Reducing the donor site morbidity in radial forearm free flaps by utilizing a narrow radial forearm free flap

BACKGROUND: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site. METHODS: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor defects were closed primarily. The Stony Brook Scar Evaluation Scale and comparison with the contralateral hand were used to assess aesthetic and functional outcomes, respectively. RESULTS: A total of 24 patients underwent nRFFF procedures during the study period. The donor arm showed excellent motor function in 22 cases (91.7%), and very good function in the remaining two cases (8.3%). The aesthetic outcomes were excellent in four patients (16.6%), very good in eight patients (33.3%), good in 10 patients (41.6%), and fair in two patients (8.3%) who developed a hypertrophic scar. All flaps were successful and there were no cases of partial or complete loss. CONCLUSIONS: For small to medium-sized soft tissue defects, the nRFFF had acceptable outcomes due to its thinness, pliability, and major reduction in donor site aesthetic and functional morbidity.

Report: antibacterial, antifungal, phytotoxic, antioxidant and hemagglutination activities of organic fractions of Arisaema tortuosum

In the current study, the antimicrobial, phytotoxic, haemagglutination and antioxidant potential of crude methanolic extract [Crd. MeOH Ext.] and four organic fractions of Arisaema tortuosum was investigated. All fractions have been screened for antimicrobial properties against eight bacterial pathogens and six fungal pathogens using agar well diffusion and tube dilution method, respectively. Furthermore, the organic fractions were also screened for its phytotoxicity against Lemna minor. Haemagglutination was performed against all human blood groups while free radical scavenging activity was performed to investigate the antioxidant potential of A. tortuosum. Results obtained for antibacterial activity exhibited various degree of zone of inhibition and significant activity was observed for Pseudomonas aeruginosa [27.16 +/- 0.60] followed by Bacillus cereus [18.55 +/- 0.69] for Crd. MeOH Ext. and chloroform [CHCl3] fraction, respectively while some strains showed resistant at same concentration. Similarly, non-significant antifungal activity was observed for the plant extracts. However, the highest activity among the strains was observed for Alternaria alternata [22 +/- 1.24%] and Aspergillus niger [20 +/- 1.00%] for ethyl acetate [EtOAc] fraction and Crd. MeOH Ext., respectively. The plant extracts showed good phytotoxic activity with 77.06% inhibition for n-hexane fraction at 1000microg/mL. The result of Nitric Oxide [NO] reducing assay revealed that the plant has less antioxidant activity with 46.06% inhibition for CHCl3 fraction at 900microg/mL. For haemagglutination assay, the result displayed no agglutination in all the testing concentration. Based on the current results, it can be concluded that A. tortuosum has significant antimicrobial and moderate phytotoxic potential and therefore can leads to antibiotics and herbicide production

Household teaspoon and oral liquid medication: the present scenario

To determine the parental dosing errors in administering oral liquid medication to pediatric population. Cross sectional study. Department of Pediatric Surgery Civil Hospital and Pediatric Medicine Lyari General Hospital Karachi, from February 2009 to September 2009. Parents of children admitted were enrolled in the study. They were asked to measure one teaspoonful [5 ml] of paracetamol syrup from the tray containing household spoons of different sizes. The amount filled by the parents was measured by 5 ml syringe. Accurate dose was defined as 5.0 ml while an acceptable dose was 5.0 +/- 0.5 ml [4.5 ml - 5.5 ml] according to National Formulary and USP Standards of a + or - of 10% of error dosage range for oral devices. A total of 530 parents participated in the study. The age of the participants ranged from 16 year to 55 year [mean= 28.93 +/- 6.6 year]. Only 118 [22.3%] participants measured accurate dose while 164 [30.9%] measured the acceptable dose and 366 [69.1%] participants measured inaccurate dose. Accuracy in measuring household teaspoon quantity was not associated wirh parents' age [p >.05], education [p >.05], cooking experience [p >.05] and previous drug administering experience [p>.05]. Household teaspoons were unreliable when measuring and administering liquid medication to pediatric population. Oral syringe is recommended as the best device for both measuring and delivering liquid medication

Comparison of urine with plasma neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after cardiopulmonary bypass surgery

To compare the accuracy of urine with plasma neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] following cardiopulmonary bypass [CPB] surgery. A prospective cohort study. Department of Chemical Pathology and Endocrinology, AFIP from December 2011 to July 2012. Ninety three adult patients planned for CPB surgery in AFIC/NIHD were consecutively included. Blood for serum creatinine were collected preoperatively, 4, 24 and 48 hours [h] after CPB surgery. Blood and urine samples for NGAL analysis were collected only at 4 h. Serum creatinine, plasma and urine NGAL samples were analyzed on UniCel[R] DxC 600 [Beckman], TRIAGE meter pro [Biosite] and ARCHITECT i2000SR analyzer [Abbott] respectively. Out of 93 patients undergoing CPB surgery, 12 [13%] developed AKI. AKI patients had significantly higher median interquartile range [IQR] urine NGAL of 180 ng/ml [105-277 ng/ml] as compared to control of 6 ng/ml [2-15 ng/ml] and median plasma NGAL of 170 ng/ml [126-274 ng/ml] as compared to control of 75 ng/ml [61-131 ng/ml]. The patients had increased urine vs plasma NGAL area under curve [AUC] [0.91 vs 0.70 [p = <0.001]], better sensitivity [91% vs 82%] and specificity [98% vs 65%]. Plasma and urine NGAL values increased significantly in AKI patients as compared to serum creatinine values. Urine in comparison to plasma NGAL revealed more sensitivity and specificity in detecting AKI following CPB surgery

Rapid detection of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass surgery

To determine the accuracy of neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] after cardiopulmonary bypass [CPB] surgery by comparing with serum creatinine. Descriptive study. Department of Chemical Pathology and Endocrinology, AFIP in collaboration with AFIC/ NIHD, Rawalpindi, from April to December 2011. Eighty eight patients undergoing CPB surgery in AFIC/NIHD were included by consecutive sampling. Blood samples of subjects for serum creatinine analysis were drawn pre-operatively, 4 h, 24 h and 48 h after CPB surgery. Spot urine samples for NGAL were collected at 4 h after CPB surgery. Urine samples were analyzed on Abbott ARCHITECT i2000SR analyzer whereas serum creatinine samples were measured on Beckman UniCel DxC 600 Synchron Clinical System. Out of 88 patients, 11 [13%] cases developed AKI 4 h postoperatively. Urinary NGAL increased markedly at 4 h postoperatively as compared to serum creatinine which showed rise at 24 - 48 h after cardiac surgery. Analysis of urine NGAL at a cutoff value of 87 ng/ml showed area under the curve of 0.91 [95% confidence interval [Cl] 0.83 - 0.96] with sensitivity of 90.9% [95% Cl 58.7 - 98.5] and specificity of 98.7% [95% Cl 92.9-99.8]. There was a positive correlation of 4 h urine NGAL and serum delta creatinine at 48 h, which was statistically significant [r[s] = 0.33, p = 0.001]. The study demonstrated that levels of urine NGAL in patients suffering from AKI increased significantly at 4 has compared to serum creatinine levels. Urine NGAL is an early predictive biomarker of AKI after CPB

Spontaneous per urethral expulsion of gossipibyoma - a rarity

Foreign bodies left accidentally during a surgical procedure are rare. In spite of careful intra-operative precautions and gauze counts mistake still occurs. Many of these cases present with sepsis, the foreign body may erode hollow viscera with and without signs of peritonitis and discovered on laparatomy. These foreign bodies may remain silent for years. We are reporting an interesting case of an 11 years old girl who presents with gauze piece coming out of her urethra 4 years after cystolithotomy and right ureterolithotomy. Such cases of intraluminal migration and spontaneous expulsion of foreign body are rarely reported

Knotting of urethral catheters: a preventable complication

A number of complications are associated with Urethral catheterization. Feeding tube is usually used for this purpose in children. Spontaneous intravesical knotting of such urethral catheters is a known but rare complication. We are reporting two cases of intravesical knotting of feeding tube used to drain bladder in patients who underwent urethroplasty

Congenital segmental dilatation of sigmoid colon, penile agenesis and umblical cord hernia: a new association

Congenital segmental dilatation of the colon, penile agenesis and umbilical cord hernia are individually rare congenital malformations. An association between all three malformations has not been previously reported. We report a neonate with congenital segmental dilatation of the colon, penile agenesis and umbilical cord hernia all coexistent in a new born

Modification of mathieu procedure to repair anterior hypospadias

To assess the results of one-stage repair of anterior hypospadias using modified Mathieu procedure. An interventional study. Department of Paediatric Surgery, Dow Medical College and Civil Hospital Karachi, from September 1997 to December 2003. Patients and All the patients with anterior hypospadias without or with minimal chordee were included. Patients with hypoplastic urethra or re-do surgery were excluded. Modified Mathieu repair was performed in all cases. The modifications used were interrupted inverting sutures of 5/0 polyglycolic acid for urethroplasty; neourethra covering with subcutaneous [dartos] pedicle flap, developed from the preputial or penile shaft skin and dorsal / anterior meatotomy for meatal stenosis. A total of 69 patients with anterior hypospadias were operated using modified Mathieu's repair. Only two patients [2.89%] developed urethrocutaneous fistula. Five patients developed partial devitalisation of the covering skin while one patient had complete breakdown. Modified Mathieu's procedure is an effective method, to repair the anterior hypospadias without or with minimal chordee

role of sclerotherapy in rectal prolapse and it's combination with Thiersch's ligature in refractory cases

This prospective study was conducted in the Department of Paediatric Surgery, Civil Hospital, Karachi on all patients with rectal prolapse who underwent sclerotherapy [ST] alone or in combination with Thiersch ligature from April 1994 to December 2003, to assess the efficacy of sclerotherapy in rectal prolapse [RP] and the role of combination of ST with Thiersch ligature[TL] in refractory cases. Out of the 104 patients that underwent sclerotherapy, 69 were males and 35 females, with an age range between 13 months to 12 years. After one session of sclerotherapy the cure rate was 86% [89 patients] and after second session 91% [95 patients], the remaining nine patients responded to Thiersch ligature with 3rd session of sclerotherapy. Postoperative complications were minimal. It is therefore concluded that sclerotherapy is a cheap, safe and effective method of treatment for paediatric rectal prolapse not responding to conservative treatment

Onlay island flap in the repair of mid and distal penile hpospadias without chordee

A prospective study was conducted on 13 patients with mid and distal penile hypospadias [without chordee] to study the out come of Onlay Island Flap repair in the Department of Paediatric Surgery of Dow Medical College and Civil Hospital Karachi from July 1997 to August 2003. Excellent cosmetic results were obtained in 12 patients. Only one patient developed urethrocutaneous fistula, which was successfully repaired. It is, therefore, concluded that the onlay island flap technique is a very good procedure for midpenile hypospadias without chordee and in patients with distal penile hypospadias with deficient ventral skin

Laparoscopy in the evaluation of impalpable testes

To examine the role of laparoscopy in the evaluation of the non-palpable testes. Design: A descriptive study. Setting: The study was conducted in the Department of Pediatric Surgery, Dow Medical College and Civil Hospital Karachi, some of the private hospitals from July 1997 to July 2003 and Pediatric Surgical unit B, National Institute of Child Health, Karachi, from January 2001 to July 2003. Patients And All the patients with impalpable testes had ultrasound examination and were evaluated laparoscopically. Twenty patients with 25 impalpable testes were seen during the study period. Ultrasound examination was inconclusive in all cases. Laparoscopic examination was helpful in the diagnosis of presence or absence of impalpable testes in all cases. Laparoscopy is a safe reliable and effective method for the evaluation of impalpable testes

Epididymal abnormalities associated with undescended testis

To identify and record the number and type of epididymal abnormalities [EA] associated with undescended testis and its correlation with the location of the testis. Design: Descriptive study. Place and Duration: Department of Pediatric Surgery, Dow Medical College and Civil Hospital, Karachi Patients And All patients with undescended testis operated in this unit from September. 1997 to October 2003 were included. Clinical data and surgical findings were recorded. A new method of classification for the anomalies was employed to make comparison between various studies easy and meaningful. A total of 107 testes in 97 patients were operated. Epididymal anomalies were found with 37 testes. Obstructive anomalies were found with 19 testes and non obstructive anomalies were found with 18 testes. Obstructive anomalies were more frequent with the testes located high up in the inguinal canal or intra-abdominally. Undescended testes that are non-palpable and located high up are more likely to have associated epididymal anomalies causing obstruction to the sperm conducting pathway

Trichobezoar and gastric polyps: a rare association

A 10 year old female child presented with upper abdominal pain and huge abdominal mass in epigastrium extending to both hypochondria and umbilical regions. Investigations revealed a trichobezoar with gastric polyps. At operation, a large trichobezoar occupying almost whole of the stomach was removed along with gastric polyps. Biopsy suggested hyperplastic polyps