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.

Has the anterolateral thigh flap replaced the latissimus dorsi flap as the workhorse for lower limb reconstructions?

OBJECTIVE: To compare the applicability and reliability of free Anterolateral thigh flap (ALTF) with Latissimus Dorsi free flap (LD) in different reconstructive scenarios of lower limb. To compare flap elevation time, vessel diameters, pedicle lengths, total operative time, peri-operative blood requirement, number of secondary procedures and complications between the two types of flaps. METHODS: Patients of all age groups with lower limb soft tissue defects requiring free tissue transfer, reporting to Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from November 2005 to November 2008, were included in the study. The patients were distributed into two groups irrespective of the primary disease; Group 'A' patients underwent LD reconstruction and Group 'B' patients had an ALTF transfer. RESULTS: A total of 60 cases were included in the study (Male : Female = 6.5 : 1). Mean patient age was 30.33 +/- 10.082 years. The mean follow up period was 19.73 +/- 9.303 months. Larger defects were covered with ALTF as compared to LD (p=0.003). The total surgery time was longer in Group 'A' (p=0.017). Peri-operative blood requirements and debulking procedures were also more frequently required in Group 'A' (p=0.002, 0.007). There was no significant difference in rest of the flap and operative parameters between the two groups. CONCLUSION: ALTF is as reliable a flap as LD for various lower limb defects. Its additional advantages include short operation time, decreased requirement of peri-operative blood transfusion and subsequent debulking procedures. Considering these benefits, the ALTF may be labeled as the 'New Workhorse' for lower limb reconstructions requiring free tissue transfer.

Fronto-orbital advancement and total calvarial remodelling for craniosynostosis.

OBJECTIVE: To describe the results of fronto-orbital advancement and remodelling for craniosynostosis in children. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, from June 2009 to June 2012. METHODOLOGY: All the patients with cranial suture synostosis operated were included in the study. Those patients who were lost to follow-up were excluded. Variables considered were age, gender, type of synostosis, intracranial pressure, and history of previous surgeries for the same problem. Outcome measures were studied in terms of improvement of skull measurements (anteroposterior and bicoronal), duration of surgery, hospital stay, blood transfusions, complications and parents satisfaction. RESULTS: A total of 36 patients were included in the study. Male to female ratio was 3:1. The age ranged from 5 to 54 months. Thirty two patients presented with non-syndromic and four with syndromic craniosynostosis. Fronto orbital advancement and total calvarial remodelling was done in 26 and 10 patients respectively. There was improvement in the skull measurements and the parents were satisfied in all cases with the skull shape. Complications occurred in 11.1% including chest and wound infection and one death. CONCLUSION: Fronto-orbital advancement and remodelling is an effective procedure for the correction of craniosynostosis, however, individual cases may require other procedures like total calvarial remodelling.

Clinical applications of the pedicled anterolateral thigh flap in penile reconstruction.

BACKGROUND: Penile reconstruction remains a major challenge in plastic surgery and, over the years, a myriad of techniques has been employed to achieve a functional phalloplasty. Unfortunately, the more commonly used forearm free flaps also have significant drawbacks. The pedicled anterolateral thigh flap (ALTF) has numerous attributes, which make it a comparable, if not a better option, for penile reconstruction. METHODS: Between January 2007 and December 2009, 14 patients with partial or complete penile loss underwent reconstruction with a pedicled ALTF. The demographic data of the patients, cause of the defects, technique of reconstruction and the details about different flap parameters are presented here. RESULTS: All the 14 patients were males, and the age range was between 27 and 60 years. Nine flaps were used for total penile reconstruction and five for partial penile reconstruction. The size of the flap ranged from 5 × 4 cm to 15 × 15 cm and was based on two perforators in four cases, while a single perforator was used in the rest. The perforators were musculocutaneous in 11 and septocutaneous in three patients. Primary urethral anastomosis was performed in three cases of total phalloplasty and all cases of partial phalloplasty (n=8), while in the rest, urethral continuity was established in a second stage. All the flaps survived completely. CONCLUSIONS: We have found the pedicled ALTF to be a very versatile flap with wide range of applicability for partial as well as total phalloplasty.