Duration of Study: the department of Plastic and reconstructive surgery, Hayatabad Medical complex, Peshawar, from January 2001 to March 2002. Subjects and Twenty consecutive patients, diagnosed with necrotizing fasciitis, were treated with intravenous quinolones [400 mg 8 hourly]. The response was evaluated in terms of subsidence of fever and C-reactive proteins levels. Majority of the patients was male [60%]. Lower limb involvement was most commonly involved [70%]. The most common initiating cause was injection abscess [45%]. Majority of the cultures showed polymicrobial infection [90%]. The most common isolate was streptococcus pyogenes [65%]. Majority of the patients showed excellent response with intravenous quinolones [Ciprofloxacin] in high doses in 24-48 hours. Only two patients [10%] failed to respond to therapy due to severe infection and delay in seeking treatment. Intravenous quinolones [Ciprofloxacin] in high doses are effective in controlling necrotizing soft tissue infections

Comparison of prepucial skin, postauricular skin and buccal mucosal graft results in hypospadias repair

To compare the results of the prepucial, postauricular skin grafts and buccal mucosal graft in two-stage hypospadias repair. Design: Comparative study. Place and Duration of Study: The department of Plastic Surgery, Hayatabad Medical Complex, Peshawar. The duration of the study was three years [from January 1999 to December 2001]. Patients and The study subjects included 242 patients with hypospadias who underwent two-stage Aivor Bracka repair. The best results were obtained with prepucial skin graft in which the graft take was 95.3% and fistula rate was 3.2%. The incidence of graft contracture and graft loss was 20.5% and 11.7% respectively in buccal mucosal graft. The prepucial skin graft, postauricular skin graft and buccal mucosal graft gives excellent results in terms of graft acceptance in stage I and graft contracture and fistula rate in stage II