Re-operation after abdominal procedures lesion learnt from our two years experience

The objective of the study are to audit our experience of the management of cases presenting with operative complications requiring acute re operation and to identify the factors resulting in the first operation failure requiring re-exploration. A prospective observational/analytical study. Acute re-operative abdominal surgery during two years period 2002-2003 in surgical Unit 1 Allied hospital, Fiasalabd. All the cases which were re-explored after abdominal surgery admitted in surgical unit 1, Allied hospital, Faisalabad are included in the study. The cases fall in three categories, trauma cases [29] 33.71%, non trauma emergency cases [32] 37.25 and elective surgery cases [25] 29.1%. The incidence of our own unit cases subjected to re-operation is 21.9% [24]. The presenting pathologies after first operation are in 6 groups; Gastrointestinal fistulas [38 cases] 41.8%, bowel obstruction [7 cases] 8.15%, abdominal abscesses [12 cases] 13.9%, bleeding [18 cases] 20.9%, miscellaneous [biliary and G.U.] [8 cases] 9.35, abdominal wound dehiscence and evisceration [3 cases] 3.6%. Total of 136 complications are in 70 cases. Mortality of 7 cases [8.14] is shared by the semi-trained surgeons, Medical officer operators [6 cases] and the trainee surgeons [1 case]. Incidence of mortality in elective surgery cases is 4% in trauma cases 10.34%, non trauma emergency cases 9.4%. Intensive resuscitation including nutritional support, team of senior consultants doing the re-operation, intra-operative and post operative monitoring are the hallmarks of the management. Training and retraining [continuous medical education] of surgeons and regionalization of trauma cases are recommended. The facilities for less invasive procedures blessed with low morbidity and very low mortality will shrink this list of re-operations

Managment of post burn contracture of neck

It is a prospective analytical study. 43 patients admitted during JAN 2001 to DEC 2002 who presented with severe functional [25 patients] of cosmetic impairment [27 patients]. We selected 4 different options to manage the patients. [1] Release of/or excision + thigh grafts [2] Release of/or excision + wolfm [3]Thick therish + local flap [4] Musculocutaneous flap. Out of 43 patients 27 were females and 16 were male and the age varies from 4-45 years. Out of 28 patients a [1] 25 given satisfactory and excellent results, and 5 out of Six patients a [2] and 4 out of 5 with [3] gave excellent results. To evaluate the outcome of different options for the management of PBNC we are presenting our 2 years experience of PBNC Neck in 43 patients from January 2001 to December 2002 who were admitted through surgical outdoor of Teaching Hospitals of PMC, Faisalabad. In our set up most of the patients presented with severe functional [25 patients] and cosmetic impairments [27 patients out of 43] because of late presentation, delayed treatment, poverty and lack of proper medical facilities. We selected 4 different options to manage these patients accordingly i.e. [1] release or and excision of contracture and thick split skin graft, [2] release or and excision of contracture and full thickness skin graft, [3] thick split skin graft and local flap, [4] musculocutaneous flap, giving satisfactory to excellent results in 25 out of 28 patients, 5 out of 6 patients and 4 out of 5 patients respectively. Thick split skin grafting after release or/and excision of contracture with strict advice of wearing cervical neck collar remained our mainstay of treatment because it was one of the best practical options to deal with severe PBC Neck while other options being reserved for difficult and recurrent cases. Thick split skin grafting is an easy, cost effective, reliable and compliant to the patient. Furthermore thick split skin grafting is a simple procedure whi ch may be carried out by any general surgeon with reserve for referred for the difficult cases