Frequency of oronasal fistulae in complete cleft palate repair

To determine the frequency of oro-nasal fistula in patients undergoing complete cleft palate repair by two flappalatoplasty. Case series. Department of Plastic Surgery, Services Hospital, Lahore, from January to December 2013. Patients admitted to the study place for repair of cleft palate after informed consent obtained were included. Cleft palate was repaired by two-flap palatoplasty, using Bardach technique. Patients were discharged on the second postoperative day and followed-up at third week postoperatively. During follow-up visits, fistulae formation and their sites were recorded on pre-designed proforma. Among the total 90 patients, 40 patients [44.4%] were male and 50 patients [55.6%] were female. The mean age was 6.4 +/- 5.7 years ranging from 9 months to 20 years. At third week follow-up, 5 patients [5.6%] had fistulae formation. Four patients [80%] had anterior fistulae and one patient [20%] had posterior fistula. With two-flap palatoplasty Bardach procedure for repair of cleft palate, the complication of fistula formation was uncommon at 5.6%, provided the repair was tension free and multi-layered

Recurrent palatal fistula and nasal regurgitation; anteriorly based dorsal tongue flap: a reliable solution

Background: Post Palatoplasty fistulas are the common complications seen after cleft palate repair. This produce various symptoms including regurgitation of fluids into nasal cavity, interference with normal speech and middle ear problems. Although small fistulas can be successfully treated with local flaps such as palatal or buccal mucosal flaps, large fistulas are difficult to treat. Because of rich blood supply, tongue is a suitable and convenient source of large flap. The anteriorly based dorsal tongue flap is a safe and effective method for closure of relatively large recurrent palatal fistula without any functional impairment of donor site

Objective: To determine the success rate of Tongue flap in correction of the nasal regurgitation in recurrent palatal fistulas

Duration of study: 12 months from 16th July 2010 to 15th July 2011

Study design: It was descriptive case series

Settings: This study was carried out in the department of plastic surgery Services institute of medical sciences, Services Hospital Lahore

Methods: Forty patients who were having recurrent palatal fistula included in this study. All underwent palatal fistula repair by dorsal tongue flap. Each patient was followed after one month of operation for fistula closure and correction of nasal regurgitation

Results: In this study 65 percent of the patients were male, while 35 percent of them were female. 21 [52.5%] of the patients belonged to age group 10-15 years, while 14 [35.0%] of the respondents had 16-20 years of age and remaining 5 [12.5%] of them had 21-30 years of age. The 90 percent [out of 40] of the patients had complete fistula closure, while only 10.0 percent of them had not complete fistula closure. Nasal regurgitation was corrected in 38 [95 %] of the patients and remaining 2 [5%] patients had un-corrected nasal regurgitation

Conclusions: Tongue flap is a effective and reliable method of treatment, not only for palatal fistula closure but also treating nasal regurgitation which is a social stigma for patients in recalcitrant palatal fistula

Local flaps and split; Sensory deficit in term of two point discrimination [TPD] thickness skin grafts [STSG]

Two point discrimination [TPD].is the minimum distance between two stimulus points on the skin, which are perceived as distinct points, Among the two types of TPD i.e., static and dynamic, static two-point discrimination [STPD] is commonly used to determine digital nerve integrity. Local flaps usually do well in maintaining sensibility of the covered area in terms of two point discrimination in contrast to split thickness skin grafts [STSG]. The objective of this study was to determine the frequency of sensory deficit in terms of TPD in STSG and local flaps for soft tissue defects of fingers after three months. It was a Quasi experimental study. Patients admitted in the indoor of Plastic surgery department, Services Hospital Lahore. February 2009 to January 2010. Thirty five patients underwent local flap coverage and other thirty five underwent split thickness skin grafting for soft tissue defects of fingers depending upon nature of defect. Patients were followed up at 2, 4, 8 and 12 weeks. The sensory deficit observed at the end of 12th week post operatively was in 8.6% of the patients with local flap coverage [3 patients] and 45.7% of those with STSG [16 patients]. Patients with no sensory deficit were 91.4% [32 patients] in the local flap coverage and 54.3% [19 patients] in the STSG at 12th week of follow up. The relative ratio of sensory deficit in local flaps and STSG was 5 [>2]. The results of this study show that Local flaps are better options in terms of TPD preservation as opposed to STSG for soft tissue defects of fingers

Dorsal tongue flap: a reliable solution in recalcitrant secondary palatal fistulas

To determine the efficacy of Dorsal Tongue Flap in repair of palatal fistula in terms of closure of fistula. It was a descriptive study which was carried out in the department of plastic surgery, Services institute of Medical Sciences, Services Hospital Lahore over 12 months from 16th July 2010 to 15th July 2011. Forty patients who were having recurrent palatal fistula included in this study. All underwent palatal fistula repair by dorsal tongue flap. Each patient was followed after one month of operation for fistula closure. In this study 65.0 percent of the patients were males. 21 [52.5%] of the patients belonged to age group 10-15 years, while 14 [35.0%] of the respondents were 16-20 years of age and remaining 5 [12.5%] of them were 21-30 years of age. 90 percent patients had overall efficacy in terms of complete fistula closure. Tongue flap is an effective and reliable treatment for palatal fistula closure in recurrent and resistant cases

Traffic accidents; correlation between skull fractures and intracranial lesions

To find out the correlation between different types of skull fractures and intracranial lesions in traffic accidents. Patients examined in surgical emergency Allied Hospital, Punjab Medical College, Faisalabad. Two years from 1st January 1996 to 31 December 1997. In this study, the reports belonging to surviving 250 cases that had head injuries in traffic accidents were examined retrospectively. Data was collected from surgical emergency record office. Collected information was analyzed with descriptive and inferential statistics. The rate of intracranial lesions among the cases with the skull fracture was 39.0%, while the rate of skull fracture among the cases with the intracranial lesion was 50.3% [P<0.001]. Depressed fractures were more in males, while linear fractures were more in females as well as in young males as whole intracranial lesions were less in patients with skull fracture due to lower intra cranial pressure

role of drainage after thyroid surgery. Is it mandatory?

To assess the comparative analysis of usefulness of drains after thyroid surgery. A prospective randomized experimental study conducted over a period of one year, from April 2006 to April 2007. Surgical Unit-I, Allied Hospital Faisalabad. A total of 60 patients presented with Goiter randomly allocated equally to drain and non drain groups. The surgeon was informed of the group just before the closure of wound. Ultrasonography of the neck was done post operatively on Day-1 and Day-4 by same sonologist, each time to assess the fluid collection in thyroid bed. Any change in voice, wound infection or respiratory distress was also recorded. The data was analyzed by descriptive and inferential statistics. Both groups were evenly balanced according to age, gender, size of thyroid gland, volume of resected thyroid gland, type of procedure and time of operation. Overall fluid collection is more in drain group assessed by USG on Day-1 [P=.00] and day Day-4 [P=.04] as compare to nondrain group. Regarding post-operative complications three patients [10%] in drain group and two [6.7%] in non-drain group had change in voice. Three patients [10%] in drain group had prolonged hospital stay as compare to non-drain group in which no patient recorded. Two patients [6.7%]in none drain group developed seroma. putting of drains after thyroid surgery do not show any advantage to non drain group regarding peri-operative complications, rather hospital stay is more in patients of drain group