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.
Background: Brachial plexus injuries are common after both blunt and penetrating traumas resulting in upper limb weakness. The nerve transfer to the affected nerve distal to the injury site is a good option where proximal stump of the nerve is unhealthy or absent which has shown early recovery and better results. Commonly used procedures to restore elbow flexion are ipsilateral phrenic or ipsilateral intercostal nerves (ICNs) in global plexus injuries. The use of both intercostal and phrenic nerves for elbow flexion is well described and there is no definite consensus on the superiority of one on another. Methods: All patients presented in the outpatient department of LNH and MC from January 2014 to December 2017 with pan plexus or upper plexus injury with no signs of improvement for at least 3 months were included in the study. After 3 months of conservative trial; surgery offered to patients. Results: A total of 25 patients (n = 25) were operated from January 2015 to December 2017. Patients were followed to record Medical Research Council (MRC) grades at 3, 6, 9, 12, and 18 months. The patients achieved at least MRC Grade 3; 70% at 12 months follow-up to 80% at 18 months in the phrenic nerve transfer group. While in the ICN transfer group, it is 86% and 100% at 12 and 18 months postoperative, respectively. Conclusion: Our study has shown better results with ICN transfers to musculocutaneous nerve, recorded on MRC grading system.
The ear has a unique architecture of cartilage and skin. The incidence of the prominent ear is about 5%. Surgical correction of the prominent or protruding ear can be carried out either by anterior or posterior approach. We created antihelical fold of cartilage by utilizing a posterior incision to score the anterior cartilage of the lateral scapha with a knife. Sutures were often used to uphold the produced fold. The additional procedure of conchal reduction and concho-mastoid suture was done when required. The objective of our research is to evaluate the patient's and surgeon's satisfaction with our technique of prominent ear correction and identify any complication if it occurs post-operatively. This is a retrospective study over a period of eight years (2011-2018) which includes all patients presented to Liaquat National Hospital with prominent ear. A total of 47 patients were included. Patients with a previous history of otoplasty were excluded. Patients were followed up for at least six months postoperatively. The outcome was assessed via Visual Analogue Score by a patient, surgeon, and a third observer (assessor). The average score by the surgeon was 7.9, by the patient it was 8.4 and by the assessor it was 8.1. The average pre-operative concho-mastoid distance was 2.2 cm which decreases to 1.4 cm post-operatively. Correction of the prominent ear by this technique is safe and easy. We did not experience any major complication, giving reproducible and good aesthetic results.
Trismus in post-radiotherapy patients is mostly secondary to fibrosis of buccal mucosa and muscles of mastication. After releasing trismus, mucosal defect needs to be covered with soft and supple tissue. We used a non-conventional method to cover this defect i.e. dumbbell-shape forearm free-flap based on a single radial artery.
OBJECTIVE: To evaluate awareness amongst general population attending Civil Hospital Karachi regarding risk factors associated with infertility. METHODS: A descriptive study was conducted on subjects who were attendants to the patients admitted in Civil Hospital Karachi or had appointment in outpatient department. They were interviewed one-on-one after their verbal consent, through separate questionnaires for each gender, from September 2012 to January 2013. Minimal age of the respondents included was 18 years. Data was entered and analyzed in SPSS (version 20.0). RESULTS: A total of 289 attendants were interviewed, 150 were females, with mean age 38.1 +/- 11.3 years, remaining 139 were males having a mean age of 32.5 +/- 9.9 years. Correct knowledge about the risk factors causing infertility was found to be limited among people. Only 159 (66.9%) and 142 (49%) of the total respondents recognized obesity and diabetes as a threat. Just 54 (36%) and 72 (48%) of females were able to appreciate hirsutism and menorrhagia respectively as cause. Sixty (43%) and 67 (48%) of males considered mumps and smoking respectively as culprits. In contrast to previous researches, men received greater votes for being a probable victim of infertility (55%; 159 of the total respondents). CONCLUSION: Inadequacy of knowledge about infertility was clearly demonstrated through this study. This lack of knowledge explains why such a strong stigma is attached to infertility in the society.
Awareness , Infertility/etiology , Adult , Aged , Female , Humans , Interviews as Topic , Male , Middle Aged , Pakistan , Qualitative Research , Risk Factors , Surveys and Questionnaires , Young Adult
