Vaginoplasty with bilateral islanded pudendal thigh flaps.

BACKGROUND: Vaginal agenesis is the most common congenital deformity of female pelvis and vaginal reconstruction remains a surgical challenge. There are various surgical and non-surgical techniques described for the reconstruction of neovagina. We have used pudendal thigh flaps raised on either side of the labia to reconstruct the vagina in 19 patients. This study is carried out in the Department of plastic and reconstructive surgery, Hayatabad medical complex Peshawar to evaluate the functional and aesthetic outcome of vaginoplasty with bilateral pudendal thigh flaps. METHODS: Vaginal reconstruction was done with bilateral islanded pudendal thigh flaps, in 19 consecutive patients with vaginal atresia, during 5 years, from Aug 2004 to Aug 2009. The flaps were raised on either side of labia and sutured to each other in midline to form a vaginal tube. This neo-vagina was inserted into the space between the rectum and bladder and anchored to the deep pelvic tissues. RESULTS: Out of 19, eleven patients (58%) were diagnosed with Mayer Rokitansky Kauser Hauser Syndrome and 8 (42%) with isolated vaginal atresia. The mean vaginal length and width was 9.2 and 4.3 cm respectively one year post operatively. CONCLUSION: This method of vaginoplasty is simple, safe, and reliable and has shown satisfactory functional and cosmetic results. The reconstructed vagina has a natural angle and is sensate in its lower part. No postoperative stenting or dilatation is required. The donor site in the groin can be closed primarily and the scar is well hidden in the groin crease.

Distally based sural fasciocutaneous flap for soft tissue reconstruction of the distal leg, ankle and foot defects.

BACKGROUND: Soft tissue management around the lower third of the leg and foot presents a considerable challenge to the reconstructive plastic surgeon. The options in this region are limited. A durable flap is the preferred option for coverage of such defects. This descriptive study was conducted at Hayatabad Medical Complex and Said Anwar Medical Centre Peshawar over a period of 4 years to evaluate the efficacy of distally based Sural flap in coverage of the lower third of leg, ankle and foot defects, in 25 patients. METHODS: A descriptive study was conducted at the department of Plastic and Reconstructive Surgery at Hayatabad Medical Complex and Said Anwar Medical centre Peshawar. 25 patients with soft tissue defects over the distal leg and foot were included in this study. Distally based sural fasciocutaneous flap was used for coverage in all cases and its survival, successful coverage of the defect and donor site morbidity studied. RESULTS: Out of 25 flaps, 20 showed complete survival (80%). Partial flap loss was found in 2 patients (8%), marginal flap necrosis in 2 patients (8%) and complete loss in 1 patient (4%). CONCLUSIONS: The distally based sural flap is a versatile and reliable flap for the coverage of soft tissue defects of the distal lower extremity. The procedure is done as a single stage; the dissection is easy with short operating time and minimal morbidity.

Management protocol of mandibular fractures at Pakistan Institute of Medical Sciences, Islamabad, Pakistan.

BACKGROUND: Maxillofacial trauma is very frequent and associated with a high incidence of mandibular fractures. Although there is universal agreement as to the treatment goals and basic therapeutic principles of reduction and stabilization, a variety of currently accepted treatment modalities indicate a lack of consensus. The authors evaluate the incidence, etiology, management and complications of 344 mandibular fractures in 228 patients treated in the Department of Plastic and Reconstructive Surgery at Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, during a three year period. Indications and techniques for closed and open treatment of mandibular fractures are reviewed along with any complications of these fractures or their management. METHODS: A total of 344 mandibular fractures in 228 patients were included in this study. The sex, age, etiology, presentation, fracture characteristics, associated injuries, various methods of management and any pre or postoperative complications were evaluated. RESULTS: Although various devices and techniques have been used to treat these fractures, modern plate and screw fixation systems have proved to provide the best rigid stabilization, early mobility and associated with least complications. There was a satisfactory bone healing in all the patients and a minimal complication rate associated with open reduction and internal fixation (ORIF). CONCLUSION: Mandibular fractures occur with high frequency in road traffic accidents and interpersonal violence. They are among the most common types of facial fractures treated by the plastic surgeons. They must be managed carefully to maintain the function of the mandible, reestablish proper occlusion, and minimize secondary complications. Open reduction and internal fixation has proven to be the most effective method for treatment of mandibular fractures.