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Background: Negative pressure wound therapy (NPWT) accelerates wound healing by inducing growth factors, evaporating fluid, removing microorganisms, and improving microcirculation. Compared to it the traditional technique involves applying a dressing that is tied over and secured with nylon stitches commonly known as tie over dressing. Both the methods of graft fixing have their pros and cons therefore current study was designed to compare the efficacy of tie over dressing and NPWT methods for securing split thickness skin grafts and sheet grafts. Methods: A randomized control trial was conducted at tertiary care hospital of Karachi from July to December 2023. Participants who visited the department for grafting, fulfilled the inclusion criteria and given consent throughout the study duration were included in the study. The participants were selected by non-probability consecutive sampling technique and groups were allotted by sealed envelope method. Group 1 received tie over dressing and Group 2 received NPWT dressing. The wounds were evaluated after 5 days for tie over dressing and after 3 days for NPWT dressing. Results: The wound were assessed for outcome (healing and complications) after 14 days. The percentage of graft take identified as 11 (31.4%) participants of tie over dressing group and 28 (80%) participants of NPWT dressing material had more than 50% graft take however, remaining participants of both the group suffered the wound healing complications and delayed healing. The significant (p<0.05) differences were observed for graft loss, hematoma formation, and infection. However, 25 (71.4%) participants of Vac-NPWT faced no complication (p-value =0.001). No patient in either group had complete graft loss. Conclusion: NPWT dressing has superiority in preventing graft loss, hematoma formation, and infection over tie over dressing. [ABSTRACT FROM AUTHOR]

Objective: To observe the short and long-term adverse outcomes of soleus muscle rotation flap for the coverage of soft tissue defects of middle and distal leg. Study Design: Case series. Place and Duration of the Study: Departments of Plastic and Reconstructive Surgery Bahawal Victoria Hospital Bahawalpur, Combined Military Hospital Bahawalpur and Combined Military Hospital Quetta from Dec 2014 to Feb 2020. Methodology: A of total 33 patients were enrolled for the study through consecutive sampling. All the patients were reviewed at first and second week (early morbidity) and six months (late morbidity) after the operation. They were examined for hematoma at the donor site, wound infection, sural nerve injury, graft loss and flap necrosis during early follow-up. In late follow-up, patients were examined for muscle weakness, sensory abnormalities, hypertrophic scarring, hyperkeratosis, soleus muscle contractures, and reduced knee mobility. Results: There were 30 (90.9%) male patients and 3 (0.9%) female patients. The mean age was 35 ± 11 years (range: 16 to 64) years. The hematoma was the commonest complication found in two (6.06%) patients. Wound infection, partial loss of flap, partial loss of skin graft and wound infection occurred in one patient each. Late follow-up revealed contractures of the soleus muscle and reduced knee mobility in three (9.09%) patients. Conclusion: The soleus muscle rotation flap is reliable, versatile and very useful for providing supple soft tissue coverage for defects in the middle and distal leg. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the severity of depression and anxiety among patients of burns and correlate depression and anxiety with areas of body involved in burns. Study Design: A cross-sectional study. Place and Duration of Study: The departments of Psychiatry and department of Plastic Surgery, Combined Military Hospital Multan, from Oct 2019 to Mar 2020. Methodology: Through consecutive sampling, 56 patients of burns reporting to burns unit were assessed for anxiety and/ or depression based on the diagnostic criteria of International Classification of Diseases version 10. Symptom severity was assessed using Beck Depressive Inventory for depression and Beck Anxiety Inventory for anxiety. Descriptive statistics like mean with standard deviation was calculated for age. Frequency along with percentages was calculated for sociodemographic variables, Anxiety and depression. Results: Depression was present among 30 (53%) of participants out of which 16 (53.5%) had mild, 11 (37.9%) had moderate while only 3 (12.5%) had severe depression. Anxiety was seen among 50 (89%) of participants out of which sixteen (32.1%) had mild, 26 (51.7%) had moderate while 8 (16%) had severe anxiety. Significant correlation existed among the major area involved in burn with both anxiety and depression (p<0.01). Conclusion: There is a very high prevalence of anxiety and depression among patients of burn. Significant positive correlation existed between the level of anxiety and the areas involved in burns. [ABSTRACT FROM AUTHOR]

Objective: To present the early and late outcomes related to donor site morbidity of Free Fibular Flap. Study Design: Prospective observational study. Place and Duration of Study: Plastic surgery department, Combined Military Hospital Rawalpindi, from Jan 2009 to Jan 2020. Methodology: In total 361 patients were enrolled for the study through consecutive purposive sampling. All patients requiring free fibula flap for reconstruction of the defect were included in the study. However, the patients with Diabetes Mellitus, Smoking or peripheral vascular disease were excluded from the study. The patients were asked to visit on second week and then at three months for late outcomes. The results were entered SPSS-24 for analysis and interpretation of data. Results: Out of total 361 patients enrolled for study 293 (81.16%) were male and 68 (18.83%) were female. The men age was 51.43 years SD 14.6 (range 4 year to 68 years). In early outcomes, graft loss 29 (8.03%) and sensory deficit 19 (5.26%), are the commonest adverse outcomes. Results of late follow up revealed chronic pain in 29 (8.03%), ankle instability in 24 (6.64%), gait abnormality in 29 (8.76%) and claw toe in 33 (9.14%) patients. The American Orthopedic Foot and Ankle Society (AOFAS) score was 88.45%. Majority (52.63%) patients were very satisfied. Conclusion: The free Fibula is excellent choice for reconstruction of a wide range of osseous defects with minimum donor site morbidity and high satisfaction rate among the patients. [ABSTRACT FROM AUTHOR]

Objective: To assess short and long term aesthetic and functional outcomes of nasal ala reconstruction by three staged folded forehead flap. Study Design: Prospective study. Place and Duration of Study: Plastic and Reconstructive Surgery Department of Combined Military Hospital Bahawalpur and Quetta, from Dec 2014 to Dec 2018. Methodology: Total of 29 patients were enrolled through consecutive sampling technique. Nasal ala defects were reconstructed by three staged frontal forehead flap under general anesthesia. Follow up visit at 2 weeks bleeding, wound Infection, partial skin graft loss and partial flap necrosis was documented. Follow up at 24 weeks, functional outcome of nasal reconstruction was assessed by history and clinical examination for nasal obstruction and/or crusting. Patients’ subjective satisfaction about aesthetic outcome of nasal reconstruction was documented on 5 point likert scale. Objective aesthetic assessment of reconstruction was done on 2D photograph by two independent surgeons. Results: Twenty six (89.66%) males and 3 (10.34%) females participated in study. The mean age was 35 years range 16 to 64 years. Follow up at two weeks revealed postoperative bleeding in 2 (6.8%), wound infection in 1 (3.4%) and partial flap loss in 1 (3.4%) patient. At 24 weeks follow up all patients had patent nasal ala. Subjective and objective assessment of nose shape was documented. Conclusion: Use of three staged folded forehead flapis useful method of reconstruction for full thickness defects of nasal alaewith good functional and aesthetic outcome. [ABSTRACT FROM AUTHOR]

Objective: The objective is to analyze the utility of theisland supraclavicular flap in a region where skin graft cannot be used and free flap is not feasible. We assessed complications and functional outcomes. Study Design: Prospective descriptive study. Place and Duration of Study: The study was done at plastic and reconstructive surgery department CMH Rawalpindi during the period of 03 year from October 2011 to October 2014. Material and Patients: An island supraclavicular artery flap was used to reconstruct oncologic, and post burn neck contractures release defects. 30 patients were included in the study. Doppler probe was used to help with localization of vascular pedicle. All the patients with scarring in both shoulder regions, history of radiation to neck and undergoing radical neck dissection were excluded. Results: Atotal of 30 patients were included 20 (66.6%) male and 10 (33.3%) were female. Oncologicre section was followed by immediate reconstruction with island supraclavicular artery flap. Post burn contractures were released and covered by a pedicled supraclavicular artery flap. The recipient sites were neck, face, oral and upper chest region. The average harvest time was 1 and half hour. Donor site was closed primarily in 22 (73.3%) while 8 (26.6%) require skin grafting. Post burn contractures needed scar management with intralesional steroid, pressure garments and scar revision with Z-plasty in 4(13.3%) cases. 1 (3.3%) flap failed completely and the defect was covered with a skin graft. We had 01 (3.3%) mortality due to respiratory obstruction, despite adequate flap perfusion for 24 hours. Minor complications included, partial flap loss, seroma, and haematoma formation. In addition hypertrophied scar, spreading scar and keloid formation occurred at the donor site 18 (60%). Conclusion: Island supraclavicular artery flap with an easy learning curve is a reliable flap. It has a good colour and texture match with minimal donor site morbidity. It is an excellent choice for neck coverage after post burns contracture release and an attractive alternative to free flap for oral/ facial defects. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to see the long and short term outcome of the reverse sural artery flap. Study Design: Case series. Patients and Methods: From January 2009 to December 2011, data was collected and analyzed for this study. Eighty nine patients with wounds on the ankle, heel, sole, distal leg, and foot were included in the study. They were followed up at 01 week, 02 weeks, and then 4 weekly for 06 months and at one year time from operation. They were examined for necrosis, congestion, surgical site infection, dehiscence of suture line, epidermolysis, donor site infection and functional outcome. Results: Most of the flaps healed nicely but two (2.25%) failed completely. Six flaps were delayed. However early follow up (within 04 weeks) revealed that there was partial loss of the distal 1-1.5 cm of flap in 04 patients (4.50%). Two patients (2.25%) developed superficial surgical site infection. Six patients (6.74%) developed venous congestion of the flaps which recovered within two weeks. Other minor complications included dehiscence of suture line in 3 patients (3.37%), and superficial Epidermolysis in four (4.50%) (Table-2). Twenty two patients (24.72%) returned to their work in 12-16 weeks, 31 (34.83%) in 16-20 weeks and 36 (40.45%) in 20-24 weeks. Long term follow-up to 06 months revealed hypertrophic scars at the donor site in three patients (4.91%) and recurrence of ulcer in 2 patients (3.27%). Conclusion: The sural fasciocutaneous flap provides reliable supple and durable most single-stage coverage of wounds of the distal third of the leg, heel, and foot with the results comparable to free-tissue transfer. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcome of early skin tumour excision and reconstruction with regards to tumour margin clearance, recurrence and aesthetic results of reconstruction. Study Design: Quasi experimental. Place and Duration of Study: This study was carried in the department of Plastic and Reconstructive Surgery Combined Military Hospital (CMH) Rawalpindi, Pakistan from January 2010 to December 2012. Patients and Methods: All patients having tumours of the cheek, upper and lower lips, nose and forehead, who underwent primary surgical excision and reconstruction with local flaps, were included in the study. Patients with nodal or distant metastasis were excluded. Tumours were excised with safe margins and defects reconstructed with local facial flaps. Patients were regularly followed up as per protocol for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Results: Eighty nine patients aged between 37-86 years with a mean age of 59.4 years (SD ± 9.24) were included in the study. There were 58 (65%) cases of basal cell carcinoma (BCC) and 31 (35%) of squamous cell carcinoma (SCC). Recurrence was seen in 3 (5.2%) cases of BCC and 2 (6.4%) cases of SCC. There was 1 (1.1%) complete and 4 (4.5%) partial flap losses. The follow-up period ranged from 4 months to 3 years with average of 16 months. Conclusion: Local flaps give a simple option for facial reconstruction for postoncological resection defects giving good aesthetic match due to local tissue. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the type of patients and procedures carried out on flood affected population near Risalpur and Nowshera in monsoon 2010. Study Design: Descriptive study. Place and Duration of the Study: Medical relief camps established at Government Technical Training College (TTC) near Kabul River Nowshera Kalan, and Federal Government Boys High School (FGS) at Risalpur Garrison and Combined Military Hospital (CMH) Risalpur from 29th July 2010 to 10th October 2010. Patients and Methods: Management of cases was divided into 2 phases. Phase 1 comprised of initial 6 days at TTC and phase 2 comprised of work at FGS from 7th day onwards till culmination of relief activity. Data was summarized on the basis of total number of patients rescued, sustained injuries, carried out procedures, detained, admitted and referred / transferred cases. Frequencies and percentages were used to describe the data. Results: Total number of patients managed during this flood relief operation were 8308. During first phase a total of 3863 cases including 969 males, 1419 females and 1495 children were treated at TTC Nowshera, while during second phase a total of 4425 flood affected cases including 1227 males,1929 females and 1269 children were managed at FGS Risalpur Garrison and CMH Risalpur. During this operation at CMH, 1024 patients were treated as outdoor cases, 74 patients were detained, 51 were admitted, 40 cases where referred while 4 cases were evacuated to DHQ Hospital/ CMH Mardan, 950 laboratory tests and 104 X-Rays/ USG were carried out. Gynecological services were of great importance as 3 caesarian sections, 18 normal vaginal devilries and 6 dilatations and curettages were performed. Conclusion: Medical services for disaster management were helpful to flood affected population in need of hour. Prompt medical treatment and early evacuation remains the mainstay. Emergency reproductive health care services should also be incorporated in effective disaster management plans. [ABSTRACT FROM AUTHOR]