Vaginoplasty with bilateral islanded pudendal thigh flaps

Vaginal agenesis is the most common congenital deformity of female pelvis and vaginal reconstruction remains a surgical challenge. There are various surgical and non-surgical techniques described for the reconstruction of neovagina. We have used pudendal thigh flaps raised on either side of the labia to reconstruct the vagina in 19 patients. This study is carried out in the Department of plastic and reconstructive surgery, Hayatabad medical complex Peshawar to evaluate the functional and aesthetic outcome of vaginoplasty with bilateral pudendal thigh flaps. Vaginal reconstruction was done with bilateral islanded pudendal thigh flaps, in 19 consecutive patients with vaginal atresia, during 5 years, from Aug 2004 to Aug 2009. The flaps were raised on either side of labia and sutured to each other in midline to form a vaginal tube. This neo-vagina was inserted into the space between the rectum and bladder and anchored to the deep pelvic tissues. Out of 19, eleven patients [58%] were diagnosed with Mayer Rokitansky Kauser Hauser Syndrome and 8 [42%] with isolated vaginal atresia. The mean vaginal length and width was 9.2 and 4.3 cm respectively one year post operatively. This method of vaginoplasty is simple, safe, and reliable and has shown satisfactory functional and cosmetic results. The reconstructed vagina has a natural angle and is sensate in its lower part. No postoperative stenting or dilatation is required. The donor site in the groin can be closed primarily and the scar is well hidden in the groin crease

Evaluating anatomical subunit approximation technique for unilateral cleft lip repair

To evaluate the outcome of anatomical subunit approximation in unilateral cleft lip of different severity. Seventy four consecutive patients with cleft lip were seen in the outpatient department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex, Peshawar and Plastic Surgery unit at Said Anwar Medical Centre, Peshawar, from 1[st] June 2007 to 31[st] December 2008. The severity was assessed and all of them were operated using David Fisher's anatomical subunit approximation technique. Postoperatively the vertical height of the lip was compared on the cleft and non cleft side along with symmetry of Cupid's bow and philtral column, the alignment of white roll, quality of the cutaneous lip scar, vermilion fullness and vermilion notching. The nose was evaluated by noting the nasal tip symmetry; alar rim level; alar base height and width; and nostril sill size, both pre and post operatively. Seventy two patients showed adequate vertical height and good nostril size, alar base height. Two patients showed 1.0 mm discrepancy of the vertical height as compared to the non cleft side. These belonged to the severe complete cleft lip category. This technique has shown good results in achieving vertical height and nostril size symmetry especially in incomplete and mild to moderate severity of complete cleft lip

Anterolateral thigh flap: versatility and anatomic variations

To determine the pattern of the cutaneous perforator of the lateral circumflex femoral artery in anterolateral thigh perforator flap. Antero lateral thigh flap has become one of the most commonly used flap for the reconstruction of various soft tissue defects. The anterolateral thigh flap is known for variations of its vascular pedicle. Its major limitation has been uncertainty in predicting perforator anatomy, with the occasional absence of suitable perforators and high variability in their size and course. Reconstruction of 13 composite defects in 13 consecutive patients by free microvascular anterolateral thigh flap at the Department of Plastic and Reconstructive Surgery, Hayatabad Medical complex, Peshawar. Thirteen patients were operated and free microvascular anterolateral thigh flap was used. In 12 patients the main vascular supply was through the descending branch of the lateral circumflex artery [LCFA]. One patient has a vascular supply through the transverse branch of the lateral circumflex femoral artery. Transmuscular perforators [mostly 3,] were found in all the patients, commonly arising from descending branch of lateral circumflex femoral artery

Distally based sural fasciocutaneous flap for soft tissue reconstruction of the distal leg, ankle and foot defects

Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the reconstructive plastic surgeon. The options in this region are limited. A durable flap is the preferred option for coverage of such defects. This descriptive study was conducted at Hayatabad Medical Complex and Said Anwar Medical Centre Peshawar over a period of 4 years to evaluate the efficacy of distally based Sural flap in coverage of the lower third of leg, ankle and foot defects, in 25 patients. A descriptive study was conducted at the department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex and Said Anwar Medical centre Peshawar. 25 patients with soft tissue defects over the distal leg and foot were included in this study. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. Out of 25 flaps, 20 showed complete survival [80%]. Partial flap loss was found in 2 patients [8%], marginal flap necrosis in 2 patients [8%] and complete loss in 1 patient [4%]. The distally based sural flap is a versatile and reliable flap for the coverage of soft tissue defects of the distal lower extremity. The procedure is done as a single stage; the dissection is easy with short operating time and minimal morbidity

Management protocol of mandibular fractures at Pakistan Institute of Medical Sciences, Islamabad, Pakistan

Maxillofacial trauma is very frequent and associated with a high incidence of mandibular fractures. Although there is universal agreement as to the treatment goals and basic therapeutic principles of reduction and stabilization, a variety of currently accepted treatment modalities indicate a lack of consensus. The authors evaluate the incidence, etiology, management and complications of 344 mandibular fractures in 228 patients treated in the Department of Plastic and Reconstructive Surgery at Pakistan Institute of Medical Sciences [PIMS], Islamabad, Pakistan, during a three year period. Indications and techniques for closed and open treatment of mandibular fractures are reviewed along with any complications of these fractures or their management. A total of 344 mandibular fractures in 228 patients were included in this study. The sex, age, etiology, presentation, fracture characteristics, associated injuries, various methods of management and any pre or postoperative complications were evaluated. Although various devices and techniques have been used to treat these fractures, modern plate and screw fixation systems have proved to provide the best rigid stabilization, early mobility and associated with least complications. There was a satisfactory bone healing in all the patients and a minimal complication rate associated with open reduction and internal fixation [ORIF]. Mandibular fractures occur with high frequency in road traffic accidents and interpersonal violence. They are among the most common types of facial fractures treated by the plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. Open reduction and internal fixation has proven to be the most effective method for treatment of mandibular fractures

Comparison of Magpi and Mathieu repair in distal hypospadias

To compare the outcome of MAGPI and Mathieu Procedures in the treatment of distal penile hypospadias in children. Material and This prospective comparative study was conducted in the Department of Paediatric surgery Lady Reading Hospital, Peshawar from Jan 2002 to Dec 2002. A total of 40 children with distal hypospadias without chordae were selected. They were divided into two groups. Group one consisted of 20 children with glandular, coronal and subcoronal hypospadias without a groove in the glans penis. For this group MAGPI procedure was performed. Group two consisted of 20 children with coronal and subcoronal hypospadias with a groove in the glans penis. This group was managed with Mathieu procedure. of the two procedures were compared. Age of these boys ranged from one to 10 years. 32 children had coronal and subcoronal hypospadias while 8 had glandular hypospadias. Functional and cosmetic were good in Mathieu procedure but the fistula rate was more as compared to MAGPI procedure. Meatal stenosis was more commonly observed in MAGPI procedure. Observed P valve of 0.02 between two procedure is significant statistically. The MAGPI procedure was found to have better as the fistula rate was significantly less in spite of the frequent meatal stenosis