latissimus dorsi flap for the reconstruction of complex chest wall defects: is a polypropylene mesh and a flap enough?

Objective: To determine the outcomes of the use of the Latissimus Dorsi Flap for the Reconstruction of Complex Chest Wall Defects: Is a polypropylene mesh and a flap enough? Study Design: Descriptive case series. Place and Duration of Study: The study was conducted in the department of Plastic and Reconstructive Surgery Shifa International Hospital Islamabad, over a period of 5 years between Jan 2012 and Dec 2016

Material and Methods: All patients with chest wall defects, post tumor resection diagnosed on tissue biopsy, trauma, osteoradionecrosis and infection were included in this study. The chest wall was reconstructed with a polypropylene mesh and the latissimus dorsi flap. All the patients with tumors were discussed in multidisciplinary team meeting. Patients with post coronary artery bypass surgery wounds were excluded from this study. Demographic data including age, sex, histopathological diagnosis of disease and other outcomes were studied

Results: Total 22 patients were included in this study over a period of 05 years, 16 patients with tumors. Age range was 12 to 63 years. Mean follow up time was 3 years. Six patients developed postoperative complications: one patient had partial skin graft loss at the recipient site. Two patients developed partial wound dehiscence one at the donor area and other at the flap inset site. One patient had partial distal flap loss and graft loss at donor area. There was no mortality in our series

Conclusion: Our study revealed that the polypropylene mesh covered with the latissimus dorsi myocutaneous flap is adequate for skeletal stabilization of composite chest wall defects achieving satisfactory functional and aesthetic results

To determine the outcomes of free tissue transfer for large scalp and forehead defects reconstruction

Objective: To determine the outcomes of free tissue transfer for large scalp and forehead defects reconstruction. Study Design: A descriptive case series. Place and Duration of Study: The study was carried out at Plastic surgery department, Shifa International Hospital Islamabad, over a period of 5 years from Mar 2011 to Feb 2016

Material and Methods: All the patients who underwent scalp reconstruction for soft tissue or composite defects greater than 6 cm 2 during the period of 5 years were included in the series and were followed post operatively for 6 months. The patient's demographic data, medical history, surgical history, comorbidities, age, and gender were also analyzed. Indications for surgical intervention included cutaneous malignancy of the scalp, bony tumors, vascular lesions and traumatic tissue loss requiring reconstruction

Results: A total of 20 patients [60% female and 40% male] with mean age of 38.75 years [SD=14.44], who underwent a reconstructive surgery for scalp defect, were assessed. The scalp defect were secondary to tumor resection [n=10; 50%], post-traumatic wounds [n=5, 25%] and resection of vascular malformations [n=5, 25%]. Free flaps used for reconstruction were: Antero Lateral Thigh Free Flap [ALTF] [n=8; 40%], Radial Forearm Free Flap [RFFF] [n=6, 30%], free latissimus dorsi [n=4, 20%] and Transversus Abdominis muscle [TRAM] flap [n=2, 10%]

Conclusion: Scalp and forehead defects, if treated adequately, can heal with stable and aesthetically acceptable results and flap selection should be individualized according to the defects, patient's factors and availability of particular flap

Agreement between serology and histology for detection of helicobacter pylori infection

To determine the percentage agreement between serology and histology for detection of Helicobacter [H.]pylori infection. Cross-sectional analytical study. Department of Pathology and Microbiology, The Aga Khan University and Hospital, Karachi, from January to December 2009. Fifty subjects were selected by non-probability purposive sampling from laboratory data who had serological testing of H. pylori IgG antibody, prior to histological evaluation of endoscopic gastric or/and duodenal biopsies. Serological Quantification of H. pylori IgG was carried out with HpG screen ELISA kit [Genesis Diagnostics, UK], using an enzyme linked immunosorbent assay for detection of IgG antibodies against H. pylori. Manufacturer's recommended cutoff value was used and results were considered positive when greater than 7 U/ml. For histological diagnosis, an expert histopathologist characterized the presence of spiral bacteria in the mucosal layer or the surface of epithelial cells on microscopic examination, as a positive test. An agreement of 0.72 was found by Kappa statistics between serology and histopathology results and a good diagnostic accuracy [86%] of serological testing was observed for the diagnosis of H. pylori infection. A substantial agreement was found between serology and histopathology results to detect the H. pylori infection. Laboratory-based serologic testing using ELISA technology to detect IgG antibodies is inexpensive, noninvasive and convenient method to detect the H. pylori infection in primary care setting.

Iron, folate and cobalamin deficiency in anaemic pregnant females in tertiary care centre at Rawalpindi

Anaemia in pregnancy is a common clinical problem contributing to increased maternal and foetal morbidity. This study was carried out to determine frequency of iron, folate and cobalamin deficiency and associated risk factors in the anaemic pregnant females who reported first time during second and third trimester for antenatal check-up in the tertiary care hospital at Rawalpindi. This case control study was carried out in a tertiary care hospital at Rawalpindi. Two hundred and fifty pregnant women [age: 19-43 years] consisting of 125 anaemic [Hb< 110 g/L] and 125 non-anaemic who reported first time at antenatal clinic were included. Data on socio-demographic characteristics, parity and dietary intake were collected. Complete blood counts were done. Serum ferritin, folate and cobalamin assays were performed by using DPC kits on Immulite-1000. The pregnant women were categorised having mild [Hb up to 54%], moderate [Hb up to 36%], or severe [Hb up to10%] anaemia during antennal visit. They had significantly lower median [range] levels of haemoglobin 96 [40-110] g/L, ferritin 8 [3-142] micro g/L, folate 15 [3-54] ETA mol/L and cobalamin 171 [111-629] RHO moll than controls [p=<0.01]. Micronutrient analysis revealed secondary pregnancy related deficiency of Iron [57%], folate [20%], combined iron and folate [19%] and cobalamin [4%] in the female. Among the risk factors, low income [OR: 7.69], multiparty [OR: 2.93], lack of iron/folate supplementation [OR 2.91] and inadequate dietary intakes [OR 2.51] were associated with anaemia. The pregnant anaemic women had iron [57%]; folate [20%], followed by combined iron folate [19%], and cobalamin [4%] deficiency during first antenatal visit. Low income, multiparty, poor diet and lack of supplements are the main contributor in development of anaemia during pregnancy

Minimally invasive papillary carcinoma of the extrahepatic bile ducts

Invasive papillary carcinomas of the Extrahepatic Bile Ducts [EBD] are uncommon [4-5%]. The course is less aggressive than conventional adenocarcinomas of the extrahepatic bile ducts. Non-invasive and minimally invasive papillary carcinomas are even rarer, behave as in-situ carcinomas and are associated with excellent long-term prognosis. A variety of lesions of the EBD that show papillary architecture should be distinguished from papillary carcinoma. Here, we report a case of papillary carcinoma of the common bile duct showing minimal invasion. Separation of invasive from non-invasive or minimally invasive papillary carcinoma is critical in estimating the patient outcome