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.

Relationship of menstrual irregularities to BMI and nutritional status in adolescent girls

To evaluate the effect of Body Mass Index and nutritional status on the menstrual pattern in adolescent girls. Four hundred one adolescent girls who attained menarche were selected from five schools in Hyderabad. The data was collected by trained medical undergraduate and postgraduates by interviewing adolescent school girls using a pre-designed pre-tested questionnaire. BMI was calculated using the formula: BMI [kg/m[2]] = Weight [kg] / Height 2 [m[2]]. Hb was estimated by Sahlis method using a haemoglobinometer. Data was analyzed using SPSS 11.0. The mean age of the girls was 14.96 +/- 1.5 years. Three hundred and five [76%] of the girls had a normal menstrual cycle, twenty-eight [7%] had frequent periods, fifty-two [13%] had infrequent periods and sixteen [4%] of the girls had totally irregular cycles and a pattern could not be determined. Three hundred and five [76%] of girls had a normal menstrual flow, sixty-eight [17%] had heavy flow and twentyeight [7%] had scanty flow. One hundred fifty two [38%] of girls complained of premenstrual symptoms. Two hundred thirty one [60%] girls were clinically anemic. Two hundred and seventy seven [69%] had a BMI between 18.5 - 24.9 kg/m[2]. One hundred and eight [27%] were underweight with a BMI of 14 - 18.49kg/m[2], while sixteen [4%] were overweight with BMI 25 - 29.99 kg/m[2]. A statistically significant relationship was found between BMI and social class [P < 0.001] and BMI and menstrual pattern P < 0.001]. The study concludes that a majority of the girls had clinically obvious nutritional deficiency diseases. Out of the four hundred and one girls who were checked, two hundred thirty one were found to be anemic. Majority of the girls [84%] had a normal menstrual pattern, normal BMI and attained menarche before the age of 16. Overweight girls had infrequent periods