Use Of Steroids In Rhinoplasty With Lateral Osteotomies For Reducing Post Operative Oedema.

BACKGROUND: TPostoperative periorbital oedema is a commonly encountered side effect of rhinoplasties in which lateral osteotomies have been incorporated. It dissatisfies the surgeon as well as the patient. Osteotomies are done at the end of all soft tissue manipulation to reduce the development of oedema. The aim of this study was to determine the efficacy of intravenous dexamethasone in reducing oedema in patients who undergo rhinoplasty with lateral osteotomies. METHODS: A Prospective randomized controlled trial was done at department of plastic and reconstructive surgery, Shifa International Hospital Islamabad. Sixty patients age between 16-55 requiring open rhinoplasty were taken for this study and divided in two groups. One group received dexamethasone 8mg intravenously preoperatively and second dose 4 hours postoperatively. The second group did not receive anything. Both groups were assessed on first post-operative day and 7th day for periorbital oedema. RESULTS: The overall decrease in oedema in patients who received steroid was by 50% while in control group was 33.3%. By the 7th day control group 13.3% patients had grade III oedema as compared to 3.33% in steroid group. Chi test was applied and p-value of 0.0289 was obtained which was found to be statistically very significant. CONCLUSIONS: Dexamethasone used in minimal dosage showed significant advantage in reducing periorbital oedema after rhinoplasty with no evidence of any side effects secondary to steroid administration.

The bilobed flap - a better option for soft tissue release in the management of Radial Club Hand.

OBJECTIVE: To establish that the bilobed flap as soft tissue release component for the radial club hand is superior to the z-plasty technique in type III and IV radial club hands. METHODS: This study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from 2009 to 2015, and comprised patients with radial club hands operated by a single consultant plastic surgeon. Soft tissue release was performed at 08 months. The extremity was then casted for 08 weeks and kept in a long-arm cast for 3 to 6 months. RESULTS: Twelve radial club hands of 9 patients treated successfully during the study period showed good to excellent results. Z-plasty was used on the radial side to correct the soft tissue deficiency in 5(42%) hands, and a bilobed flap in 7(58%) hands for soft tissue rearrangement on the radial side. Of all hands, 1(8.3%) z-plasty flap developed partial flap necrosis and 1(8.3%) each developed infection and needed implant (Kirschner wire removal), which were dealt with efficiently with no long-term sequelae. CONCLUSIONS: The bilobed flap was found to be superior to the z-plastytechnique since the flap had better predictability and no tissue was wasted.