RESUMEN
Objective: To share the experience of vacuum assisted closure therapy in private setup
Design: Descriptive
Setting: A private clinic for Aesthetic Plastic Surgery, Rawalpindi - Pakistan
Study Period: June 2005 to June 2008
Materials and Methods: The vacuum assisted closure [VAC] therapy was used in 35 patients suffering from the open wound involving various anatomical areas. All the wounds had failed to heal after treatment with multiple wound dressings and debridement. Before the application of VAC, surgical debridement was performed to remove all the devitalized necrotic tissues, and the wound was packed with povodine/iodine [Pyodine[registered sign]]. VAC was applied after 24 to 48 hours. Tissue cultures for micro-organisms were obtained before the application of VAC and at the end of VAC therapy. Wound dimensions were noted prior to and at the end of VAC, before the definitive treatment using skin graft or flap was performed
Results: Thirty-five patients were included in this study with male to female ratio of 1.7:1. Majority [40%] of the patients were 31-40 years of age. Road traffic accident was the commonest cause [31.4%] followed by diabetic ulcers [17.1%]. Leg was most commonly effected area [31.4%]. There were 28.6% diabetics, 22.9% smokers and 20% hypertensives among study subjects. Mean wound size decreased from 12.64x9.68-cm to 10.4x8.32-cm in non-diabetics, and from 10.5x8.7-cm to 9.0x6.4-cm in diabetic patients. Mean hospital stay was 24.4 days in nondiabetics as compared to 42.6 days in diabetics. Average 11.6 VACs were performed in diabetics, and 6.9 in non-diabetics
Conclusion: VAC is a useful adjunct to the standard treatment of chronic wounds. It is an extremely simple modality and does not require expensive equipment
RESUMEN
Objective: To present the experience of characteristics and management of facial fractures in a tertiary care Hospital in Islamabad, Pakistan
Methods: Study was conducted in the department of Plastic Surgery at Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2002 to December 2003. Only adult patients of either sex were included who presented with facial fractures. Patients below 12 years of age and those having only facial lacerations were excluded. In all cases, plain X-rays, OPG [Orthopantomogram], Water's view and CT scan [in more severe cases] were obtained. Majority of the patients was operated on routine operation days [Monday to Saturday]. All other fractures were managed by Open Reduction Internal Fixation [ORIF] via intra-oral approach [gingivobuccal incision]. Only those fractures were approached from the external wound when the wound lied on the line of fracture
Results: Total 133 fractures were noted in 96 patients. Most of the patients were males [76%] with a male to female ratio of 3.1:1. Mean age of the patients was 36.5 years [range 13 - 79 years]. The commonest cause was road traffic accident [53.1%] followed by assault [21.9%]. Mandible was the commonest facial bone to be involved [59.4%]. Various associated injuries were also noted in these patients with facial lacerations [29.9%] being the most common. Various treatment modalities were employed including Maxillo-Mandibular Fixation [n=37], lag screws [n=21], microplates [n=23]. The most frequent complication was pain and or lower lip paraesthesia
Conclusion: Patients with these injuries must undergo early interventions including reduction and stabilization of fractures. Moreover, ORIF should also be undertaken wherever possible not through an external approach but the intraoral approach
RESUMEN
To assess the prevalence of Thyroid peroxidase [TPO] auto antibodies among pregnant women and its relation with their pregnancy outcome. Cross-sectional analytical study. The study was carried out at Zayed Medical Complex, Lahore, in the department of Obs/Gynae and NHRC from July 2000 to July 2002. The study included 1500 Euthyroid pregnant women, ages 18 - 40, registered for antenatal care at Obs/Gynae department. Previous fertility history was recorded and thyroid peroxidase antibody level was assessed by ELISA method. A cut off value of TPO antibody of upto 100U/ml was considered negative and more than 100 U/ml was considered positive.The cases were followed for the outcome of their pregnancy and compared with TPO antibody levels. A comprehensive proforma was used to collect the data. The prevalence of positive TPO autoantibodies was found to be 11.2%. The raised TPO autoantibodies were found to have higher risk of abortion [O.R 49.2] and prematurity [O.R.8.1]. The complications were found to be significantly raised among positive TPO autoantibodies cases, when analysed by parity and age of mother at time of registration. Thyroid autoimmune diseases among euthyroid pregnant women may contribute to low-birth-weight of neonates and high abortion rate in all pregnancies. Raised levels of TPO autoantibody is a good marker to assess early hypothyroidism state and should form a screening modality in Pakistan