Off-pump Bidirectional Glenn shunt using clamp and sew technique

To evaluate the efficacy of performing Bidirectional Glenns [BDG] using "clamp and sew technique". Quasi-experimental study. Armed Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1[st] January 2011 to 31[st] December 2013. All patients subjected to BDG using clamp and sew technique during study period were included. The salient operative steps included. 1] Dissection of superior vena cava, azygous vein and pulmonary arteries 2] Clamping and division of superior vena cava at cardiac end 3] Clamping of ipsilateral branch pulmonary artery and its anastomosis to the divided superior vena cava. Observed variables included oxygen saturations and internal jugular venous pressure before, during and after the procedure, postoperative ventilation requirements, ICU stay, neuro-cognitive assessment, pleural drainage and mortality. A total of 27 patients were included. 85.2% patients had unilateral BDG while 14.8% patients had bilateral BDG. Mean internal jugular venous pressure on clamping superior vena cava was 29.21 +/- 6.13 mmHg [range 19-23 mmHg] and mean clamp time was 14.32 +/- 3.39 minutes with a range of 11-21 minutes. Mean Glenn pressure was 14.29 +/- 2.53 [range 12-18 mmHg]. Mean postoperative Oxygen saturation was 86.07 +/- 2.71% which was significantly increased as compared to preoperative oxygen saturation of 71 +/- 5.16% [p < 0.001]. Mean ICU stay was 70.45 +/- 8.94 hours [38-210 hours]. No neuro-cognitive impairment was observed and there was no 30 day in hospital mortality. Off-pump BDG with clamp and sew technique is a safe procedure in selective patients. It avoids the need for cardiopulmonary bypass and high cost associated with it

Toe to thumb transfer

Thumb is the most important part of human hand both functionally and cosmetically. The reconstruction of lost thumb is always challenging for the surgeons. The aim of study is to evaluate the results of micro - vascular reconstruction of thumb by toe transfer. B. Victoria hospital Bahawalpur from January 1998 to December 2008. Both male and female patients who presented to the orthopedic Department with traumatic amputation of thumb were included in the study. All ten thumbs survived with minor complication as for as functionally and cosmetically are assessed. Dominant hand was involved in eight cases. Results of Microvascular reconstruction are much better as compared to conventional methods. This is single stage procedure and early rehabilitation of hand is possible. Cosmetically and functionally this is far superior to conventional methods.