Nasolabial and extended nasolabial flaps for reconstruction in oral submucous fibrosis

OBJECTIVES: The objective of the study was to evaluate the results of nasolabial/extended nasolabial flaps as a modality for treatment of oral submucous fibrosis. MATERIALS AND METHODS: Eleven patients of Stage III or IVa maximum interincisal opening were selected to be operated. Nasolabial/extended nasolabial flaps were done for both the sides. All of the flaps were done in a single stage and were inferiorly based. A similar flap harvest/surgical technique was utilized for all the cases. RESULTS: The preoperative mouth opening ranged from 5 to 16 mm, with a mean of 10.09 mm. At 6 months the mouth opening ranged from 29 to 39 mm. Some of the complications encountered were poor scar, wisdom tooth traumatising the flap, decreased mouth opening due to non compliance and too much bulk. All of theses were managed satisfactorily. CONCLUSION: The nasolabial flap is a very reliable flap to restore the function of oral cavity. Important adjuvant measures are habit cessation, lifestyle changes, and aggressive physiotherapy.

Efficacy of gauze-based negative pressure wound therapy after split-thickness skin graft in the care of large wounds

Background: Negative-pressure wound therapy [NPWT] or vacuum dressings involve the application of a controlled negative pressure on the wound. Traditionally, STSGs were fixed with Bolster technique, where sutures are used to fix pressure dressings over the top of recently placed grafts. Taking it a step further in our study we applied an effective and user friendly filler material [surgical roll gauze] on very large defects. The objective of this study was to assess the clinical efficacy of gauze-based negative pressure wound therapy as an adjunctive therapy to STSG, over complex and very large wounds

Material and Methods: This descriptive study was conducted at Army Burn Center, Combined Military Hospital Kharian and PNS Shifa Hospital Karachi from January 2016 to June 2017. Gauze based VAC system used. Negative pressure was applied at -80 mm Hg. Evaluation was carried out to assess the performance of gauze-based NPWT

Results: Total of 63 patients, 42 males and 21 females, with mean age of 32 years SD+15 were included in the study. The wound size included in the study ranged from 12x10 cm to 88x66 cm. Mean duration of NPWT dressings was 15 days and 313 dressings were employed in total with satisfactory healing achieved in 3 to 4 VAC dressings in most of the cases. Mean duration of hospital stay was 23.92 days at which point graft uptake percentage was in the range of 90% [n=7] to 100% [n=20]. Only 3.2% [n=2] cases required partial re-grafting for complete coverage of residual wounds

Conclusion: Gauze-based Negative-pressure wound therapy over split thickness skin graft is a cost-effective addition to the care and management of large and complex wounds

Surgical correction of grade III hypertelorism

Orbital hypertelorism is an increased distance between the bony orbits and can be caused by frontonasal malformations, craniofacial clefts, frontoethmoidal encephaloceles, glial tumors or dermoid cysts of the root of the nose, and various syndromic or chromosomal disorders. We report a series of 7 cases of hypertelorism that were treated in our hospital. The underlying causes in our series were craniofacial clefts 0 to 14 (4 cases), craniofacial clefts 1 to 12 (1 case), and frontonasal encephalocele (2 cases), all congenital. Surgical techniques used to correct the deformity were box osteotomy and medial wall osteotomy with or without calvarial and rib grafts. A few of our cases were reoperations with specific challenges.

Fronto-orbital advancement and total calvarial remodelling for craniosynostosis

To describe the results of fronto-orbital advancement and remodelling for craniosynostosis in children. Case series. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to June 2012. All the patients with cranial suture synostosis operated were included in the study. Those patients who were lost to follow-up were excluded. Variables considered were age, gender, type of synostosis, intracranial pressure, and history of previous surgeries for the same problem. Outcome measures were studied in terms of improvement of skull measurements [anteroposterior and bicoronal], duration of surgery, hospital stay, blood transfusions, complications and parents satisfaction. A total of 36 patients were included in the study. Male to female ratio was 3:1. The age ranged from 5 to 54 months. Thirty two patients presented with non-syndromic and four with syndromic craniosynostosis. Fronto orbital advancement and total calvarial remodelling was done in 26 and 10 patients respectively. There was improvement in the skull measurements and the parents were satisfied in all cases with the skull shape. Complications occurred in 11.1% including chest and wound infection and one death. Fronto-orbital advancement and remodelling is an effective procedure for the correction of craniosynostosis, however, individual cases may require other procedures like total calvarial remodelling

Grebe syndrome: a rare association with congenital heart disease

Grebe syndrome is a very rare form of short-limbed dwarfism. It is a genetic condition, passed by autosomal recessive inheritance. It is characterized by marked acromesomelic shortening of all the four limbs. There are no other associated anomalies. The affected baby has normal intelligence and normal life span. We present here a case of Grebe syndrome along with congenital heart disease

Free anterolateral thigh flap raised on musculocutaneous perforators of rectus femoris muscle

The anterolateral thigh flap [ALTF] has been in wide clinical use for the last two decades, its major disadvantage has been its variable anatomy. We are presenting a case in which no substantial perforators were found to be arising from either the lateral septum of thigh or Vastus Laterlis muscle. In this case, instead of raising another flap, we used the same skin paddle raised on the musculocutaneous perforators of rectus femoris muscle

Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps

To assess the improvement in Quality Of Life [QOL] after ablative surgery in locally advanced head and neck malignancies by microvascular free flaps reconstruction. Quasi-experimental. Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from September 2005 to February 2007 A total of 44 patients with locally advanced stage III and IV malignancy of head and neck were included in the study. All patients were treated with ablative surgery and reconstruction with microvascular free flaps. QOL was assessed by using a scoring questionnaire [including 5 parameters for extra oral cancers including physical and role function, body image, weight loss score and pain donor site morbidity; and an additional 5 parameters for intraoral tumours that included swallowing, speech, drooling of saliva and mouth opening]. A high score indicated a poor QOL. Patients were assessed pre-operatively and then at 2, 4 and 6 months postoperatively. Mean accumulative score and mean individual parameter scores for both extra- and intraoral tumours were significantly improved [p < 0.05]. Microvascular free flap reconstruction after ablative surgery in locally advanced head and neck malignancy had a profound impact on the improvement of QOL. There was an initial deterioration of physical scores postoperatively and postradiotherapy, followed by gradual improvement. By the end of 6 months, it surpassed the pre-operative QOL scores

Tuberculous tenosynovitis: a cause of carpal tunnel syndrome

To highlight the presentation of tuberculous tenosynovitis as Carpal Tunnel Syndrome [CTS]. A descriptive study conducted with purposive sampling on the patients presenting between April 2004 to January 2005 to the department of Plastic Surgery, CMH Rawalpindi, with the clinical picture of CTS. Symptoms and signs were recorded. The carpal tunnels were explored under nerve blocks. Where tenosynovitis was observed per-operatively, specimen of excised synovium were sent for histo-pathological examination, acid fast stains and bacterial cultures, to ascertain or rule out the presence of tuberculosis. A total of 53 patients predominantly males were included in the study. The median age was 43 years and average duration of symptoms was 9 months. Tenosynovitis was observed in three patients [6%] per-operatively, with histopathology suggestive of Tuberculous tenosynovitis. Point Prevalence of tuberculous tenosynovitis as a cause of CTS was 6%. These patients reported clinical improvement with anti-tuberculosis treatment. NCS/EMG co-related well with clinical relief. Tuberculous tenosynovitis is an uncommon cause of median nerve compression at the wrist. As symptoms are usually typical of CTS, diagnosis is frequently missed. Consideration of the possibility, examination of the opened canal at surgery and proper treatment can result in a successful outcome

Outcome of septoplasty as a day case. A clinical audit done at doncaster royal infirmary and rotheram district general hospital

This clinical audit was carried out at department of ENT at Royal Infirmary Doncaster and Rotheram District General Hospital Rotheram to review the surgical outcome of Septoplasty along with the incidence of complications, and to determine the level of patient satisfaction with day case septoplasty and septorhinoplasty. Multiple perioperative patient and surgeon dependent treatment variables were also evaluated to determine their impact on outcome. A retrospective casenote review of 110 patients who had septoplasty +/- other nasal procedures between May 2002 and Aug 2003 Septoplasty done as day case surgery achieved desired results for 83% of patients with Deflected nasal Septum, with significant improvement in symptomatology. There were no serious complications or adverse outcomes. The incidence of complications was comparable to previous published studies. Among all the evaluated variables a history of previous nasal surgery predicted worse outcome. We conclude our this experience by commiting that Day case/23 hours septoplasty is reliably safe with an acceptably low incidence of the associated complications. Furthermore if properly planned, and provided that stringent patient selection criteria are adhered to, it is practical, with a good patient satisfaction rate and therefore should be encouraged

Skin sparing mastectomy and immediate breast reconstruction

To evaluate skin sparing mastectomy[SSM] and immediate breast reconstruction[IBR] in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems. An interventional study. The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003. Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done. The patients' age ranged between 25-46 years. Two patients [7%] were nullipara. Tumor size was T1 in 10 [36%] and T2 in 18 patients [64%]. In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 [86%] and latissimus dorsi flap in 4 patients [14%]. All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 [10.5%], infection in 03 [10.5%], axillary seroma in 03 [10.5%] and abdominal seroma in 01 patient [3.5%]. As late complication 5 patients [19%] developed fat necrosis. Adjuvant chemotherapy was given in 6 [21%] and adjuvant radiotherapy in 4 patients [14%]. No recurrence encountered in maximum follow-up. We found an excellent aesthetic restoration in 23 [82%], good in 1 [3.5%] and fair in 4 patients [14%]. SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression