Neuropathy following intramuscular injections: a clinical and neurophysiological study from a tertiary care centre in Pakistan.

OBJECTIVE: To assess the clinical and neurophysiological profile of peripheral nerve injuries in patients following intramuscular injections. METHODS: The descriptive, cross-sectional study was conducted at the Department of Neurology, Mayo Hospital, Lahore, Pakistan, from July 2019 to January 2021, and comprised adult patients of either gender with isolated peripheral nerve injuries following intramuscular injections. Nerve conduction studies were performed for each patient. Data was analysed using SPSS 26. RESULTS: Of the 99 patients, 59(59.6%) were males and 40(40.4%) were females. The mean age was 26.7+/-18.1 years, 34(34.3%) patients were under weight and 78(78.8%) were either illiterate or had low literacy level. Radial nerve was involved in 56(56.6%) cases, followed by sciatic in 39(39.4%) and axillary nerve 4(4.04%). Overall, 14(14.14%) injection had been administered by doctors, while the other 85(85.85%) were given by paramadics. Marked reduction in compound muscle action potential 72(72.7%) and sensory nerve action potential 82(82.8%) was noted, while re-innervation was seen in 78(78.7%). CONCLUSIONS: Intramuscular nerve injuries can be greatly minimised by spreading awareness regarding safe injection techniques and strict implementation of standard operating procedures in hospitals and clinics.

Rarest of the rare: a case of pharyngeal-cervical-brachial variant of Guillain-Barré syndrome presenting with a demyelinating neuropathy.

BACKGROUND: Guillain-Barré syndrome (GBS) is a heterogeneous disease characterized by rapidly progressive, symmetrical limb weakness with hyporeflexia or areflexia. The rare pharyngeal-cervical-brachial (PCB) variant of GBS occurs in 3% of patients, presenting as rapidly progressive oropharyngeal and cervicobrachial weakness characterised by axonal, rather than a demyelinating neuropathy on nerve conduction studies. CASE DESCRIPTION: A 35 year old male presented with a 5-day history of dysphagia, dysarthria, slurred speech and upper limb weakness. Physical examination showed bilateral facial nerve weakness and an impaired gag reflex. Nerve conduction study was suggestive of sensory and motor polyneuropathy of predominantly demyelinating variety. As the condition of the patient worsened, respiratory support was required and plasmapharesis was started. There was significant improvement in his condition after completion of 5 sessions of plasmapharesis. CONCLUSION: The rare PCB variant may present with a predominantly demyelinating neuropathy. Early clinical recognition of this variant and prompt treatment with plasmapharesis is essential for preventing respiratory complications.

Relationship between muscular impairment and psychological health with lower extremity functions in patients with transtibial amputation.

OBJECTIVE: To determine the relationship of muscular impairment and psychological health with lower extremity functions in patients with transtibial amputation. METHODS: The correlational study was conducted from March to September 2021 at the Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised male patients with transtibial amputation. Data was collected using the depression anxiety stress scale and the lower extremity functional scale. The correlation of muscular impairment and psychological health with lower extremity functions was determined. Data was analysed using SPSS 21. RESULTS: There were 85 male patients with a mean age of 53.74±11.30 years. There was weak iliopsoas muscle strength 4.64±0.50 and reduced muscle length of hamstrings 67.00±6.41 on the affected side. There was non-significant correlation in muscle atrophy of both amputated limb (p=0.82) and non-amputated limb (p=0.58) with lower extremity function. Significant inverse correlation was present between depression, anxiety and stress (p=0.001) with lower extremity function. CONCLUSIONS: Weak iliopsoas muscle strength and tight hamstrings were observed on the amputated side. Muscle atrophy was more in non-amputated limb than amputated limb. There was significant inverse correlation of depression, anxiety and stress with lower extremity function.

Sensory symptoms on admission as a predictor of respiratory insufficiency in patients of Guillain-Barre Syndrome (GBS).

OBJECTIVE: To assess sensory symptoms on presentation as a predictor of respiratory insufficiency in patients of Guillain-Barre Syndrome. METHODS: The descriptive cross-sectional study was conducted from November 2018 to March 2019 at the Neurology Department of King Edward Medical University, Lahore, Pakistan, and comprised patients aged 18-60 years suffering from Guillain-Barre Syndrome as per Brighton criteria. All patients were monitored for respiratory insufficiency by single breath count and arterial blood gases. Data was analysed using SPSS 22. Results: Of the 87 patients, 61(70.1%) were male and 26(29.9%) were female. The overall mean age was 37.51±15.36 years. Sensory symptoms were noted in 27(31%) patients, and respiratory distress in 17(19.5%). Of those who had sensory symptoms, 10(37%) also had sensory symptoms. CONCLUSIONS: Respiratory insufficiency in Guillain-Barre Syndrome patients presenting with sensory symptoms was common.

Effect of platform switching on peri-implant bone: A 3D finite element analysis.

STATEMENT OF PROBLEM: A consensus regarding the effects of platform switching on peri-implant marginal bone levels is lacking. Finite element studies have reported contradictory results. PURPOSE: The purpose of this finite element analysis study was to evaluate stress distribution in platform-switched (PS) and platform-matched (PM) implants and their surrounding bone. MATERIAL AND METHODS: An implant (4.5×11 mm) was modeled and screwed into a human mandibular bone block using a computer-aided design (CAD) software program. Two separate models were generated: (1) PM, 4.5-mm implant with 4.5-mm-wide abutment and (2) PS, 4.5-mm implant with 3.5-mm-wide abutment. Implant components were modeled with linear isotropic properties and bones with anisotropic properties. Vertical (200 to 800 N) and oblique (50 to 150 N) forces were applied to each model to simulate occlusal loads. Linear elastic analysis was performed using ANSYS Workbench 16. von Mises equivalent stresses in the implant assemblies and peri-implant bone were calculated and compared with independent samples t test (α=.05). RESULTS: von Mises equivalent stress values under simulated axial and nonaxial occlusal loads were lower for PM than for PS implant assemblies. However, the differences were not statistically significant. Stress within the peri-implant bone was significantly higher for the PM group than for the PS group (P<.001). CONCLUSIONS: Platform switching decreased stress within peri-implant bone and may help limit marginal bone resorption.

Ceramic Fracture in Metal-Ceramic Restorations: The Aetiology.

All dental restorations are liable to failure during function. Failure could be biologic, aesthetic, mechanical or a combination. Ceramic restorations in particular, including metal-ceramics, are prone to mechanical fracture, especially the fracture of veneering porcelain. Fracture of a metal-ceramic restoration jeopardizes function as well as aesthetics. It is equally onerous to manage for both patient and dentist. Optimal management of such cases requires a detailed knowledge of the aetiology behind this phenomenon. The current paper aims to highlight possible causative factors involved in the mechanical failures of metal-ceramic restorations. Clinical relevance: Ceramic fracture in metal-ceramic crowns and fixed partial dentures is routinely encountered in dental clinics. Knowledge of the aetiology is required to diagnose and manage such cases accurately as well as to avoid these errors in future.

Antibacterial activities of Diospyros blancoi, Phoenix dactylifera and Morus nigra against dental caries causing pathogens: An in vitro study.

The study was undertaken to determine the in-vitro antibacterial potential of Diospyrosblancoi, Phoenix dactylifera and Morusnigra leaf extracts in hexane, chloroform, methanol, ethyl-acetate and aqueous extracts against dental caries causing bacteria. Disc diffusion assay was used to determine the antibacterial efficacy; the extracts were further separated using Thin Layer Chromatography and the anti-biofilm activity of the extracts was also determined. The preliminary phytochemical screening of the extracts revealed the presences of flavonoids, saponins, alkaloids and tannins because of which the extracts showed strong antibacterial activity against the selected pathogens. The ethyl-acetate extracts showed maximum inhibitory effect on biofilm formation by S. mutans.96% inhibition was observed in methanol extract of Diospyrosblancoi, and 95% in ethyl acetate extract. The results evidenced that the plants inhibit the growth of oral bacteria responsible for dental caries with their abundance source of secondary metabolites and can be used as an alternative treatment for caries, thus minimizing the antibiotics used to treat the disease in local medicine.

THORACODORSAL ARTERY PERFORATOR FLAP FOR UPPER LIMB RECONSTRUCTION.

BACKGROUND: Thoracodorsal artery perforator flap (TAP) is a feasible option to reconstruct defects in upper limb where only skin and subcutaneous tissue is required. METHODS: This case series was carried out at department of Plastic and Reconstructive Surgery Combined Military Hospital Rawalpindi. A total of 5 patients with upper limb defects were reconstructed with thoracodorsal artery musculocutaneous perforator flaps. Among them, 3 were pedicled and two free TAP flaps. All flaps except one pedicled flap were raised on a single perforator pedicle. Recipient sites were one axilla, two shoulder regions and two hands. The soft tissue defects in the patients had resulted from burns, trauma, wide local excision of synovial sarcoma and surgery for hidradenitis suppurativa. Preoperative hand held Doppler ultrasound was used to locate and mark the perforator. RESULTS: All flaps survived without significant complications. All flaps were hyperemic in the immediate postoperative period. We designed and raised all the five flaps on eccentrically placed perforators. All the raised perforators originated from the descending branch of the thoracodorsal artery. The donor sites were closed primarily with linear scars in all cases except one, in which partial closure was accomplished with split thickness skin grafting (STSG). CONCLUSION: The thoracodorsal artery perforator flap has great potential for reconstructing large, relatively shallow, defects of upper limb because of its suitable skin quality, texture and appropriate thickness, as well as hidden donor site, a reliable pedicle and sparing of muscle unit.

Use of vascularised free fibula in limb reconstruction (for non-malignant defects).

The case series was conducted at the Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to May 2011, and comprised 19 patients in whom free fibula flap was performed for upper and lower limb reconstruction, using SPSS 16. Results showed that flap survival was 100%. One (5.2%) flap was re-explored for venous congestion and was salvaged. One (5.2%) patient of congenital pseudoarthrosis of tibia had a fracture of the fibula and was treated with external fixation. Average follow up was 8 months. Mean union time and full weight-bearing was 6.5 +/- 1.34 months (range 3-8 months) and 9 months, respectively. No recurrence of pseudoathrosis was observed until the last follow up, with only a 1.5 cm length discrepancy in one patient. The results proved that a microvascular free fibular flap heals rapidly, causes early functional recovery and it can be raised as an osteocutaneous flap.

Inbreeding-Driven Innate Behavioral Changes in Drosophila melanogaster.

Drosophila melanogaster has long been used to demonstrate the effect of inbreeding, particularly in relation to reproductive fitness and stress tolerance. In comparison, less attention has been given to exploring the influence of inbreeding on the innate behavior of D. melanogaster. In this study, multiple replicates of six different types of crosses were set in pair conformation of the laboratory-maintained wild-type D. melanogaster. This resulted in progeny with six different levels of inbreeding coefficients. Larvae and adult flies of varied inbreeding coefficients were subjected to different behavioral assays. In addition to the expected inbreeding depression in the-egg to-adult viability, noticeable aberrations were observed in the crawling and phototaxis behaviors of larvae. Negative geotactic behavior as well as positive phototactic behavior of the flies were also found to be adversely affected with increasing levels of inbreeding. Interestingly, positively phototactic inbred flies demonstrated improved learning compared to outbred flies, potentially the consequence of purging. Flies with higher levels of inbreeding exhibited a delay in the manifestation of aggression and courtship. In summary, our findings demonstrate that inbreeding influences the innate behaviors in D. melanogaster, which in turn may affect the overall biological fitness of the flies.

Fahr's syndrome as a manifestation of autoimmune polyendocrine syndrome-1 and its unusual association with neuromyelitis optica spectrum disorder.

Fahr's syndrome, also known as bilateral striopallidodendate calcinosis, is a rare inherited neurodegenerative illness characterized by abnormal calcium deposition in several areas of the brain, resulting in a wide range of neuropsychological symptoms. Fahr's syndrome, secondary to autoimmune polyendocrine syndrome type 1, which includes adrenal insufficiency and mucocutaneous candidiasis in addition to hypoparathyroidism, is exceedingly rare. No case report has been documented to date to show the co-occurrence of Fahr's syndrome and neuromyelitis optica spectrum disorder. Here, we discuss the case of a 30-year-old man with a previous history of seizures and symptoms of ectodermal dystrophy presented with seizures, left-sided hemiparesis, dysarthria, and other characteristics indicative of severe hypocalcemia. The neuroimaging findings strongly suggested Fahr's syndrome, with radiographic evidence of Neuromyelitis optica spectrum disorder as longitudinal extensive transverse myelitis in the cervical spinal cord, high titers of serum aquaporin-4 antibodies, and demyelinating neuropathy on nerve conduction studies. This distinct neuropsychological presentation and neuroimaging findings led to the diagnosis of Fahr's syndrome as a result of hypoparathyroidism caused by autoimmune polyendocrine syndrome type 1 with cooccurrence of neuromyelitis optica spectrum disorder. The patient's clinical symptoms improved considerably after he was treated based on a provisional diagnosis. The clinical importance of our case is significant for both neuropsychiatrists and endocrinologists, as autoimmune polyendocrine syndrome should be considered as the etiology of Fahr's syndrome. This case report also aims to report this unusual association of Neuromyelitis optica spectrum disorder with Fahr's syndrome to give the future prospective to know whether this association is incidental or there is a missing link between these two different disorders.

Opalski syndrome, a rare variant of wallenberg syndrome, the first case reported from Pakistan: A case report.

Background: Wallenberg syndrome, also known as a lateral medullary syndrome, is a rare neurological condition caused by an infarction in the brainstem's lateral medulla. There are subtypes of Wallenberg syndrome with distinctive and atypical symptoms, such as Opalski syndrome. Case presentation: A 41-year-old hypertensive male arrived at the emergency department with abrupt onset of right-sided bodily weakness, vertigo, facial numbness, dysphagia, hoarseness of voice, and double vision. The neurological examination indicated right hemiparesis, right facial numbness, crossed sensory deficit, right limb ataxia, right uvulopalatal deviation, and vertical double vision. An MRI showed a lateral medullary infarct leading to the suspicion of the atypical lateral medullary syndrome. The patient was treated with physiotherapy and daily oral medications including aspirin, clopidogrel, atorvastatin, and Cap Risek. On follow-up 14 days later, the patient's condition had significantly improved. Conclusion: This case study demonstrates the significance of recognizing atypical variants of Wallenberg syndrome, such as Opalski syndrome, in order to provide a correct diagnosis and the most effective treatment. Our patient's condition improved as a result of the therapy measures used, however, people with Opalski syndrome may have a poor prognosis and require continuous monitoring.

Brait-Fahn-Schwartz Disease: A Unique Co-Occurrence of Parkinson's Disease and Amyotrophic Lateral Sclerosis.

The Parkinson's disease-amyotrophic lateral sclerosis (ALS) complex typically manifests as levodopa-responsive parkinsonism, followed by ALS. It is extremely rare for Parkinson's disease and ALS to coexist without other neurological disorders. Named after the scientists who first described this overlap of two neurodegenerative conditions, it is referred to as Brait-Fahn-Schwartz disease. Given its variable presentation, increasing rarity, and lack of any diagnostic test, it poses a diagnostic challenge for physicians. We present a case of a 55-year-old Pakistani male experiencing progressive quadriparesis with spastic lower limbs and flaccid upper limbs, in addition to the cardinal features of idiopathic Parkinson's disease. Since there is currently no cure available for either Parkinson's disease or ALS, all available treatment focuses on improving quality of life, which we achieved in our patient. This case is unique in being the first incidence of Parkinson's disease-ALS complex in a novel geographic region such as Pakistan, where genetic testing and cost constraints limit the diagnosis of rare disorders. The coexistence of extrapyramidal symptoms and pyramidal symptoms is uncommon. In such situations, physicians may overlook one group of symptoms, potentially leading to a misdiagnosis. This case highlights the value of a thorough physical examination and electrodiagnostic studies and suggests the association between Parkinson's disease and ALS. This case demonstrates the significance of understanding when Parkinson's disease symptoms start to appear in patients with ALS and the need to start dopaminergic therapy in those who had Parkinson's disease features before ALS to alleviate the suffering of an individual and enhance quality of life.

Assessment of health-related quality of life among patients with obesity, hypertension and type 2 diabetes mellitus and its relationship with multimorbidity.

Obesity, hypertension (HTN) and type 2 diabetes (T2D) are among the multifactorial disorders that occur at higher prevalence in a population. This study aims to assess the health-related quality of life (HRQoL) of patients with obesity, HTN and T2D individually and in the form of multimorbidity. A questionnaire-based cross-sectional study was conducted among the patients in 15 private clinics of Punjab, Pakistan. A stratified random sampling technique was used to collect the data from patients with obesity, HTN and T2D or their comorbidity. A total of 1350 patients responded by completing the questionnaire. The HRQoL of these patients was assessed using the EQ-5D-5L questionnaire (a standardized instrument for measuring generic health status). Statistical analysis was performed using chi-square test, Mann-Whitney U test, and Kruskal-Wallis test. Multivariate linear regression model was used to model the visual analogue scale (VAS) score. In total, 15% of patients had combined obesity, HTN and T2D; 16.5% had HTN and T2D; 13.5% had obesity and HTN and 12.8% had obesity and T2D. Only 15.8% of patients had obesity, 14.3% had HTN, and 12% had T2D. Mann Whitney-U test gave the statistically significant (p = <0.001) HRQoL VAS score55.1 (±23.2) of patients with the obesity. HRQoL VAS scores of patients with obesity were found to be higher when compared to patients with both T2D 49.8 (±15.4) and HTN 48.2 (±21). Diagnosis of one, two and three diseases showed significant results in VAS with all variables including gender (p = 0.004), educational level (p = <0.001), marital status (p<0.001), residence (p = <0.001), financial situation (p = <0.001) and monthly income (p = <0.001). The most frequently observed extremely problematic dimension was anxiety/ depression (47%) and the self-care (10%) was the least affected. Patient HRQoL is decreased by T2D, HTN, and obesity. The impact of these diseases coexisting is more detrimental to HRQoL.

Pleomorphic Adenoma of Minor Salivary Gland.

Pleomorphic adenoma is a benign tumor of salivary glands, arising from minor salivary glands, is very rare and presents with a minor female predilection; and the highest occurrence is between the fourth and sixth decades of life. It is of glandular origin, usually presenting as a slowly growing, painless, firm swelling that does not cause ulceration of the overlying mucosa. In this case, a 27-year male presented with swelling on buccal mucosa for three years. The swelling was firm and well circumscribed. Excisional biopsy was done under general anesthesia and the mass was excised. The histopathological evaluation revealed pleomorphic adenoma. This case highlights the need to keep this entity in the differential diagnosis of intra-oral indolent swellings of some duration. Key Words: Pleomorphic adenoma, Buccal mucosa, Minor salivary glands.

An infant with omenn syndrome: A case report.

BACKGROUND: Omenn syndrome is a rare, autosomal recessive disorder. It is a disorder that stems from severe combined immunodeficiency in an affected individual. The disease is also of rare occurrence in children in Pakistan because this is the age where this disease usually presents, after having developed in the child. This case report will explore all the reasons that lead to the occurrence of this syndrome while also reflecting on the management profile of the child. CASE PRESENTATION: This case report deals with the discussion of one such child who was diagnosed with Omenn Syndrome after being diagnosed with several other diseases, which were being mistaken for being the actual problem and disease, but the reality was that the child was suffering from Omenn syndrome. DISCUSSION: The child is only 3 months old and his symptoms pose a great risk to his overall health status while also making him predisposed to develop several complications and nutritional deficiencies as a result, all of which keep on adding to the burden of diseases that the child faced. In Omenn syndrome, there is an increased susceptibility to develop infections of the skin, lungs, joints, as well as sepsis. Usually, the death of the patient ensues due to pneumonia and septicemia or septic shock. CONCLUSION: Omenn syndrome is a rare disease caused by missense mutations in the recombinase activating genes. It can be treated by bone marrow transplantation or lymphocytic stimulation depending on the severity of the presenting underlying immunodeficiency.

Postpartum superior sagittal, left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report.

Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient's coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.

Etiology and risk factors of stroke in young adults: A multicentric study.

Objective: The main objective of this research was to assess the risk factors and causes of ischemic stroke in the young population (age less than 50 years). Methods: This was a prospective multicenter study conducted at Pakistan Atomic Energy Commission General Hospital, Islamabad, and Mayo hospital Lahore from June 2019 to June 2020. In this research, patients with ischemic stroke, aged 15-50 years were included. Prior to noting demographics, each patient gave ethical approval via filling out consent forms. After that, all demographical details including residence, education, gender and age, and socioeconomic status were noted. Risk factors were evaluated on the questionnaire proforma. Outcomes were measured using the modified Rankin scale (MRS) score. Additionally, data were analyzed by using SPSS V26. A P-value of <0.05 was set as statistically significant. Results: Out of 80 patients, 53 (66.25%) were male, while 27 (33.75%) were female. Six (7.5%) patients were between the ages of 15 and 25 years, 18 (22.5%) patients were between 26 and 35 years, 48 (60%) patients were between the ages of 36 and 45, and eight (10%) patients were between the ages of 46 and 50. According to this research, hypertension was found to be the most frequently occurring risk factor in 28 participants (35%), Diabetes mellitus in 23 patients (28.75%), dyslipidemia in 20 patients (22.5%), and smoking in 18 patients (22.5%). The etiology remained undetermined in 30 patients (37.5%). Most of the patients (87.5%) reported positive functional outcomes (MRS score 0-2). However, 3 (3.75%) patients died during the study period. Conclusion: This research showed that common risk factors of ischemic stroke in the local young population included hypertension, diabetes mellitus, and smoking, whereas the etiology of stroke remained unidentified in the majority of patients.

An Analysis of Maxillary Anterior Teeth Crown Width-Height Ratios: A Photographic, Three-Dimensional, and Standardized Plaster Model's Study.

OBJECTIVE: To analyze the width and height ratios of maxillary anterior teeth at different crown levels through photographs, 3D, and plaster dental model techniques in a subset of the Pakistani population. Material and Methods. This clinical study consisted of 230 participants. The maxillary impression, standardized photographs, and models were constructed for crown width and height analysis. The SPSS version 25 was used for statistical analysis. Descriptive statistics were carried out for mean, standard deviation, and percentage calculation of teeth width and height, gender, and age of participants. Paired t-test analysis was carried out to compare the dependent variables (teeth size, width, and height ratios) with independent variables (techniques applied, side disparity). A p value of ≤ 0.05 was considered statistically significant. RESULTS: The mean width and height of maxillary anterior teeth obtained through photographs, 3D, and plater models were statistically different. The 3D dental model analysis showed reliable and accurate results. The mean width and height ratio of teeth were different on both sides of the arch. There was a significant difference (p = 0.001) in crown width-height ratios at different crown levels. CONCLUSION: The width and height ratios in the studied population were different at various crown levels. The dimensions of teeth varied from the incisal to the cervical part of the crown. Hence, rather than relying on a single, fixed ratio of 78% to 80% suggested by researchers for anterior teeth, the clinician should adopt different crown width-height ratios to restore teeth with the optimum esthetic outcome.

Functional Compatibility of Local Flaps for Coverage of Digital Skin Defects.

OBJECTIVE: To determine if local flap coverage is functionally compatible of digital defects. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Plastic and Reconstructive Surgery, Fauji Foundation Hospital, Rawalpindi, from January 2017 to June 2019. METHODOLOGY: Patients with small and medium skin defects on digits were included. Data was collected for both independent and dependent variables, emphasising on functional outcome based on five parameters (adequate coverage of the defect, functional length of the digit, painless scar, finger-tip sensation, and inter-phalangeal joint motion). Follow-up was done for six months. RESULTS: Total number of patients included in the study was 96, with 45 male and 51 female patients. Mean age of study participants was 26.6 ± 16.9 years. Small to medium size defects were included in the study for coverage by local flaps like cross figure, lateral proximal phalanx, flag, thenar, homo-digital flaps etc. Results were studied in terms of functional outcomes. All the five parameters were achieved in 84 (87.5%) patients. Complications were observed in 10 (10.4%) patients. The most frequent complication was wound infection, which was observed in 2 (2.1%) patients. CONCLUSION: Local flaps for finger defects are a very effective way of providing durable soft tissue coverage. Key Words: Digital defects, Digital reconstruction, Local flaps for digits, Hand injuries.