ABSTRACT
Objective: to assess the reliability of non-islanded distally based sural artery flap, in terms of number of flap failure [partial and major flap necrosis], number of surgeries related to the problem for which flap surgery was performed, hospital stay and return to work, for coverage of soft tissue defects of the distal one-third of leg, ankle and heel
Study Design: cohort study
Place and Duration of Study: department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2003 to March 2014
Methodology: distally based sural artery flaps in 87 patients requiring coverage of distal lower lumb were studied, retrospectively. They were divided into two groups. G1 included 46 cases in which distally based sural artery flap was islanded. G2 included 41 cases in which flap was not islanded and pedicle was raised. The variables that were measured in two groups included age, gender, size and cause of defect, co-morbidities, number of surgeries, total hospital stay, return to work and flap related complications. Independent sample t-test and tests of proportions were used for comparison with significance at p < 0.05
Results: the mean age of patients was 38.4 +/- 16.2 years in G1 and 35.1 +/- 18.6 years in G2. In G1, 34 cases were traumatic, 5 caused by diabetic ulcers and another 7 cases were trophic ulcers in paraplegic patients caused by pressure sores. In G2, the cause was trauma in 32 cases, diabetic ulcers in 7 cases, trophic ulcers in 2 cases. The mean number of surgeries in G1 was 3 +/- 1 and 2 +/- 1 in G2 [p < 0.001]. The mean hospital stay in G1 was 43.1 +/- 3.6 days while 27.9 +/- 2.1days in G2 [p < 0.001]. There was epidermolysis in 21 out of 46 islanded distally based sural artery flaps [G1] and in 9 out of 41 non-islanded flaps [G2] [p=0.0203]. Partial necrosis occurred in 12 of flaps in G1 and in only 3 of G2 flaps [p=0.024]
Conclusion: distally based sural artery flap can be made more reliable and with lesser complications by raising the pedicle with skin rather than islanding the flap
ABSTRACT
Paralysis of facial nerve leads to a severe deformity which seriously handicaps the patients, both aesthetically and functionally. Anderson's modification of Gilles' technique involves the use of ipsilateral temporalis muscle lengthened by the slips of its overlying temporalis fascia to restore function and rehabilitate the patient with typical deformity. A total of 28 patients underwent facial reanimation with this technique at the Department of Plastic Surgery, Mayo Hospital, Lahore from January 1990 to June 1998. The mean age was 23.25 years and mean duration of facial palsy was 14.5 years at the time of presentation. The results were evaluated in terms of aesthetic and functional improvement. The aesthetic appearance of eye was excellent in 3 patients, good in 23 patients. Functional recovery was excellent in 15 patients, good in 12 patients and satisfactory in one patient. Aesthetic improvement in the region of cheek and oral sphincter was excellent in 4 patients, good in 17 patients, satisfactory in 5 patients and poor in 2 patients. Functional gain In this region showed excellent results in 7, good in 15, satisfactory in 5 patients and poor in one patient. The results reaffirm the role of dynamic reanimation, in long standing cases of facial palsy, by temporalis muscle transfer