Flexor tendon injuries of hand: experience at Pakistan institute of medical sciences, Islamabad, Pakistan

Flexor tendon injury is one of the most common hand injuries. This initial treatment is of the utmost importance because it often determines the final outcomes; inadequate primary treatment is likely to give poor long term results. Various suture techniques have been devised for tendon repair but the modified Kessler's technique is the most commonly used. This study was conducted in order to know the cause, mechanism and the effects of early controlled mobilization after flexor tendon repair and to assess the range of active motion after flexor tendon repair in hand. This study was conducted at the department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad from 1[st] March 2002 to 31[st] August 2003. Only adult patients of either sex with an acute injury were included in whom primary or delayed primary tendon repair was undertaken. In all the patients, modified Kessler's technique was used for the repair using non-absorbable monofilament [Prolene 4-0]. The wound was closed with interrupted non-absorbable, polyfilament [Silk 4-0] suture. A dorsal splint extending beyond the finger tip to proximal forearm was used with wrist in 20-30 [degree sign] palmer flexion, metacarpophalangeal [MP] joint flexed at 60[degree sign]. Passive movements of fingers were started from the first post operative day, and for controlled, digits were studies. 94% of the patients had right dominated hand involvement. 51% had the complete flexor digitorum superficialis [FDS] and flexor digitorum profundus [FDP] injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% of the patients. Zone III [46%] was the commonest to be involved followed by zone II [28%]. Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmer crease distance [TPD] was <2.0 cm in 71% cases [average 2.4cm] at the end of 2[nd] postoperative week. Total number of patients was 34 at the end of 6[th] week. TPD was <2.0 cm in 55% patients and <1.0 cm in 38% cases [average 1.5 cm] at the end of 6[th] week. Total 9 patients were lost to the follow up at the end of 8[th] week. TPD was <1.0 cm in 67% [average 0.9 cm] at the end of 8[th] postoperative week. No case of disruption of repair was noted during the study. Early active mobilization programme is essential after tendon repair. Majority of the patients [92%] had fair to good results at the end of 2[nd] week which increased to 97% at the end of 8[th] week to good to excellent

Distally based sural neurocutaneous flap for ankle and foot reconstruction

To evaluate role of sural neurocutaneous flap for reconstruction of ankle and foot in our set up. Department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad. From January 1997 to August 2004. We conducted a prospective study to evaluate the role of distally based sural neurocutaneous flap for soft tissue reconstruction of the ankle and foot. A total of 33 patients with soft tissue defects of the ankle and foot were managed by this flap. Mean age of the patients was 31.8 years with range 10-70 years, 30 males and 3 female were included in the study. Most common cause of the defect was trauma and heel was the most common location. Mean flap length was 18.4 cm and mean width 6.2 cm. Range of flap dimensions was 12 x 4 cm. to 28 x 8 cm. Minor complications occurred in three cases. These included partial flap necrosis, wound dehiscence and flap oedema. We conclude that distally based sural neurocutaneous flap is a very effective tool for reconstructing the soft tissue defects in the difficult ankle and foot region

Management of phalangeal fractures of hand

Phalangeal fractures are approximately 10% of all the fractures of skeletal system. Most fractures are functionally stable. Surgical treatment is necessary when fracture is displaced and reduction is not possible. This study was conducted in order to study the aetiology, features and management of the phalangeal fractures of hand. This descriptive study was conducted in the department of Plastic Surgery, Pakistan Institute of medical Sciences, Islamabad from June 1[st] 2002 to July 31[st] 2003. Adult patients of either sex with acute injury presenting in the out-patient department and emergency department were included whereas patients below the age of 13 years and patients with amputated digits were excluded. The site and side of fracture were noted. All patients were X-rayed pre-operatively. These patients were divided into two groups. Group A comprised of those patients in whom only closed reduction was done. Group B comprised of patients in whom operative procedure was carried out. Various modalities used were percutaneous Kirschner wire fixation, open reduction and internal fixation with K-wires, screws, microplates and dental wires/ after operation, immobilization of fracture site was done for 3 - 4 weeks. Chi square test was used for statistical analysis of complications in both the groups. 51 fractures were seen in 43 men and 8 fractures in 8 females. Mean age of the patients of group A was 35.6 years as compared to 29.5 years of group B. 31% fractures were associated with soft tissue injury. Ring finger was the commonest to be involved in 36% patients. Left hand [64%] was commonly involved. Left proximal phalanx [31%] was the most frequently injured part. Intraarticular fractures were seen in 10% cases. 15 fractures were treated conservatively and some kind of operative modality was used in 44 fractures. Crush injury remained the commonest cause. In 36% patients fractures were fixed with K-wire using open reduction and internal fixation technique. In 22% patients, only percutaneous K-wire was used. In two patients, dynamic traction device was used. One case of post operative infection was noticed in group B. Whereas only one case of malunion and one case of limited joint movement and stiffness was noted in group A. Results of both the closed reduction and open reduction and internal fixation were equally good [p < 0.05]. If there is any soft tissue injury, it is advisable to use open reduction and internal fixation technique

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