Medial perforator flap for coverage of defects around the ankle

Wounds around the ankle with exposed bones, tendons and nerves are very common in our practice and their reconstruction remains a challenge for the plastic surgeons. They often lead to infection and mal-union if early vascularized cover is not provided. To evaluate efficacy of medial perforator flap for reconstruction of this difficult area. A total number of 40 patients with injuries around the ankle were studied between December 2004 to December 2006 and all of them underwent reconstruction with medial perforator flaps. The Medial perforator flap is a quick, versatile, reliable reconstructive option and has minimal donor site morbidity

Early graft function and carboxyhemoglobin level in liver transplanted patients

Heme-Oxygenase-1 catalyzes hemoglobin into bilirubin, iron, and carbon monoxide, a well known vasodilator. Heme-Oxygenase-1 expression and carbon monoxide production as measured by blood carboxyhemoglobin levels, increase in end stage liver disease patients. We hypothesized that there may be a correlation between carboxyhemoglobin level and early graft function in patients undergoing liver transplant surgeries. In a descriptive retrospective study, 39 patients who underwent liver transplantation between the year 2005 and 2006 at KFSH and RC, are included in the study. All patients received general anesthesia with isoflurane in 50% oxygen and air. Levels of oxyhemoglobin, carboxyhemoglobin and methemoglobin concentration in percentage were recorded at preoperative time, anhepatic phase, end of surgery, ICU admission and 24 hr after surgery. The level of lactic acid, prothrombin time [PT], partial thrombin time [PTT], serum total bilirubin and ammonia were also recorded at ICU admission and 24 hr after surgery. The numbers of blood units transfused were recorded. 39 patients were included in the study with 13/39 for living donor liver transplant [LDLT] compared to 26/39 patients scheduled for deceased donor liver transplant [DDLT]. The mean age was 35.9 +/- 16.9 years while the mean body weight was 60.3 +/- 20.9 Kg. Female to male ratio was 21/18. The median packed red blood cell [PRBC] units was 4 [Range 0-40]. There was a significant increase in carboxyhemoglobin level during the anhepatic phase, end of surgery and on ICU admission compared with preoperative value [p < 0.005]. However, there was insignificant changes in methemoglobin level and significant decrease in oxyhemoglobin levels throughout the study period compared to the preoperative value [p < 0.005]. The changes in carboxyhemoglobin level on ICU admission and 24 hrs postoperatively were positively correlated with the changes in serum total bilirubin and prothrombin time [R = 0.35, 0.382, 0.325 and 0.31] respectively p < 0.05] but not with the changes in serum lactic acid. The same strong correlation was found when analysing LDLT and DDLT patients separately between carboxyhemoglobin concentration and PT and total bilirubin while still the correlation with lactic acid was weak. There was no correlation between average perioperative carboxyhemoglobin concentration during different timing of measurements and average units of transfused blood [R = -0.02] p > 0.05. The changes in carboxyhemoglobin level significantly correlate with the changes in graft functions particularly prothrombin time and serum total bilirubin and may be used as an early, rapid and simple test for early evaluation of graft function

Cleft lip and palate surgery "where do we stand in the 21st century?" based on study of referral patterns to a tertiary care cantre

A prospective study was carried out over the period of six years including 215 patients. The objective of this study has been to evaluate the types of the clefts, their predisposing factors, age at first presentation and need for revisional surgery and to compare these with published studies on the subject and to draw conclusion about the epidemiology and the facilities available for its surgical correction. Prospective, observational study. 215 patients were evaluated over a period of six years by filling a proforma, which was entered into database. Different parameters were evaluated. There are a significant number of cleft patients presenting for first time above the age of 10 years. A large number of inappropriately treated patients require revisional surgery because of lack of properly trained cleft surgeons. Due to lack of specialized cleft care teams in our country no patient in this study could get comprehensive care for this deformity. It is need of the hour to pr ovide multidisciplinary care to these patients

Transversely meshed skin grafting for aesthetically sensitive areas

Meshing of split thickness skin grafts [SSG] improves the chances of their 'take' by allowing blood and exudates to escape. Traditional wide meshing has a major disadvantage of having a cosmetically compromised checkerboard or lizard skin appearance. For which reason they can not be used on aesthetically sensitive areas like head and neck and extremities. Unmeshed SSG does not ensure adequate drainage and at times results in poor 'take'. Transverse meshing ensures better drainage and its cosmetic appearance is also comparable to that of unmeshed SSG. The objective of this study has been to analyze the advantages of this novel technique in skin grafting and see its efficacy over un-meshed grafts. An original article based on a prospective, observational study. A total number of 69 patients were studied between October 1999 and April 2003. Both male and female patients of all age groups were selected, ranging between 11/2 and 70 years. Patients selected for skin grafting inc luded those with wounds caused by burns, degloving injuries of the scalp, genitalia, hands and feet and post burn contractures of the neck and extremities, and flap donor sites [see table below]. Skin grafts were harvested with a pneumatic dermatome. A mesher board of 1.5: 1 expansion was cut into two equal halves which were placed side by side with the grooved side up. Skin grafts were applied and secured in the standard fashion. The patients were followed up on outpatient basis. Graft success rate was 93% with acceptable cosmetic appearance. There was a total loss of two grafts [2.7%] and partial loss of three [4.3%]. The healing of the graft was excellent. Transverse meshing is a new technique in meshed skin grafting with improved 'take' and acceptable cosmesis as compared to unmeshed skin grafts. This technique can obviate the need for two- stage skin grafting for areas where wide meshing is not desirable

Medication based; erectile dysfunction

Objective: the medication considered to be important for the treatment of some vital diseases and may cause erectile dysfunction. This article aim to describe some adverse drugs reaction that directly or indirectly exert its effect on the various routs of excretion process. A computer as well as manual research was made to collect the relevant data published in various journals on the drugs. The study of these drugs show positive effect on sexual performance due to the side effect of a range of commonly prescribe drugs and is important cause of noncompliance with anti hypertensive treatment. This article review the drugs implicated in erectile dysfunction ED and provide advice and how to avoid it

Evaluation of the relationship of maternal nutritional status with that of the newborn

To evaluate and see the relationship of maternal nutritional status with that of the newborns. Design: This was a prospective observational study. Place and Duration of Study: The research was carried out on mothers between the age of 20 to 40 years in the Lady Willingdon and Ittefaq Hospital. Patients and The study was carried out on 30 mothers, divided in two groups, comprising 15 in each. 15 mothers belonging to the low socio-economic class whose income was < Rs 6000/month, and 15 to those belonging high socio-economic class with an average monthly income Rs > 20000 / month. Anthropometrics indexes of the infants from Lady Willingdon Hospital indicated that all the infants were of low birth weight [<2500gm]. Low hemoglobin [<10gm/dl] were found in many women though the ferritin stores were satisfactory. Similarly half of the infants had low hemoglobin levels [11-13 gm/dl] with an adequate ferritin stores. It was also found that high maternal hemoglobin levels [>11 gm/dl] were positively correlated with higher infant hemoglobin, serum ferritin, weight, height and head circumference measures. It was thus concluded that maternal nutritional status is directly related with that of newborn