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Open de-gloving hand injuries with exposed tendons and bones require coverage by a flap. Conventionally used groin or abdominal flaps are cumbersome to patients due to extensive dressing and prolonged passive positioning of the hand until pedicle division. Superficial circumflex iliac artery (SCIA) flap is evolved from a traditional groin flap, and because of its thinness, pliability, and concealed donor site, it is an ideal option for single-stage reconstruction of traumatic hand defects avoiding discomforting passive hand position, joint stiffness, and unexpected flap avulsion which were associated with traditional groin flap. All patients with exposed bones or tendons due to traumatic hand injuries who opted for free flap coverage during the year 2018 to 2020 were enrolled in our study. After initial debridement, the wound was covered with a free SCIA flap. Duration of hospital stay, days out of work, the number of dressings required, postoperative complications, and any secondary procedures for flap readjustment were noted till six months postoperatively. A total of eight patients were included in the study. The mechanism of injury was road traffic accidents in a single patient and occupational injury in eight patients. The average duration of hospital stay was six days after reconstructive surgery. The average number of dressings a patient had was 18, and only two patients required flap thinning. Only one patient had a postoperative infection which was managed with dressings and antibiotics. One patient had peripheral flap necrosis. We had zero flap re-exploration. Therefore, we conclude that hand defects coverage with SCIA flap leads to a smaller number of working days lost and rarely requires secondary procedures.
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Background Complex wounds of hands and feet have always been a challenge for reconstructive surgeon. We aim to share our experience of reconstruction of such defects using free fibula osteocutaneous flaps. Materials and methods This is a retrospective study over a period of six years which was conducted at a tertiary care teaching hospital in Karachi. All patients, who were included and had reconstruction with this flap, agreed to participate in this study. Hospital records were retrieved for patient's demographic details, mode of injury, size of the defect, number of bone loss in the defect, dimensions of flap, size and number of bony segments in each flap. Outcomes were recorded in terms of flap survival and secondary procedures, with post-operative radiographs. Results In 14 patients, 25 (80.5%) metacarpals and 6 (19.5%) metatarsals defects were reconstructed. K-wires were used for bony stabilization and were removed at 8 weeks post-operatively. Only two flaps were re-explored due to venous congestion. Minor wound dehiscence was noted in two flaps which were managed conservatively. Conclusion Proper planning and meticulous flap dissection and inset using free fibula flap can save many hand and foot from amputations.
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BACKGROUND: Traumatic vascular injuries of the extremities are a major challenge especially in the third world countries. These injuries are mostly due to poor traffic laws, street crimes, firearms and blast associated injuries. We therefore would like to share our 10 years of experience in dealing with vascular injuries in Pakistan. METHODS: This was a retrospective observational study conducted in the department of vascular surgery of Liaquat National Hospital, Karachi, Pakistan. Patients' records were retrieved from the department and were reviewed. Cases with vascular injuries of upper and lower limb that presented with signs of salvageable limb and presented within 12 hours of injury were included in the study. Patients with more than 12 hours of presentation and in whom primary amputation was done, were excluded from the study. RESULTS: There were 328 patients who presented with vascular injuries of the extremities that fell in the inclusion criteria. Limb salvage rate was 41 %, whereas 30-days perioperative mortality was 5.48 %. The major cause of limb loss was delay in presentation of more than 8 h of injury. Major vessels involved were popliteal artery (41.76 %), followed by femoral artery (27.43 %). CONCLUSION: Vascular injuries are becoming a major contributor of limb loss in third world countries due to violence, terrorism and unavailability of vascular facilities. This morbidity can be reduced by improving law and order situation, evolving an effective emergency ambulatory system and with better training and provision of vascular services in remote areas so that the delay factor can be reduced.
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OBJECTIVES: To study patients' belief and practice about Sadqa (charity) and its role in recovery from illness and restoration of health. This study will determine whether such belief and practice is related to any demographic factors such as sex, education, and religious sects. METHODS: A questionnaire was designed that included the demographic profile of patients and questions in accordance to the study objective. It was administered to 400 patients or their attendants against the calculated sample size of 385. There were very few refusals to participate with response rate of around 98%. The study objective was explained to all participants, written consent was obtained and full confidentiality was assured. RESULTS: The mean age of the study population was 34.33 years, majority of the patients were males with 65.6% having grade XII or higher education. The practice of giving sadqa/charity for healing was significantly associated with females (p<0.001); Ismaili sect (p=0.017); educational level of grade V (p=0.03); graduate (p=0.041); being housewives (p<0.001), students (p=0.048) and employees in private services (p<0.001). Approximately 85% of the study population gave sadqa/charity for healing diseases and 84.8% believed that sadqa/charity heals diseases. According to 97.5% of the participants, medical treatment should be combined along with sadqa/charity for healing. CONCLUSION: This study highlights the importance of the patients' attachment to charity giving and expectation that it will lead to recovery from illness. Future research in this area should be qualitative rather than quantitative to explore more about beliefs, attitude and behavior of the individuals. It is recommended that health care professionals should consider and also respect patients' and relatives beliefs about sadqa and charity; clashing with their beliefs during provision of medial care should be avoided.
