Patterns of secondary deformities after bilateral cleft lip repair in a cohort of patients

Objective: To analyze the secondary deformities and possible causes in bilateral cleft lip cases in a cohort of 69 consecutive cases

Methodology: It was a retrospective analytical study of 69 cases of secondary bilateral cleft lip deformities. Earlier all these cases had been recorded for their deformities along with pre and postoperative photographs. Per operative photographs, with markings for the incisions, were also part of record. All these cases were studied individually with the help of these photographs to record the presence of various deformities

Results: Study included 69 cases of secondary bilateral cleft lips with 47[68.11%] male and 22 [31.88%] female patients. Thirty six patients, were in second decade of their life at time of revision surgery, 20 cases in first decade of life and 13 in third decade. Wide alae and large nostrils seen in 55 [79.71%] cases were the commonest deformity, with central vermilion deficiency in 53 [76.81%] patients, wide prolabium in 49[71%] cases and depressed nasal tip in 48 [69.56%] cases. Irregular scar formation was noted in 43 [62.31%] cases

Conclusions: Bilateral cleft lip repair is a challenging job. Wide alae and large nostrils followed by central vermilion deficiency remain common secondary deformities. Careful selection of repair technique, and a knowledge of outcomes of different repair techniques may help to achieve good results. Variety of deformities in presentation of bilateral cleft lips necessitates to individualize the selection of repair technique for every case

Lignocaine toxicity in burn cases

Pain is one of the constant features of burn injuries. Many protocols are utilized to alleviate pain in these patients. Lignocaine containing ointment and fusidic acid in combination with hydrocortisone cream are routinely used as topical application in the wound care of burn patients in our setup. During a period of nine years, five patients experienced adverse effects of lignocaine, active ingredient of ointment, which were immediately controlled once this drug was discontinued. All these patients, who were being treated for burn injury involving more than 20% BSA [Body Surface Area], responded well on excluding the lignocaine from treatment medication and did not require any anticonvulsant to treat these adverse effects

analysis of different reconstruction modalities utilized for full thickness defects of scalp

Objective: to highlight the use of various reconstruction modalities and to stress the importance of timely and proper coverage of these defects as otherwise the chances of Marjolin ulcers increase with the passage of time

Material and Methods: a total of 35 cases included 20 males and 15 females. All the cases which presented with full thickness soft tissue defects of scalp or where the defect was the result of excision of some growth were included in the study. Long standing wounds were biopsied to rule out any chances of malignancy before reconstruction of the defect

Results: in 11 cases defect was result of burn injury, in nine cases etiology was road traffic accident, while another group of eight patients had these defects as a result of ablation surgery. One defect resulted from excision of the arteriovenous malformation and in other flaps necrosed after a craniotomy. All the treated cases did well. There was partial flap necrosis in one case caused by excessive tension on the flap. Surgery was deferred in three of the cases as they were in advanced stage of malignant degeneration in the post burn scar

Conclusion: series witnessed a spectrum of options for coverage of soft tissue defects. Every case needs to be dealt on individual basis for selection of the option. Post burn wounds if not provided with a proper soft tissue cover may lead to malignant transformation

First dorsal metacarpal artery flap for soft tissue defects of hand

Objective: To highlight the various uses of flap based on first dorsal metacarpal artery in various soft tissue defects of hand

Material and Methods: Twelve cases of various soft tissue defects of hand, of various etiologies, falling within the arc of rotation of the first dorsal metacarpal artery were selected to be dovered by the flap based on this artery

Results: This flap provided cover for soft tissue defects of thumb in seven cases. Three of these cases had defects on dorsal aspect of thumb, three on the volar aspect and in one case it provided the pulp of the distal phalanx. It covered defects at palm, thenar eminence and dorsum of hand in one patient each. Soft defect at first web space were covered in two cases

Conclusion: This local flap is a good option for the smaller soft tissue defects at the base of index finger, palm, and various aspects of thumb which are within the arc of rotation of the first dorsal metacarpal artery

Use of latissimus dorsi myocutaneous flap in reconstruction of extensive soft tissue defects of upper limb

Objective: To evaluate the role of latissimus dorsi myocutaneous flap in providing soft tissue cover for extensive defects of upper limb at shoulder, mid arm amputation stump, arm, elbow joint, forearm and wrist level

Patients and Methods: An observational study carried out at the Department of Plastic Surgery, Services Hospital, Lahore from January 2004 to June 2007. Patients presenting with extensive soft tissue defects of various areas of upper limb managed with latissimus dorsi myocutaneous flap were included in this study. In all the cases classical pedicled myocutaneous latissimus dorsi flap was used

Results: Study was carried out on twelve cases. It included nine males and three females. Flap provided soft tissue cover to defects at arm and elbow in three cases. Two cases needed soft tissue cover at arm, forearm region, elbow joint area and shoulder. In one case it covered the mid arm amputation stump. All flaps survived

Conclusion: Latissimus dorsi myocutaneous flap may be considered as a workable option in extensive soft tissue defects of various areas of upper limb

Fracture maxilla-an analysis of consecutive 199 cases

Background: To analyzes the patterns, etiologies and modalities of treatments being utilized for fracture maxilla at a tertiary care center

Methods: A total of 199 consecutive cases of fracture maxilla managed during period of two years were included in the study. This included 168 males and 31 females. Age of the patients ranged from 2 years to 70 years. The cases were managed as per nature and extent of trauma following standard methods of reduction and fixation

Results: It was third decade of life where majority of the patients, 70 cases, presented with this fracture followed by second and fourth decade with almost equal number. In 74 cases only maxilla was involved while In 125 cases it got fractured in combination with mandible and zygoma. Most common etiology found in 120 cases was road side accidents followed by fall in 25 cases. Firearm injury was the cause in 16 cases while in 11 cases interpersonal violence was the etiology. Internal fixation was the method utilized for fixation of these fractures, throughout this series

Conclusion: Most common etiology of fracture maxilla is road traffic accident. Third decade of life is the usual age range of the patient. Fracture needs reduction with internal fixation

Patterns of hand injuries and reconstruction modalities

Background: To assess the age groups involved, mechanism and extent of injury and treatment methods being utilized for the patients of hand trauma

Methods: Seventy-six cases of hand trauma treated at The Department of Plastic Surgery Services Hospital Lahore during a period of two years were included in the study

Results: Twenty five percent of cases resulted from mechanical trauma, which was the most common etiology in this series. Different burn injuries and post burn complications were responsible for soft tissue defects of various magnitudes in forty-four percent cases. Forty percent of the cases were in teenage at time of injury. Fifteen percent either lost their thumb or it was affected badly and in five percent of patients all four fingers were amputated or badly injured

Conclusion: It is stressed that most of these injuries are predictable and hence avoidable and certain simple precautions may decrease the number of sufferers