Surgical site infection in diabetic and non-diabetic patients undergoing laparoscopic cholecystectomy

Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients

Study Design: Cohort study

Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012

Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05

Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs [p = 0.07]

Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy

frequency of GAstric malignancy in patients undergoing endoscopy for dyspepsia

To find out the frequency of Gastric Malignancy in endoscoped patients presenting with dyspepsia. A descriptive study carried out for 12 years. Gastroenterology Department of CMH Quetta from 1991-95, CMH Peshawar 1995-2000 and CMH Lahore 2000-2003. Patients came from Baluchistan, Sind, NWFP, and Punjab respectively. Hundred adult patients, who presented with symptoms suggestive of upper digestive tract disease and were confirmed to have gastric malignancy on histopathology of the gastric lesion. Out of 5000 patients presenting with dyspepsia, 100 patients were ascertained to have gastric malignancy on endoscopic biopsy and registered in the study. Twenty four [24%] were female and 76 [76%] male. The Age ranged from 25 to 85 years with average 54.51 years. Ninety four [94%] patients had adenocarcinoma including 20[20%] signet ring carcinoma, 4[4%] lymphoma, 1[1%] adenosquamous carcinoma and 1[1%] had leiomyoblastoma. Eighty- five [85%] were registered in Peshawar and Quetta out of two thousands i.e. one out of every 23rd gastroscoped patient, while 15[15%] were diagnosed in Lahore out of 3000 i.e. one out of 200. Gastric Malignancy is the cause of dyspepsia in 4. 25% patients in Baluchistan and NWFP and 0.5% in Punjab, who presented with upper digestive tract disturbances, substantive enough to warrant endoscopy. Hence gastric malignancy is much more common in Baluchistan and NWFP as compared to Punjab. The average age is 54 .51 years

Hemisoleus muscle flap, a better option for coverage of open fractures involving middle third of tibia

Local reconstructive options for middle third of leg make good use of Soleus muscle flap. Soleus being the prime ankle planter flexor and stabiliser of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. Due to this geometrical advantage, it is a superior option than the whole Soleus. We conducted a study to evaluate the reliability of the medial hemisoleus muscle flap for coverage of middle third tibial defects. This descriptive study was conducted at department of plastic surgery, Jinnah Hospital, Lahore from August 2008 to May 2009. Ten patients with middle third tibial defects were included in the study. All the patients were provided soft tissue coverage with proximally based medial hemisoleus muscle flap with split thickness skin graft on it. All the flaps survived with primary healing of the wound except one patient who developed wound infection which settled after wound drainage and irrigation. Hemisoleus muscle flap is a valuable local option for soft tissue coverage of middle third of lower leg. It does not sacrifice the whole function of the Soleus muscle. Due to its longer arc of rotation, this flap can cover the defects of different size and shape in middle third of leg

Scalp as a donor site for split thickness skin grafts

Use of scalp as a donor site was reported for the first time in 1964. Since then, authors have described scalp as a donor site, which heals rapidly and re-growth of hair conceals the donor site. This study was aimed at evaluation of scalp as donor site by calculating the healing time, and frequency of post-operative complications. This was a descriptive study and was conducted at Plastic Surgery Department Jinnah Hospital, Lahore, from October, 2006 to December 2007. Thirty patients requiring split skin grafting for small to moderate sized defects [requiring up to 4 sheets] were included in this study. After taking informed consent skin graft were taken from the scalp using Zimmer Electric Dermatome. Donor site was covered with occlusive dressing. Donor site healing time and complications were recorded. Patients having scalp lesions were excluded from the study. All the patients in this study achieved healing of the donor site. None of them required grafting. 26 [86.67%] patients achieved healing by 6th post-op day.3 [10.0%] patients achieved healing by 10th postop day and the remaining 1 [3.33%] patients achieved healing by 20 days. Complications noted were folliculitis in 2 patients and scab formation in 1 patient. Alopecia, hair transplant to recipient site and hypertrophic scarring was not encountered in our study. Patients were discharged by 6th post operative day and complications were managed on outpatient basis. Overall patients' compliance and satisfaction was excellent. scalp is an excellent donor site for taking split skin graft. It has shown to be very useful in terms of quick healing, convenient post-op care and negligible complications. It should be given preference when donor site for taking skin graft is to be selected