Scalp defects

Scalp defects can result from trauma, tumors or infection. Whereas small defects can be closed with wide undermining and local flap coverage, large full thickness defects with exposed calvarium cannot be treated as such. Twenty patients with scalp defects were treated in the department of plastic and reconstructive surgery Mayo Hospital Lahore from 8.10.89 to 17.9.95. Fourteen [70%] of the patients were females. Thirteen [65%] belonged to rural areas. Trauma [65%], burns [25%], infection [5%] and tumors [5%] were the main causes of defects. Five [25%] patients [all females] had avulsion injury of the scalp. The size of defects varied from a minimum of 9 cm[2] to a maximum of 615 cm[2]. Nineteen [95%] had skin grafting with eighteen [90%] requiring split and one [5%] full thickness graft. Three [15%] required local flap rotation and seven [35%] bone chiselling. Majority [80%] of patients required two or less operations. The mean hospital stay was 38.5 days. There was only one mortality, which was related to burn injuries. It is concluded that bone chiselling followed by skin grafting is a safe and effective way of treating very large scalp defects and should be offered to patients where microsurgery is not feasible or available

Transperitioneal drainage in liver abscesses

The clinical features and surgical management of 64 consecutive cases of liver abscess admitted over a period of 18 months were reviewed and form the basis of this retrospective study. The incidence of liver abscess was 0.358% of all hospital admissions. Ages varied from one to 72 with a mean age of 38.8 years +/- standard deviation 13.36 [S.D.] There were 53 [83%] single lobe abscesses in the right lobe, 4 [6%] in the left lobe and present bilaterally in 7 cases [11%]. Fever was the commonest symptom, present in 57 cases [89%], pain in 50 [78%] cases and leucocytosis in 47 [73%] patients. Eleven patients [17%] responded to antimicrobial therapy and were excluded. All the other 53 patients [82%] underwent transperitoneal drainage. Ultrasound scan was successfully used in confirming the diagnosis. There were no deaths and 6 patients [11.7%] developed wound infection. Eight [15.6%] patients had controlled biliary fistulae, one of whom had a prolonged stay

Surgery in acute cholecystitis

Eighty eight patients presented with symptoms leading to an initial diagnosis of acute cholecystitis over a 12 month period [1986-1987]. Forty eight presented with a palpable gallbladder [Group 1], eight with a vague tender mass in the right upper quadrant [Group 2], and thirty two presented with biliary colic, with minimal abdominal signs, which settled within 24 hours [Group 3]. Jaundice was present in 8 patients [6 in group 1, in group 2]. All patients in group 2, but only 19% in group 3, and 23% in group 1, had a past history of right upper quadrant pain. Surgery was required in 40 Pakistan [46%]. Seventy four and 94% of patients in group 2 and 3 respectively, had fever as against only 6% of patients in group 1. Seventy percent of group 1 patients and 62% of group 2 were operated and during their current admission. Initially, all group 3 patients were treated conservatively, but 2 developed distended gallbladder, and were operated on. Organisms grew from the gall bladder aspirate in only 8 [9%], and only when the bile was dark green. Acute gallbladder disease is more causally related to pressure changes resulting from obstruction than infection. Early operation relieves obstruction and allows and progression of the disease