Radial forearm flap versus anterolateral thigh flap in the treatment of problematic wounds of the leg a clinical prospective study

Deep electrical and thermal burns and crushing injuries often result in exposure and devascularization of underlying structures. This study was done to evaluate the results of free flaps in reconstruction of these problematic wounds. Our study included 30 patients who were treated by free flap reconstruction. Twenty-three patients were males [76.67%] and 7 patients were females [23.33%]. Their mean age was 36.5 +/- 12.31 years. Problematic wounds were post-traumatic in 22 cases and post burn in 8 cases. The free flaps used were radial forearm flap [n=15] and anterolateral thigh flap [n=15]. Reconstruction was done using microsurgical technique by one team of surgeons. The total success rate was [90%]. The radial forearm flap succeeded in 14 cases [93.33%] and failed in 1 case [6.67%]. The anterolateral thigh flap succeeded in 13 cases [86.67%] and failed in 2 cases [13.33%]. Post-traumatic wounds were found to have a lower success rate compared to post-bum cases. We think that free flaps should be strongly considered in the management of problematic wounds for their advantages as better preservation of tissues, less number of operations and short hospitalization than other traditional techniques

value of splenic vicryl mesh repair in cases of rupture spleen

Twenty-three patients [15 males and 8 females] with rupture spleen; grade II in 3 cases [13.04%], grade IIl in 12 cases [52.17%] and grade IV in 8 cases [34.78%] had been managed with splenic preservation and vicryl mesh application. Splenic salvage with mesh was done in 20 cases [86.96%] while in the remaining 3 cases [13.04%] partial splenectomy was done followed by mesh application. The vicryl mesh was successful in controlling splenic bleeding in all cases [100%]. However, re-exploration was performed in two cases for causes other than bleeding. The first case was explored due to peritonitis from disrupted gastric tear and splenectomy was performed. The second case was explored due to small bowel gangrene and resection anastomosis was done with preservation of the mesh and the patient was discharged after 10 days. One patient died in the first post-operative day suffering from cerebral laceration. One week after the operation duplex scanning demonstrated normal flow in the splenic vessels in the surviving 22 cases and IgG, IgA and IgM were found to be within normal limits. The application of splenic mesh for preservation of injured spleen is a safe and reliable method for splenic salvage and maintenance of splenic function

Closed peritoneal lavage in the treatment of foecal peritonitis: an experimental study

This study was carried out on 72 guinea pigs to evaluate the use of every 12 hours intermittent lavage for 72 hours with or without antibiotics in management of fecal peritonitis. Animals were divided randomly into 6 groups, each received either low or high doses of standard fecal inocula intraperitoneally. Results of the groups of high inocula [100% mortality] showed that the least mortality [16.6%] was seen with the use of lavage containing gentamycin and clindamycin [p <0.05]. Intramuscular antibiotics did not improve survival of this group. Other methods [lavage alone or parenteral antibiotics alone] had either little or no effect on mortality. By contrast, in the groups of low fecal inocula [33.3% mortality], lavage not containing antibiotics increased mortality to 100% [p <0.05]. The specific antibiotics used are not critically provided that they are effective against enteric organisms. These results demonstrated that postoperative peritoneal irrigation containing antibiotics is beneficial in treatment of fecal peritonitis, but the lavage alone may be harmful. To find out the validity of these results in man, further studies are needed