ABSTRACT
Objectives: To find out the relationship between recurrent laryngeal nerve[s] [RLN] and inferior thyroid artery [ITA] in patients undergoing thyroid surgery in our population
Study Design: Descriptive, cross-sectional study
Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi and Combined Military Hospital Rawalpindi from Aug 2008 to Dec 2014
Material; and Methods: One hundred recurrent laryngeal nerves, 50 right and 50 left were studied in 64 patients. All cases of benign goiter, malignant T1, T2 goiter, completion thyroidectomy cases on virgin side were included. Malignant T3, T4 cases, redo surgery, and large multi nodular goiter, cases in which posterior nodules have displaced the nerve [s] were excluded from the study. The course of the nerve was dissected in the thyroid vicinity and its relation with the inferior thyroid artery was recorded and photographed. All the data and special points were noted by the surgeons themselves in a register in all the cases and photographs were also taken. The data was entered and analyzed using statistical package for social sciences [SPSS] version 16. A p-value of <0.05 was considered significant
Results: Hundred RLN were studied in 64 patients. In 36 patient RLN on both sides and in 14 patients the right and in 14 patients the left RLN were studied. The age ranged from 15-65 years with mean age 36.4 years. Male to female ratio was, 1: 4.3. Percentage of male patients was 18.75 percent as compared to female was 81.25 percent. In our study the nerve was more commonly found passing posterior to inferior thyroid artery on both sides and in both sexes. On the right side it was seen in 60 percent of cases and on the left side it was seen in 70 percent of the cases
Conclusion: Relationship of RLN with ITA is variable in our population. The surgeon should be aware of these variations and meticulous dissection of RLN is mandatory in tumor surgery and redoes thyroid surgery to avoid injury to these nerves
ABSTRACT
Objective: To determine the effect of mechanism of injury on wound healing, and on the viability and success of distally based sural flap when used for the coverage of defects of lower leg, ankle and foot
Study Design: Descriptive study
Place and Duration of Study: Department of Surgery, Combined Military Hospital, Peshawar and Khariyan, from January 2012 to December 2014
Methodology: Patients with soft tissue defects over the distal leg, ankle and foot were selected by purposive sampling technique and divided into 2 groups of 19 patients each. Group A [road traffic accidents] and group B [war injuries]. Sural fascio-cutaneous flap was the reconstructive tool used in all the cases using single technique by the same surgical team; and time for recipient site preparation, size of the defect, graft survival, its healing time and complications, were studied
Results: The mean age of the 38 patients in the study was 28.2 +/- 13.4 years. There were 36 male and 2 female patients. The most common site of injury encountered was leg [n=20] followed by foot [n=11] and ankle [n=5]. Maximum wound size seen in group A was 10 x 12 cm and in group B was 15 x 38 cm. Recovery was uneventful in 17/19 cases of group A while 7/19 in group B and with no graft failure. Superficial epidermolysis was seen in 2 and 8 cases in group A and B respectively while edge necrosis of the flap was observed in group B only [n=4]. Healing time on average was 2 to 3 weeks in group A, and 4 to 5 weeks in group B
Conclusion: Soft tissue defects of the distal lower extremity as a result of war injuries and road traffic accidents have different dynamics in terms of wound size, time of wound healing, wound complications and functional outcome; but distal based sural flap has promising results in both situations
ABSTRACT
To describe the demography, types of injuries and their management in all non-disaster spinal injury patients admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. Case series. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, from April 2001 to December 2008. Data of all new non-disaster spinal injury patient admissions, kept in a custom-built database at Spine Unit, was analyzed. Demography, type of injuries and their management was described in percentages. Five hundred and twenty one non-disaster patients were selected out of a total 671 new admissions with spinal injuries. Mean age was 39.1 years and 77% were males. Mechanisms of injury included; fall in 62% and road traffic accidents in 32%. Fracture dislocations and burst fractures were equally distributed [36% each]. Most of the injuries [43.6%] were at T11-L1 level. Forty three percent patients had complete spinal cord injury [SCI], 33% had incomplete SCI and 24% did not have any SCI. Eight patients had concomitant spinal injury at a different level. Twelve percent patients had associated other major injuries. Seventy percent patients were treated surgically. Average follow-up was for 4 years. Non-disaster spinal injury was frequent in young males usually due to fall or road traffic accident. It involved fracture dislocation or burst fracture at T11-L1, level in most cases requiring surgical treatment