Our experience of pectoralis major myocutaneous pedicled flap

The pectoralis major myocutaneous pedicle flap [PMMPF] has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity [25 patients]; oropharynx/ hypopharynx, [7 patients]; and neck or face [5 patients]. Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients [67.59%] had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed

Aetiology of pancytopenia

Pancytopenia is a reduction in the number of each type of peripheral blood cell. Therefore the role of bone marrow examintion in diagnosis of pancytopenia is important to know etiology of pancytopenia. The objective of the study was to know the aetiology of pancytopenia. This descriptive [Cross sectional] study was carried out in Khyber teaching hospital. Fifty patients with pancytopenia were included in the study from 1[st] January 2008 to 30[th] October 2008. Full blood counts, bone marrow examinations and trephine biopsies were performed according to standard methods. Statistical packages for social science [SPSS.11] was used to analyze data. Out of 50 patients, 36% were of aplastic anaemia, 16% megaloblastic anaemia, 14% myelodysplastic syndrome and 12% acute lymphoblastic leukemia [ALL], Hypersplenism in 10%, 4% non Hodgkin lymphoma [NHL] and 4% multiple myeloma, 2% each of acute myeloblastic leukemia and chronic myelocytic leukemia. All of these disorders were common in male as compared to female. Aplastic anaemia was the commonest cause of pancytopenia followed by megaloblastic anemia and myelodysplastic syndrome in our study

Intertrochanteric fracture of femur; outcome of dynamic HIP screw in elderly patients

Intertrochanteric [IT] fracture is common in elderly population. The dynamic hip screw is widely accepted in the treatment of IT fractures of the proximal femur. To determine the outcome of dynamic hip screw in intertrochanteric fracture of femur in elderly patients. A descriptive observational study Department of Orthopaedic Khyber Teaching Hospital, Peshawar. Period: From 7[th] Jan 2008 to 7[th] Jan 2009. 113 consecutive patients with intertrochanteric fracture of the femur treated with dynamic hip screw. All patients were investigated and optimized for surgery. An accurate close reduction was done under fluoroscopic control. A dynamic hip screw [DHS] was inserted by a standard technique. Patients were reviewed clinically and radiographically on 2nd, 6th, 12th and 24th weeks. We studied 113 Patients of intertrochanteric [IT] fracture, 13 patients were lost to follow up and the study was completed on 100 patients. Forty seven [47.0%] patients were male and 53 [53.0%] were female. Postoperatively seven patients [7%] suffered from infections, 3 [3.0%] patients suffered from restricted hip joint movements. There was shortening of lower limb in 3 [3.0%] patients, 2 [2.0%] patients developed non union of the fracture site, 1 [1.0%] patient develop varus deformity. Seven [7.0%] patients had implant failure, 3 of which have lag screw cut-out through superior cortex, 3 patients have broken leg screw at barrel shaft junction and 1 patient has broken leg screw at 3 sites. 77 [77.0%] healed without complications. It is concluded that the Dynamic Hip Screw is safe, suitable and reliable method of fixation for Boyd and Griffin type I and type II intertrochanteric fracture of femur

Management of closed tibal shaft fractures with reamed inter locking nail

The objective of the study was to evaluate the results of closed reamed interlocking nail in the management of closed tibial shaft fractures. Descriptive Observational study Place and Duration: This study was conducted in the Department of Orthopedic, Khyber Teaching Hospital Peshawar, from Jun 2007 to December 2008. A total of 32 patients above the age of 18 years were included in the study. Patients were admitted through accident and emergency department. Written informed consent was obtained from all patients. Detailed history was asked, every patients was assessed clinically and radiographycally. Reamed interlocking intramedullary nailing was done as per protocol. Patients were followed for 1 year, and were evaluated for union, infection, range of motion of knee and ankle and implant problems. 2 patients were lost to follow up and the study was completed on 30 patients. All the fractures united without any need for bone graft. Simple fractures united in average period of 12.5 weeks while comminuted and segmental fractures took longer by four weeks, and united in an average of 16.5 weeks. Two patients developed superficial infection at the site of screws which were treated accordingly with drainage and antibiotics and removal of the distal screw. All the patients had full range of knee movement while 28 patients had full range of ankle movements. The remaining two patients had 15-20 degree loss of ankle dorsiflexion. Nail breakage was not observed in any patient while two had breakage of the proximal and two had breakage of distal screws. We concluded that closed intra medullary nailing for closed diaphyseal fracture of the tibia is a safe and rewarding technique which has high rate of union and relatively low complications rate, there is early return to activities

Our experience with macrodactyly: a rare congenital anomaly

To present our experience with [Macrodactyly] a rare congenital anomaly and its associated anomalies. Macrodactyly is an increase in the size of one or several fingers or toes. The overgrowth is limited to or predominantly affects the digits. It is characterized by an increase in all mesenchymal elements particularly fibro-adipose tissue. It does not appear to be an inherited condition and is thought to be caused by abnormal nerve supply, abnormal blood supply or abnormal humeral mechanisms. Pathologically, they are benign, soft tissue growths. Macrodactyly is commonly an isolated condition but other congenital anomalies are associated with it. It can be static or a progressive disorder. Soft tissue debulking, phalangectomies, ray resection, ostetomies and arthrodesis of interphalangeal joints are different modes of treatment. Descriptive case series. This study was conducted in Plastic Surgery Unit of Hayatabad Medical Complex Peshawar and Orthopaedic unit of Khyber Teaching Hospital, Peshawar from April 2007 to December 2009. A total of 32 patients were registered during the study period. Patients were admitted through out patient department, written informed consent was obtained from all individuals. Detailed history was taken, every patients was assessed clinically and radiologically. All patients were followed for recurrence. 2 patients were lost in follow up and the study was completed on 30 patients. Mean age of the patients was 13.7 years. Out of 30 patients, 19 were male and 11 were female. Hands were involved in 20 patients and feet in 10 patients. There was no bilateral hands or feet involvement. Eighteen patients had progressive and 12 patients have static macrodactyly. Seventeen patients had isolated macrodactyly while in 13 patients macrodactyly was associated with other congenital anomalies most commonly syndactyly. Most commonly involved digit was index finger in hand and big toe in foot. Macrodactyly is a rare congenital anomaly but cosmetic and functional disability of the patient is significant. Although it is mostly isolated but a significant number of cases were associated with other congenital anomalies which necessitate further research in this field