Short and long term follow up results of [the versatile] reverse sural artery flap

This study was designed to see the long and short term outcome of the reverse sural artery flap.Case series. From January 2009 to December 2011, data was collected and analyzed for this study. Eighty nine patients with wounds on the ankle, heel, sole, distal leg, and foot were included in the study.they were followed up at 01 week, 02 weeks, and then 4 weekly for 06 months and at one year time from operation. They were examined for necrosis, congestion, surgical site infection, dehiscence of suture line, epidermolysis, donor site infection and functional outcome. Most of the flaps healed nicely but two [2.25%] failed completely. Six flaps were delayed. However early follow up [within 04 weeks] revealed that there was partial loss of the distal 1-1.5 cm of flap in 04 patients [4.50%]. Two patients [2.25%] developed superficial surgical site infection. Six patients [6.74%] developed venous congestion of the flaps which recovered within two weeks. Other minor complications included dehiscence of suture line in 3 patients [3.37%], and superficial Epidermolysis in four [4.50%] [Table-2]. Twenty two patients [24.72%] returned to their work in 12-16 weeks, 31 [34.83%] in 16-20 weeks and 36 [40.45%] in 20-24 weeks. Long term follow-up to 06 months revealed hypertrophic scars at the donor site in three patients [4.91%] and recurrence of ulcer in 2 patients [3.27%]. The sural fasciocutaneous flap provides reliable supple and durable most single-stage coverage of wounds of the distal third of the leg, heel, and foot with the results comparable to free-tissue transfer

Reconstruction of non-melanotic facial tumours with local flaps; replacing like with like

To assess the outcome of early skin tumour excision and reconstruction with regards to tumour margin clearance, recurrence and aesthetic results of reconstruction. Quasi experimental. This study was carried in the department of Plastic and Reconstructive Surgery Combined Military Hospital [CMH] Rawalpindi, Pakistan from January 2010 to December 2012. All patients having tumours of the cheek, upper and lower lips, nose and forehead, who underwent primary surgical excision and reconstruction with local flaps, were included in the study. Patients with nodal or distant metastasis were excluded. Tumours were excised with safe margins and defects reconstructed with local facial flaps. Patients were regularly followed up as per protocol for basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]. Eighty nine patients aged between 37-86 years with a mean age of 59.4 years [SD +/- 9.24] were included in the study. There were 58 [65%] cases of basal cell carcinoma [BCC] and 31 [35%] of squamous cell carcinoma [SCC]. Recurrence was seen in 3 [5.2%] cases of BCC and 2 [6.4%] cases of SCC. There was 1 [1.1%] complete and 4 [4.5%] partial flap losses. The follow-up period ranged from 4 months to 3 years with average of 16 months. Local flaps give a simple option for facial reconstruction for postoncological resection defects giving good aesthetic match due to local tissue

Ondansetron versus combined dexamethasone and metoclopramide in prevention of nausea and vomiting after laparoscopic cholecystectomy

To compare the efficacy of combined metoclopramide and dexamethasone with ondansetron in preventing nausea and vomiting after laparoscopic cholecystectomy. Randomized controlled trial. Surgical Unit I Combined Military Hospital Rawalpindi, from 1[st] June 2010 to 3[rd] January 2011. A total of 120 patients were observed for 24 hours after elective laparoscopic cholecystectomy for nausea and vomiting and divided into two groups of 60 patients each. Nausea and vomiting was rated by the patients according to a three point scale [O=no nausea and vomiting, 1= nausea, 2= retching or vomiting]. Early postoperative nausea and vomiting was not present in 31[51.7%] patients of group 1 and 40[66.7%] of group 2 [score = 0]. In 11[18.3%] patients of group 1 and 12 [20.0%] of group 2 only nausea was present [score = 1], while 18[30.0%] patients in group 1 and [13.3%] in group 2 scored 2.The late postoperative nausea and vomiting was not present in 21[35.0%] patients in group 1 and 37[61.7%] in group II [score = 0]. In 28 [46.7%] patients in group 1 and 22[36.7%] in group 2 nausea was present [score = 1] while 11[18.3%] patients of group 1 and 1[1.7%] in group 2 scored 2. Ondansetron was effective as compared to combined metoclopramide and dexamethasone in prevention of post-laparoscopic cholecystectomy nausea and vomiting

Ultrasonography in obstructive jaundice

To evaluate the validity of ultrasonography in patients who have obstructive jaundice. Descriptive study. The study was carried out from September 2006 to May 2008 in department of Radiology Combined Military Hospital Quetta. A total of 30 patients; 14 male and 16 female underwent operation for obstructive jaundice. All of them had preoperative ultrasonography. The site and nature of biliary obstruction were noted and the accuracy was determined with pre-operative findings/ histological diagnosis as gold standard. The cause of obstructive jaundice identified by ultrasonography with reasonable sensitivity of 90% and specificity of 90% for choledocholithiasis and sensitivity of 95.2% for pancreatic head tumors. Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and shows reasonable sensitivity and specificity to identify causes of obstruction jaundice

unique presentation of unexploded ordnance in a patient

Rocket injuries in the war are common,but the retained unexploded rocket injury is quite rare and uncommon. We report an unusual case of unexploded rocket in knee area that required removal with unique safety measures, so as to prevent patient from potentially catastrophic situation

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.

Comparison of simultaneous and sequential repair of bilateral inguinal

Comparison of morbidity and short term complications of simultaneous bilateral inguinal hernia repair with sequential repair of bilateral inguinal hernia. Quasi-experimental study. Surgical department of CMH Rawalpindi from 19-8-2005 to 11-6-2006. In the study 50 patients underwent inguinal hernia repair, 25 underwent simultaneous bilateral repair [Group I] while the other 25 patients underwent sequential repairs with a variable time duration in between [Group II]. Results were recorded on a pre designed proforma. The number of days spent in the hospital by patients in group I was significantly less [4.8 days] than patients in group II [9.6 days]. The need for narcotic analgesics was also significantly increased in group II patients [19 as compared to 8]. The post operative complications were comparable in both the groups [6 in group I and 9 in group II]. A tension free technique allows bilateral inguinal hernias to be repaired during one operation with similar outcomes as unilateral tension free repair and less hospital stay than sequential repair

Comparison of frequency of heamaturia with rapid and slow decompression of urinary bladder in the management of chronic urinary retention

The objective of this study was to compare frequency of haematuria after slow decompression and rapid decompression of urinary bladder in the management of chronic urinary retention. Quasi experimental study. This study was carried out in Combined Military Hospital Quetta from May 2007 to Nov 2007. Sixty patients fulfilling the inclusion criteria were randomly assigned to two equal groups. Group A was subjected to intermittent clamping of Foley catheter and group B was subjected to no clamping of Foley catheter. On insertion of Foley catheter sample of urine was taken in a test tube and saved. A second sample was also taken in another test tube after one hour of complete decompression of either group and compared with original sample for occurrence of haematuria. Frequency of haematuria was calculated after both the procedures and recorded. confounding variables were traumatic catheterization and patients who were taking anticoagulants or having bleeding disorders. These were controlled by including only those cases where catheter was passed atraumatically by registrar surgery. The frequency of haematuria was found to be equal in both groups. Rapid decompression of the urinary bladder in cases of chronic urinary retention is a safe and convenient method of decompressing the urinary bladder in patients of chronic urinary retention, without any increase in frequency of haematuria

Mastalgia comparison of topical non steroidal anti inflammatory drugs with evening primrose oil

Mastalgia is a common clinical symptom experienced by up to 70% of women at some stage of their life. A wide variety of therapeutic agents are available for the treatment of mastalgia. Both evening primrose oil and non steroidal anti-inflammatory drugs have been assessed in randomized controlled trials and demonstrated to be effective. The objective of this Quasi experimental study was to compare the efficacy and safety of topical nonsteroidal anti-inflammatory drugs with evening primrose oil in the treatment of mastalgia. We studied 90 females patients presenting the breast pain from 25 July 2006 to 25 July 2007 at the surgical outpatient department of CMH Kharian. The patients were divided into three groups. Group-1 was given capsule Effamol [evening primrose oil], group-2 topical brufen gel and group-3 topical Vaseline for two months. Patients were followed every two weeks for two months. Response was assessed using Cardiff breasts pain score. Side effects of drugs were recorded at each follow up. Out of 30 patients of group-1, 14 [46.6%] had clinically significant response at the end of 8 weeks treatment as compared to 27 [90%] in group-2. 5 [16.6%] patients of group-1 showed mild side effects while none in group-2 had any side effect. P-value was <0.0001 showing highly significant difference between 2 groups. Topical nonsteroidal anti-inflammatory drugs are safe and effective as compared to evening primrose oil in the treatment of mastalgia

Eliciting explanatory models of common mental disorders using the short explanatory model interview [SEMI] urdu adaptation - a pilot study

The purpose of this pilot study was to describe the presenting symptoms and its explanation from the patients' perspective of GHQ [General Health Questionnaire] from SEMI [Short Explanatory Model Interview]. Though there was no consistency in the presenting symptoms of GHQ positive cases on presentation to a general practitioner, all described their problems as intense, less than 2 years on onset and on reflection located its origins in their social worlds. These findings have implications in terms of providing preliminary data for a larger study, perhaps looking at development of psychosocial interventions for treatment of mental distress in our local context as it seems to have its origins in their social worlds