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Abstract Background A lymphocele or lymphocyst is formed when lymphatic fluid accumulates in a space, following disruption of lymphatic channels. Here, we report a case of a giant lymphocele in a middle-aged female, who underwent Trendelenburg operation (saphenofemoral junction ligation) for varicose veins of her right lower limb. Case presentation A 48-year-old Pakistani Punjabi female presented to the plastic surgery outpatient department with a history of painful, progressive swelling of the right groin and medial aspect of the right thigh for 4 months. After investigation, it was diagnosed as a giant lymphocele. A pedicled gracilis muscle flap was used to reconstruct and obliterate the cavity. There was no recurrence of the swelling. Conclusion Lymphocele is a common complication after extensive vascular surgeries. In the unfortunate case of its development, prompt intervention must be done to prevent its growth and ensuing complications.

Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020. Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data. Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improvedv and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007). Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores.

Objective: To compare the outcomes of mandibular reconstruction with vascularized fibular graft in adjuvant and nonradiotherapy Groups. Study Design: Retrospective longitudinal study. Place and Duration of Study: Plastic Surgery Department, Shifa International Hospital, Islamabad Pakistan, from 2010 to 2018. Methodology: The data of 92 patients from 2010-2018 was included. Outcomes regarding local wound complications, wound dehiscence, fistula, skin necrosis, plate exposure and bone union rate were compared in Radiated (IR) and Non-Radiated (NR) Groups. Orthopantomography (OPG) was done at one month, six months, and one-year follow-up and was reviewed by a Radiologist. Results: Ninety-two patients were included in the study, 56(60.9%) patients in the IR-Group and 36(39.1%) patients in the NRGroup. In the IR-Group, 56(60.9%) causes were intraoral squamous cell carcinoma in 51(91.0%) cases and osteosarcoma in 5(9.0%) cases. In NR-Group cases were ameloblastoma (15,41.6%), giant cell tumor (4,11.1%), craniofacial microsomia (4,11.1%), osteonecrosis (6,16.6%) and trauma (7,19. 4%). Common complications were plate exposure (2.1%), wound breakdown (10.8%) in the IR-Group, and, on the other hand, in the NR Group, wound breakdown noted in (3.2%) respectively(p=0.05). Conclusion: With our experience, adjuvant radiation is an important modality that increases survival rate and can be safely administered without any significant complications related to soft tissue and reconstructed bone.