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

Mandibular fractures in different pediatric age groups and their current management modalities

A number of cases of growing age trauma within oro-facial region have been observed in Pakistan, unlike developed countries of world. Mandibular fractures occur in greater frequency than those of the middle third of the face in children, later being very small and plastic comparative to mandible. These fractures of mandible do not demonstrate different clinical features as compared to adults but there is relative difference in treatment management due to, different patterns and plasticity of the facial bones in children, developing tooth buds at different levels in the jaws, mixed dentition, shedding deciduous teeth and incomplete roots of anterior teeth. The causes and patterns of fracture in children older than 12 years resemble to those found in adults. Mandibular fractures are common in Pakistan and commonly related etiology is accidental fall. 57 patients presented with mandibular fractures at Oral and Maxillofacial Surgery department of Punjab Dental Hospital and Children Complex Hospital, Lahore from September 2003 to September 2005. The age of the patients ranged from infancy to early teenage [6 month to 15 years]. After confirming diagnosis, the children were divided into following four groups; Group "A" [Infants], Group "B" [Pre-school], Group "C" [School] and Group "D" [Teenage]. All patients were treated with one of the following treatment modalities, depending upon the site of fracture and age group of the patients; Micro and miniplates, Eric arch bar splints, Acrylic splints, Ivy eyelet wires, Trans-osseous wiring and Conservative treatment. Group "A" of only 3 patients was managed with open reduction and microplate rigid fixation. Six months follow up showed healing without any complications. Group 'B' with 60% males, had mostly body fractures, was treated with acrylic splints and circummandibular wires. Two bilateral body fractures, with avulsed few teeth, were fixed with rigid fixation. Five patients of about age 3 with minimally displaced body fractures were man aged with Eric arch bar fixation alone. Two bilateral condylar bowing fractures were treated conservatively [no active treatment] with no TMJ complications during follow up. The mandibular trauma was noticed exceedingly high in group 'C' with overall 50.87% and exclusively in males [90%]. Acrylic splints were utilized to treat either condyle with body fractures or condyles alone. Two children had postoperative ipsilateral jaw deviation on opening, which was improved with reverse elastic exercises during follow up. Five patients of high condylar fractures with either no or minimum occlusal disturbance, were conservatively managed. Early mobilization was the prime concern in them to avoid late complications. 17.54% patients were of group 'D' with again high male [90%] ratio. Two horizontally unfavorable angle fractures were managed by trans-osseous wires. Five with minimum displacement were managed with miniplates rigid fixation. All others' with associated condylar fractures were treated with Eric arch bar splint with one plate at body and intermaxillary fixation for two weeks. The patterns and management modalities of pediatric mandibular fractures vary in different age groups. The pediatric fractures should be managed as early as possible to avoid complications. Majority of trauma results in school going and teenage groups with definite high male proportion. High condylar fractures should be treated with extra care, keeping in mind of post traumatic TMJ ankylosis. Acrylic splints showed ideal results in body and condylar fractures, whereas, microplates may be the treatment of choice in infants with no or few deciduous teeth. No serious complications were observed during 6 months follow up

Primary repair vs colostomy in colonic injuries - a two year experience at Lahore general hospital and Mayo Hospital, Lahore

The object of the study was to compare the results of primary repair in colonic injury with colostomy. 200 patients were selected, 100 being allocated to each group.All patients underwent laprotomy mostly indicated by peritoneal irritation. Most of the injuries were of the transverse colon. 22 patients underwent into exteriorization of the repaired part. Right hemicolectomy and ileocolic anastomosis was done in 30 patients. A significant morbidity occurred from wound sepsis, abdominal abscess formation and postoperative pulmonary complications. 22 patients suffered from burst abdomen and 10 developed faecal fistulas. 4 patients died. Prolonged mean hospital stay and more incidences of postoperative complications occurred in colostomy group. This shows that primary repair of colonic injuries should be done in selected cases instead of colostomy in each case

Comparative study between bupivacaine infiltration in inguinal hernia and intravenous narcotic analgesia a multicenteric study

The object of the study was to assess the pain relief after Bupivacaine infiltration in the wound in the patients following hernioraphy and to compare it with patients who received narcotic analgesia. 400 patients were selected, 200 being allocated to each group. Pain was compared according to pain scale and mobility of the patients post operatively. After the first 6 hours patients who received Bupivacaine were mobilized earlier as compared to 2nd group. This shows that long acting local anesthesia can be used in a day care surgery

study of complications related with colostomy closure

To determine the complications associated with colostomy closure following a suggested protocol and then compare the incidence with recent reported literature and to suggest measures for reduction of morbidity and mortality associated with colostomy closure. This study is based on a review of all the patients undergoing colostomy closure from August 1995 to September 1997 in East Surgical Ward, Mayo Hospital, Lahore. This prospective clinical study was carried out in the East Surgical Ward, Mayo Hospital, Lahore. A total of 32 patients belong to either sex who underwent colostomy closure following emergency colostomy were included in this study. Patients under 12 years of age were not included as these were managed in Paediatric Surgery Department of Mayo Hospital, Lahore. Time interval between construction and closure of colostomy was three months and all the patients were fit for anaesthesia. Pre-operative barium enema was done prior to admission to check a ny distal pathology like stricture or leakage. In only two cases strictures were found, and these patients were excluded from study. All patients were admitted through the outpatient department three days before operation, and a special proforma was filled for each patient. A detailed history was taken to find the time and indication for colostomy. A short note was made about the state of other injuries and site of colostomy. A thorough examination was performed to find the state of colostomy, type of colostomy and fitness of the patient. A total of 32 patients were included in this study. Of these 26[81.2%] were male and 6 [18.7%] patients were female. 21[65.6%] were with loop colostomy, 7[21.8%] end colostomy with mucus fistula and 4[12.5%] were with end colostomy with Hartmann's pouch. Penetrating injury of the colons is the most common etiology for colostomy at the initial operation. 15[46.8%] were made in the transverse colon, 13[40.6%] were made in the left colon and 4[12.5%] were made in the right colon. It has been concluded in this study that the most common indication for colostomy construction in Pakistan is the penetrating injury of abdomen. Young males are more commonly suffered from firearm injuries of abdomen. Loopogram should be done before colostomy closure especially in non-traumatic cases

Hepatic trauma: effects of delay in presentation

Hepatic trauma carries a substantial amount of morbidity and mortality. The purpose of the study is to study the effects of delay in initiation of management of patients suffering from hepatic trauma. Prospective study. The study was carried out in the Department of Surgery, Mayo Hospital Lahore from the year 1995-1997. 57 patients were included in this study. They were operated and different methods of repair were employed. 57 patients were studied. 50 were males, 7 were females. They belonged to an age range of 12-62 years. 55.7% patients suffered from blunt trauma while the rest of the cases were of penetrating injury. Over 50% of the patients presented within 4 hours of injury. All of the patients were operated and there findings noted. Different types of haemostatic measure were employed. There were ten mortalities in this study. Early presentation to the hospital of hepatic trauma cases, has a good impact o n the ultimate outcome of the patients

Outcome of surgical management of carcinoma of the pancreas

Majority of the pancreatic tumours arise from ductal epithelium and practically the term pancreatic cancer is reserved for that tumour. Mates are predominantly the victims with male to female ratio of 3:1 in this study. A number of etiological factors have been blamed to be associated but smoking and diabetes mellitus are closely related. Fifty percent patients in this study were found to be either current smokers or have been smoking till last five years. The tumour is notorious for its silent growth and non specific presentation. The most common symptom being jaundice when the tumour arises from head region of the gland, associated with anorexia, vomiting weight loss and malaise. Migrating thrombophlebitis is another unusual feature in some cases. The tumours of body and tail present as mass in the epigastrium. In the present study 90% turnours were arising from the head of the gland and 10% from the body. Cystic neoplasms are common in female patients and arise from the body and tail. Silent spread of the tumour involves the lymph nodes and peripancreatic tissues making it most of the time unresectable at the time of presentation. In the text 10% is the usual resectabte rateIn our study the resectability rate was 25%. Management of the case depends upon the stage of the tumour at time of presentation. Surgical management is the best suitable with chance of curative resection of the tumour. Various modifications in pancreaticoduodenectomy have been done since the Whipples procedure was introduced. Pylorus preserving pancreaticoduodenectomy is one such modification. Pancreatic stump is associated most of the time with complications of leakage. Although the techniques of pancreaticoduodenectomy have been improved with better pre operative evaluation, anaesthetic facilities and post operative care of the patient, the long term five year survival is still not much increased. Moreover, post operative hospital stay and complication rate is still high. Alternatively, bypass procedure especially where the disease i s advanced and the tumour is not resectable, are applied. These palliative procedures are associated with short hospital stay, less post operative complications, early relief of symptoms and better quality of life. Short term survival is rather better in these patients as compared to those undergoing resection. Six months survival in our study was 66.6% as compared to 60% in resected cases. Supportive therapies including chemotherapy, radiotherapy and hormone therapy at present are not of much help