Versatality of supraclavicular flap in neck, face, and upper chest region coverage

The objective is to analyze the utility of theisland supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Prospective descriptive study. The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Atotal of 30 patients were included 20 [66.6%] male and 10 [33.3%] were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 [73.3%] while 8 [26.6%] require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4[13.3%] cases. 1 [3.3%] flap failed completely and the defect was covered with a skin graft. We had 01 [3.3%] mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 [60%]. Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap for oral/ facial defects

Management of war injuries - experience at CMH Rawalpindi during 2008 - 2010

To see the changing mode of injury from firearm to blast, pattern of injury with modern body armor and improved surgical options with results of different procedures done. Descriptive study. Department of Plastic Surgery Combined Military Hospital Rawalpindi between Jan 2008 and Dec 2010. All victims of low intensity conflict whether civilian or military personnel from all age groups without sex discrimination were included. Data was collected from history, transferring notes from the forward medical facility to this hospital, case record documents in this hospital and `patients follow up proforma. All these cases were managed in collaboration with other concerned specialties including orthopedic surgery, general surgery, otolaryngyology, maxillofacial surgery and vascular surgery. Plastic surgery department managed 212 patients over last three years i.e. 2008-2010. Age range was 14-58 years and male to female ratio was 71:1. Primary surgical wound management was done at field military hospitals in majority of cases and few were air evacuated directly to CMH Rawalpindi. Majority of injuries were caused by explosions followed by firearms. Simultaneous injuries were 68.9% and isolated injuries were 31.1%. Decision of wound closure was usually dependent on level of tissue damage, contamination and infection. Concept of reconstructive ladder was followed. Majority of wounds were closed in delayed primary setting. Infection was the most common complication followed by partial or complete graft or flap loss. Minimum complication rate was encountered in the wounds which were closed in delayed primary setting. All war wounds are primarily contaminated. If these wounds are closed in delayed primary setting after 2-3 debridements, best results can be achieved. Although infected wounds, wounds with severely damaged structures and injuries associated with tendon or nerve injuries or bone loss will require secondary reconstructive procedures.

Frequency of duodenal ulcer perforation with radiological evidence of pneumoperitoneum

To determine the frequency of duodenal ulcer perforation with radiological evidence of gas under the diaphragm on X-ray chest. Descriptive. Department of Surgery Combined Military Hospital [CMH] and Military Hospital [MH], Rawalpindi, from Nov, 2005 to May 2006. Patients with acute abdomen presenting as emergency at CMH and MH Rawalpindi were evaluated. Preoperatively X-ray chest PA view, in standing posture, was done in all cases and presence or absence of pneumoperitoneum noted. The patients were then followed by laparotomy to confirm or otherwise a perforation of duodenum. Only 30 patients were included in the study where duodenal perforation was confirmed per-operatively. Pneumoperitoneum on X ray chest PA view was found in 25 [83.3%] out of 30 patients with duodenal ulcer perforation; The remaining 05 patients i.e. 16.67% did not show pneumoperitoneum. X-ray chest is a helpful tool in diagnosing majority of patients with a perforated duodenal ulcer. However there is a significant number of patients where the clinical acumen of the doctor would help in an early diagnosis and prompt treatment