Evaluating anatomical subunit approximation technique for unilateral cleft lip repair

To evaluate the outcome of anatomical subunit approximation in unilateral cleft lip of different severity. Seventy four consecutive patients with cleft lip were seen in the outpatient department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex, Peshawar and Plastic Surgery unit at Said Anwar Medical Centre, Peshawar, from 1[st] June 2007 to 31[st] December 2008. The severity was assessed and all of them were operated using David Fisher's anatomical subunit approximation technique. Postoperatively the vertical height of the lip was compared on the cleft and non cleft side along with symmetry of Cupid's bow and philtral column, the alignment of white roll, quality of the cutaneous lip scar, vermilion fullness and vermilion notching. The nose was evaluated by noting the nasal tip symmetry; alar rim level; alar base height and width; and nostril sill size, both pre and post operatively. Seventy two patients showed adequate vertical height and good nostril size, alar base height. Two patients showed 1.0 mm discrepancy of the vertical height as compared to the non cleft side. These belonged to the severe complete cleft lip category. This technique has shown good results in achieving vertical height and nostril size symmetry especially in incomplete and mild to moderate severity of complete cleft lip

Speech results of furlow's soft palate repair

To evaluate the speech results of Furlows repair in soft palate repair. Cleft lip and palate is a common and complex disorder. It is relatively more common in Asians. The functional goals of cleft surgery are to improve speech and hearing and avoid retardation of maxillary growth. These goals are achieved by early cleft palate repair. The patients' age at the time of surgery in our series was 6- 18 months. The timing of cleft surgery is very important optimum speech and hearing. We perform Millard's repair for unilateral cleft lip at 3-6 months of age and lip adhesion for bilateral cleft lips. Clefts of the soft palate are repaired by Furlow's double opposing Z-plasty technique at the age of 6-9 months. Hard palate clefts are repaired at the age of 12-18 months by Von Langenbeck's technique. Out of 80 patients 57[71.25%] had unilateral cleft lip and palate where as 23[28.75%] patients had bilateral cleft lip and palate. Although Furlow's repair of the soft palate is considered a difficult technique but we have found that it yields excellent results in terms of speech and hearing, without interfering much with maxillofacial growth. We achieved normal speech results in 78.75% [n=63] cases and normal articulation in 93.75% [n=75], after treatment with Furlow's double opposing Z-plasty of the cleft soft palate. The fistula rate in our series is 2.26%. Furlow's repair is technically difficult procedure, but it yields excellent speech results

Treatment of necrotizing fasciitis with quinolones

To evaluate the effect of high dose quinolones therapy in patients with necrotizing fasciitis. Design: descriptive analytical study. Place and Duration of Study: the department of Plastic and reconstructive surgery, Hayatabad Medical complex, Peshawar, from January 2001 to March 2002. Subjects and Twenty consecutive patients, diagnosed with necrotizing fasciitis, were treated with intravenous quinolones [400 mg 8 hourly]. The response was evaluated in terms of subsidence of fever and C-reactive proteins levels. Majority of the patients was male [60%]. Lower limb involvement was most commonly involved [70%]. The most common initiating cause was injection abscess [45%]. Majority of the cultures showed polymicrobial infection [90%]. The most common isolate was streptococcus pyogenes [65%]. Majority of the patients showed excellent response with intravenous quinolones [Ciprofloxacin] in high doses in 24-48 hours. Only two patients [10%] failed to respond to therapy due to severe infection and delay in seeking treatment. Intravenous quinolones [Ciprofloxacin] in high doses are effective in controlling necrotizing soft tissue infections

Comparison of prepucial skin, postauricular skin and buccal mucosal graft results in hypospadias repair

To compare the results of the prepucial, postauricular skin grafts and buccal mucosal graft in two-stage hypospadias repair. Design: Comparative study. Place and Duration of Study: The department of Plastic Surgery, Hayatabad Medical Complex, Peshawar. The duration of the study was three years [from January 1999 to December 2001]. Patients and The study subjects included 242 patients with hypospadias who underwent two-stage Aivor Bracka repair. The best results were obtained with prepucial skin graft in which the graft take was 95.3% and fistula rate was 3.2%. The incidence of graft contracture and graft loss was 20.5% and 11.7% respectively in buccal mucosal graft. The prepucial skin graft, postauricular skin graft and buccal mucosal graft gives excellent results in terms of graft acceptance in stage I and graft contracture and fistula rate in stage II