Paraumbilical Perforator Flap: A Reliable Option for Coverage of Soft Tissue Defects of Forearm and Hand.

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.

"Screen and Treat" Approach among VIA Positive Women during Cervical Cancer Screening Program: Experience at Low Resource Setting.

Cancer of the uterine cervix is one of the leading causes of mortality and morbidity among women in poor countries. It is the most common reproductive cancer among women in Bangladesh and most women are diagnosed at advanced stage when appropriate treatment is not possible. But this cancer is preventable through proper screening and simultaneous treatment of premalignant lesions. The same day "Screen and Treat" approach is an endeavour to reach the goal especially at low resource settings. Ablation of precancerous lesions by thermo-coagulation is a promising mode of complete cure as this method is easy to apply, effective and relatively cheaper than other procedures. To avoid the issue of overtreatment, an intermediate approach- colposcopy can be used. Aim of this study was to diagnose premalignant lesions of cervix during screening procedure and to treat the lesions by thermo-coagulation at the same sitting. This prospective study was carried out at Upzilla Health Complex (UHC), Rangunia, from 3rd February 2018 to 6th February 2018 in a campaign of cervical cancer screening program by visual inspection of cervix with 5.00% acetic acid (VIA). About 1000 women attending the outpatient department were enrolled in this study by consecutive sampling technique according to inclusion and exclusion criteria. Informed consent was taken after explaining the screening method, thermo-coagulation procedure and follow up schedule. VIA was found positive in 22 cases. Colposcopy was done in VIA positive cases by Gynocular colposcope. Punch biopsy was taken when colposcopy revealed positive in 12 women. Then thermo-coagulation was done. Histopathology report revealed, CIN1 (cervical intraepithelial neoplasia 1)- in 6 cases (50.00%); CIN 2 (cervical intraepithelial neoplasia 2)- in 01 case (8.33%); Chronic cervicitis with squamous metaplasia- in 05 cases (41.67%). Sensitivity and specificity of colposcopy was calculated considering colposcopy directed biopsy as gold standard, which was 100.00% and 75.00% respectively in CIN-1. While in CIN-2 it was 100.00% and 95.20% respectively. VIA is an effective screening tool for cancer cervix. Main advantage is the "screen and treat" approach can be attempted for at risk women in low resource setting by thermo-coagulation which is accepted by women while guaranteeing satisfactory cure rates. Thus, reduces loss to follow-up and have an impact on cervical cancer control.