Lower eye lid reconstruction using single stage Mustarde' cheek rotation flap

To determine the functional and cosmetic outcome of Mustarde' cheek rotation flaps performed for reconstruction of large lower eyelid defects. Bahawal Victoria Hospital, Bahawalpur from August 2003 to March 2006. All those patients in whom Mustarde 'cheek rotation flap was done for the reconstruction of large lower eyelid defects, were included. Follow up included assessment of position of eyelid, closure, presence of epiphora, aesthetic balance, and donor-site morbidity. Thirty patients, aged 2 year to 70 years, have been operated with this technique for total or sub total defects of the lower eyelid. Two patients received an auricular chondro-cutaneous graft. Rest of them received a nasal chondro-mucosal graft for inner lining. The flap remained viable in every patient, without total or partial necrosis. Mustarde cheek rotation flap is very reliable procedure that provides complete reconstruction and can be used with good functional and cosmetic results in patients with total and sub-total lower eyelid defects

Distally based sural neurocutaneous flap for ankle and foot reconstruction

To evaluate role of sural neurocutaneous flap for reconstruction of ankle and foot in our set up. Department of Plastic Surgery, Pakistan Institute of Medical Sciences, Islamabad. From January 1997 to August 2004. We conducted a prospective study to evaluate the role of distally based sural neurocutaneous flap for soft tissue reconstruction of the ankle and foot. A total of 33 patients with soft tissue defects of the ankle and foot were managed by this flap. Mean age of the patients was 31.8 years with range 10-70 years, 30 males and 3 female were included in the study. Most common cause of the defect was trauma and heel was the most common location. Mean flap length was 18.4 cm and mean width 6.2 cm. Range of flap dimensions was 12 x 4 cm. to 28 x 8 cm. Minor complications occurred in three cases. These included partial flap necrosis, wound dehiscence and flap oedema. We conclude that distally based sural neurocutaneous flap is a very effective tool for reconstructing the soft tissue defects in the difficult ankle and foot region

Role of prenatal sonography in the managment of encephalocele

We present the findings in a series of 13 fetuses diagnosed as having encephalocele. 92% encephaloceles were located in the occipital region and 8% at the frontal region. The prognosis of the encephalocele was poor. Only 3[23%] of the 13 with follow up were borne alive at full term. One died in postpartum period. Out of the other two one died after surgery while one is surviving normal. One fetus was diagnosed as Meckle-Gruber syndrome. Associated cranial and extracranial abnormalities observed in various number of fetuses included Ventriculomegaly [43%], microcephaly [31%], unilateral microphthalmia [8%], Clept lip [16%]. Accurate prenatal diagnosis of encephalocele plays a major role in the management of the pregnancy, depending upon the type and extend of encephalocele, especially with associated anomalies and in care of the fetus and in counseling the parents prenataly for pediatric neurological problem

Experience of duhamel procedure in hirschsprung's disease

A study is being carried out to analyze the results of Duhamel Procedure in patients of Hirscheprung's Disease. This is an initial report on 7 patients operated upon in the first year of the study Jun. 95 - Jun. 96, with a follow up of 12 to 20 months. The results of the operation were critically analyzed for faecal continence and residual constipation. These are rare but trouble some complications seen after endo rectal pull through, being previously done by the senior author. In the seven patients being reported, no patient had any degree of incontinence. Only one patient complained of constipation and painful defaecation post operatively, he had a fissure in ano and responded to anal dialatation. This is only a preliminary report, however the results are encouraging, as incontinence is the most irritating complication after a soave procedure and occasionally lasts for years before a reasonable control is developed by the child

Anterior abdominal wall defects antenatal diagnosis with review of literature

During the last three years a total of 3982 patients were screened at a private clinic in Lahore. Out of these, 1525 patients were screened mostly for routine antenatal assessment. The actual number of congenital malformations detected during tills period were 47/1525. Two cases of anterior abdominal wall defects were detected during routine antenatal screening. This gives a 0.131% incidence in this very small series. The diagnostic criteria, clinical implications and results of early management are discussed. Conclusions were drawn and suggestions made for proper antenatal assessment using ultrasound

Preoperative myelographic evaluation of lower spinal lesions

One hundred patients underwent myeolgraphy for low back pain. Twelve had normal myelograms. The accuracy of myelography in predicting diagnosis of different causes of low back pain was evaluated in 88 patients. These patients later underwent surgical procedure and final diagnosis was made at operation. On myelography the prolapsed intervertebral disc [PID] was suspected in 59 [67.1%], spinal stenosis [SS] in 15 [17.0%], tumour in 12 [13.6%] and abscess in 2 [2.3%] cases, while at surgery PID was found in 51 [57.9%], SS in 18 [20.5%], tumour in 14 [15.9%] and abscess in 5 [5.7%]. In 8 false positive cases for PID, 3 were spinal stenosis, 2 were tumour and 3 were abscesses. Accuracy rate of myelogram was 88% and sensitivity for PID, SS, Tumour and abscess were 86.4%, 83.3%, 85.7% and 40% respectively. Myelography seems to be a safe and fairly accurate test in diagnosing the different causes of low back pain

Cerebrovascular accident pattern and distribution of different types based on computed tomography

This study was undertaken to determine the pattern and distribution of various types of C. V.As in 110 patients who underwent C.T. for suspected C.V.A. The percentage of all C.V.A. by pathological type was: Ischaemic cerebral infarction [I.C.I.] 55.4% localized primary intracerebral haemorrhage [P.l.C.H.] - 37.3% generalized subarachnoid haemorrhage [S.A.H.] 5.5% and cerebellar haematoma 1.8%. Right side was affected in 33 patients [30%] and left in 52 [47.2%]. Seventeen patients [14.6%] had multiple areas involved. It was also noted that ischaemic stroke was common in older age group [70-85%]. The most common area of brain involved for all types of C. V.A. was internal capsule and basal ganglia 31 [28.1%] followed by parietal region 17 [15.4%]. frontal region 7 [6.36%], frontotemporal 3 [2.7%], frontoparietal 12 [10.9%], temporal 4 [3.6%], temporoparivtal 10 [9%], parietooccipital 8 [7.2%] and occipital 2 [1.8%]. We recommend C.T. scan of all patients with C.V.A. for proper assessment. A national project to determine its incidence, risk factors, pattern and complications should be undertaken