Maxillofacial trauma: Current practice in management at Pakistan institute of medical sciences

This study was carried out to determine the aetiology, pattern and management of maxillofacial injuries at PIMS, Islamabad. This descriptive study was conducted at Plastic Surgery Department, PIMS Islamabad from 1st February 1998 to 30th April 2002. All the adult patients presenting with maxillofacial injures were included where as patients less than 12 years of age and only facial lacerations were excluded. Similarly isolated nasal bone fractures were also excluded because these patients were routinely managed by ENT department. Age, sex, presentation, aetiology, associated injuries and treatment modalities undertaken in these patients were recorded. In 164 patients 254 fractures were noted. Most were male [86%], ranging in age from 13'71 years with a male to female ratio of 6:1 respectively. The most frequent [48%] cause noticed was road traffic accidents followed by assault. Mandible was the commonest to be involved in such injuries followed by maxilla. Most of the patients [32%] had associated facial injuries. Various treatment modalities were practiced. Maxillofacial fractures should be managed by open reduction and internal fixation as early as possible

comparison of two fasciocutaneous flaps in the reconstruction of defects of the weight-bearing heel

To compare the indications, ease of elevation, operative time, complications and durability of two fasciocutaneous flaps i.e. sensate medial plantar artery flap and distally based sural artery neurocutaneous flap, used for the coverage of weight bearing heel in young ambulant adults. Design: A comparative study. Place and duration of study: CMH Rawalpindi and PIMS Islamabad during the period from May 1995 to April 2002. Patients and All the patients fulfilling the inclusion criteria discussed later in the text were divided into two groups. Twenty patients underwent a medial plantar artery flap [MPAF] while 30 had their defects reconstructed by a sural artery neurocutaneous flap [SANF]. The mode of presentation was noted in each case with a special note of the etiology. Postoperatively the patients were followed-up to evaluate any early or long-term complications. The MPAF group consisted of 20 patients including 16 males and 4 females with a mean age of 28 years [range 22 to 37 years]. The SANF group consisted of 30 patients including 29 males and only one female with a mean age of 30 years [range 23-38 years]. In both groups a majority of patients presented with a history of road traffic accidents and was managed by delayed primary procedure. The duration of the operation was considerably less in SANF coverage i.e., 50-100 minutes compared to 120-190 minutes for the MPAF. Flap survival was 100% in both the groups. The postoperative complications were more in patients who underwent SANF. Complete weight-bearing was started at 6 weeks in medial plantar artery flap whereas the same started 6-8 weeks in sural artery neurocutaneous flap. Average time for return to work was 8 weeks in medial plantar artery flap but it was double [12 weeks] in sural artery neurocutaneous flap. The medial plantar artery flap provides sensate and the same quality skin cover to the weight-bearing heel as compared to the distally based sural artery neurocutaneous artery flap. The medial plantar artery flap procedure is longer to perform but allows early weight-bearing with less complications than the distally based sural artery neurocutaneous flap