Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan.

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

Ancient Schawanoma of radial nerve: a rare case report.

Soft tissue swellings on the forearm can present with a range of clinical and histopathological diagnosis. Ancient Schawanoma is a rare benign condition that can develop over the flexor surface of the forearm as a cystic swelling and can involve the median or the ulnar nerve. However, the presentation of this condition on the extensor surface with involvement of the radial nerve is an extremely uncommon diagnosis. A 69 year old female presented at the outpatient department with a swelling on the extensor aspect of her right forearm for the past 2 years. Ultrasound examination showed a mixed cystic solid mass and MRI report revealed a complex predominantly cystic mass in the extensor compartment of the forearm, measuring 4.3 x 5.3 x 7.2 cm size. After obtaining informed consent, the patient was operated under tourniquet control and the mass was removed sparing the radial nerve that was adherent to its capsule. The final histopathological report confirmed the diagnosis as Ancient Schawanoma.

Acquired Radial Club Hand: An Algorithm to Manage Radial Deficiency.

Introduction Loss of radius either due to trauma or infection results in a deformity resembling a congenital radial club hand. This deformity results in difficulty to perform hand functions and cosmetic appearance and is called acquired radial club hand. There are a few case reports for the treatment of this severe deformity, but there are no proper guidelines for the management of this disease. From our experience, we decided to provide treatment guidelines for acquired radial club hand. Objectives To evaluate the outcome of radial deformity treatment in acquired radial club hand injuries and develop a treatment algorithm. Patients and methods It is a case series study of 11 patients with acquired radial club hand. It was conducted at a tertiary care hospital in Pakistan, from year 2016 to 2022. Basic principles of management of infection and trauma were followed. For the treatment of radial deformity, different options were opted according to the type of deformity, following the principles of treatment of congenital radial club hand. The outcome was graded on functional activity, pain, and bony union. Results Out of 11 patients, 36.36% showed excellent results, 27.27% showed good results, 27.27% showed fair results, and 9.09% showed poor results. Results were excellent in all patients with avascularized bone graft and distraction lengthening, with or without the Darrach procedure. Of the patients in whom distraction lengthening was performed, one patient showed excellent results while the other patient achieved similar results after the Darrach procedure of ulnar shortening. In the case of one bone formation by radioulnar synostosis, the results were variable. Two of the patients showed good outcomes while the other two had fair outcomes. Results in the case of ulnar centralization were mixed with good, fair, and poor results in one patient each. After three months of follow-up, 87% of the patients showed fair to excellent results. Conclusion With our experience, we recommend an algorithm for the treatment of acquired radial club hand.

An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone.

Background and objective Facial aesthetics have a huge impact on how individuals view themselves and are viewed by society. The aesthetics of the face are tremendously influenced by the shape of the chin and neck. In this study, we aimed to observe the outcomes in individuals after the use of ATX-101 (deoxycholic acid injection) in an expanded safe zone for submental fullness. To ensure optimal outcomes and reduce the risk of adverse events, appropriate patient selection is the key. ATX-101 treatment may be administered in combination with hyaluronic acid fillers, botulinum toxins, cryolipolysis, and radiofrequency treatment. This is the first study of its kind to be carried out at the national level in Pakistan. Materials and methods This was a quasi-experimental study conducted at the Rawalian Burn and Reconstructive Surgery Unit, Holy Family Hospital, Rawalpindi, Pakistan for a period of nine months, from 10-1-2021 to 11-10-2021. A total of 62 patients who fulfilled the inclusion criteria were enrolled. We recorded if any complications had occurred or not. Moreover, the total number of treatment sessions, the volume of injectables used, and the interval between sessions were also documented. ATX-101 package was injected into the treatment area. Due care was taken to avoid the region of the marginal mandibular nerve. After the procedure, outcomes and complications were observed. Results In this study, patient satisfaction was reported in 59 (95.2%) patients. After the fourth session, final improvement was observed in 59 (95.16%) patients. Tenderness was found in seven (11.3%) patients, bruising was noted in four (6.5%), edema was found in seven (11.3%), numbness was noted in one (1.6%), whereas paresis and alopecia were not found in any of the patients. Conclusion Our study concluded that ATX-101 is a very useful modality with fewer complication rates and is associated with significant improvement in the expanded safe zone for submental fullness.

Two-Stage Cross-Hand Transfer: A Case Report.

This is a case report of a patient who presented with amputation of all digits of the left hand just distal to the metacarpophalangeal joint level due to a fodder cutter injury one year ago. There was poliomyelitis of the right hand since childhood. The patient was managed at the National Orthopedic Hospital, Bahawalpur, in 2014-2015. The surgery was planned in two stages. In stage 1, only the thumb transfer from the opposite hand was done. Stage 2 was performed three months later, in which the transfer of three digits was done from the opposite hand. Follow-up was done at one month, four months, and one year after surgery. The patient had a good recovery and is able to perform daily activities of life with excellent cosmetic results.

Outcome of Buried Versus Exposed Kirchner Wires in Terms of Infection in Fractures of Phalanges and Metacarpal Bones of Hand.

Introduction and objective The fracture of hand bones is very common among manual hand workers and a fractured hand imparts a great effect on a person's productivity both socioeconomically and from a body image point of view. The most common method of hand fractures fixation is with the help of Kirschner wires. Kirchner wires can be inserted in exposed or in buried manner. There are a few studies that provide a comparative analysis of rate of infection between these two techniques. This study aimed to assess the rate of infection in buried versus exposed Kirschner (K)-wires for hand fractures. Material and method The study was designed as a randomized controlled trial with consecutive non-random sampling. It was conducted in the Department of Plastic Surgery, Holy Family Hospital, Rawalpindi, Pakistan, and lasted from June to December 2019. Blinding was not possible as both the operating surgeon and patient were aware of the procedure being done; however, the assessor was blinded and was not aware which group got which treatment. Total 122 patients with fractures of metacarpals and phalanges of hand were included in the study and were divided into two groups with 61 patients in each. Group A was treated with buried K-wires and group B with exposed K-wires. The patients were followed for one month for the outcomes in terms of infection in the patients. Results Group A had 24 females (39.3%) and 37 males (60.7%). Group B had 16 females (26.2%) and 45 males (73.8%). In group A, nine (14.8%) patients had ages between 10 and 20 years, 18 (29.5%) patients between 21 and 30 years, 14 (23.0%) patients between 31 and 40 years, 11 (18.0%) patients between 41 and 50 years, and nine (14.8%) were between 51 and 60 years. The mean duration of surgery was 35.16 minutes for group A and 27.30 minutes for group B. Based on modified Oppenheim scoring system for pin site infection, out of 61 patients, seven (11.5%) with buried K-wires while 14 (23%) with exposed K-wires developed pin site infection. Conclusion Rate of infection is low in buried K-wires as compared to exposed K-wires though not statistically significant (p>0.05) for the fractures of metacarpals and phalangeal fractures of hand.

Rotationplasty for Spindle Cell Tumor of Tibia.

Rotationplasty has gained popularity for lower limb salvage in oncological resection in place of amputation. It provides more reliable and functional results, with overwhelming cosmetic concerns. We discuss the use of this functional and oncologically reliable technique for an 18-year-old male patient who presented with malignant spindle cell carcinoma. With a multidisciplinary team (MDT) approach and involvement of occupational therapy and rehabilitation, we achieved satisfactory results with no discernible impact on the social and emotional functioning of our patient.

Vacuum-assisted Closure in Integration of Skin Graft Over Scalp Wounds: A Randomised Control Trial.

OBJECTIVE: To compare outcome of split thickness graft with and without vacuum-assisted closure over the scalp soft tissue defects in terms of graft take and complications. STUDY DESIGN: Randomised controlled trial. PLACE AND DURATION OF STUDY: Department of Plastic Surgery, Jinnah Burns and Reconstructive Surgery Centre, Lahore, from June 2017 to June 2018. METHODOLOGY: Patients with scalp soft tissue defects were recruited for the study. Patients with history of poly trauma, hypertension and diabetes mellitus were excluded. Patients were randomly divided into two groups by balloting lottery method. In group A, simple dressing were done after split thickness skin graft; and into group B, VAC dressing was applied after split thickness skin graft. Outcome variables (graft take and complications rate at recipient site) were assessed clinically at 2 weeks and analysed by Chi-square test with p-value <0.05 was taken as significant. RESULTS: Mean age of 120 patients was 33.44 ±14.65 years. Graft take was seen in 24 (40.0%) patients in group A and in 56 (93.3%) patients in group B (p = 0.0001). Seroma was recorded in eight (13.3%) in group A (simple dressing) patients and one patient (1.67%) in group B (VAC dressing, p = 0.015), hematoma was seen in 04 (6.67%) versus 0 (0.0%), respectively (p = 0.042) and graft edge dehiscence in 03 (5.0%) versus 0 (0.0%), respectively (p = 0.079). CONCLUSION: Outcome of split skin graft over scalp soft tissue defects with VAC dressing is better than simple dressing in terms of graft take and complications rate.

Early Active Mobilization Vs Immobilization Following Modified Kessler Repair Of Extrinsic Extensor Tendons In Zone V TO VII.

BACKGROUND: The long-disputed issue of rehabilitation of extensor tendon repairs in zones V-VII has been treated with either complete immobilization or mobilization within the constraints of splint. In recent times, most authors have preferred some mobilization. Many studies have shown good results with early mobilization techniques; however, these studies have limitations. Most of these are retrospective observations. Some prospective studies are without proper controls. This study was conductive to compare the functional outcome of early active mobilization versus immobilization following repair of extensor tendons in zone V-VII. METHODS: Functional outcome was determined by total active motion, pain and complications during rehabilitation. Total active motion (TAM) was graded by scores of the American Society for Surgery of Hand as TAM=total active flexion (MCP+PIP+DIP)-total extension deficit (MCP+PIP+DIP). A randomized control trial was conducted including 50 subjects of with extensor tendon injury exclusively in zone V-VII. Patients were divided randomly in two groups. All extensor tendon repairs (zone V to VII) were performed with modified Kessler's method. The pain and TAM was assessed during all visits in both groups except TAM in group B that was assessed after four weeks. RESULTS: We found that outcome of 12% cases in Group A as excellent and no patient fell in category of fair results. While, in comparison, there was no case of excellent result in Group B. 4% cases showed fair results that were treated with immobilization. The pain score at the end of treatment, i.e., at 12 weeks were same in both the groups but, generally the score remained higher in group of EAM. There was significant difference in adhesion formation that was more in patients of immobilization group. The overall suture dehiscence was insignificant and was only 8% in each group. CONCLUSIONS: EAM has better outcome in terms of pain and range of motion.

Comparison of Graft Survival between Fat Harvested from Abdomen and Medial Thigh for Facial Contour Deformity: A Randomised Control Trial.

OBJECTIVE: To compare the graft survival between fat harvested from abdomen and medial thigh for facial contour deformity. STUDY DESIGN: Randomised control trial (RCT) . PLACE AND DURATION OF STUDY: Jinnah Burn and Reconstructive Surgery Center, Lahore, from October 2015 to April 2017. METHODOLOGY: Patients fulfilling the inclusion criteria were randomly divided into two groups. Fat was harvested from medial thigh in Group A and from abdomen in Group B. Outcome was measured in terms of fat survival by comparing mean fat at baseline, first and 12ᵗʰ week. Final fat survival thickness >6.00 mm at 12ᵗʰ week was considered as excellent. ANOVA was used for comparison of mean fat thickness (mm) between the groups, and Chi-square test for outcome and complications among groups with p-value <0.05 as statistical significance. RESULTS: Mean age of subjects was 27 +7.44 (range 12 to 60) years. Mean final fat thickness in Group A was 6.030 +0.095 mm and in Group B was 4.989 +0.094 mm (p=0.001). Thirty patients (76.9%) in Group A and none in Group B showed excellent response (p=0.001). CONCLUSION: Outcome of graft survival with fat harvested from medial thigh was better as compared to that from abdominal fat.

Effectiveness of platelets rich plasma versus corticosteroids in lateral epicondylitis.

OBJECTIVE: To compare the treatment modalities of lateral epicondylitis in terms of pain relief. METHODS: The randomised controlled study was conducted at Hayatabad Medical Complex, Peshawar, Pakistan, from April 2013 to March 2014, and comprised cases of lateral epicondylitis. The patients were selected through consecutive sampling from the outpatient department and were randomly allocated to two equal groups; group A receiving corticosteroid injections, and group B receiving injection of platelet-rich plasma. The patients were followed up for three weeks to determine the effectiveness of intervention. RESULTS: The 102 patients in the study were divided into two groups of 51(50%) each. The over mean age was 33.9±10.3 years. Mean age of patients in the corticosteroid group was 34.2±10.2 years and in the other group it was 33.6±10.5 years. Mean baseline visual analogue score in group A were 6.5±1.2 and in group B it was 6.7±1.4. In group A, 74.5% of patients presented in moderate pain category and 25.5% presented in severe pain category. In group B, 70.6% presented in moderate with 29.4% presented in severe pain category. On follow-up, the mean pain score in group A was 4.0±2.6 and in group B it was 3.5±2.61. Group A showed effectiveness in 52.9% patients and group B showed effectiveness in 82.3% (p=0.001). CONCLUSIONS: PRP is an effective alternate to corticosteroid in the treatment of lateral epicondylitis (tennis elbow).

Hemisoleus muscle flap, a better option for coverage of open fractures involving middle third of tibia.

BACKGROUND: Local reconstructive options for middle third of leg make good use of Soleus muscle flap. Soleus being the prime ankle planter flexor and stabiliser of the ankle in ambulation cannot be sacrificed without significant morbidity. Soleus is a bipennate muscle with independent blood supply of each half. Using one half retains its important function, increases arc of rotation, and makes it easy to orientate for coverage of defect of any shape thus obviating the need for use of whole Soleus muscle flap. Due to this geometrical advantage, it is a superior option than the whole Soleus. We conducted a study to evaluate the reliability of the medial hemisoleus muscle flap for coverage of middle third tibial defects. METHODS: This descriptive study was conducted at department of plastic surgery, Jinnah Hospital, Lahore from August 2008 to May 2009. Ten patients with middle third tibial defects were included in the study. All the patients were provided soft tissue coverage with proximally based medial hemisoleus muscle flap with split thickness skin graft on it. RESULTS: All the flaps survived with primary healing of the wound except one patient who developed wound infection which settled after wound drainage and irrigation. CONCLUSION: Hemisoleus muscle flap is a valuable local option for soft tissue coverage of middle third of lower leg. It does not sacrifice the whole function of the Soleus muscle. Due to its longer arc of rotation, this flap can cover the defects of different size and shape in middle third of leg.