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An Assessment of Patients with Hand Mutilation

// December 24th, 2011 // No Comments » // My Publications

Background: Hand mutilation due to burn injury has its own lifelong imprints. The resultant contracture needs meticulous and aggressive management by a team consisting of Plastic, Reconstructive, Hand, Orthopedic Surgeons and Physiotherapist. The objective of this study was to assess the frequency of hand mutilation secondary to burn injury and to evaluate the treatment options for its management.

Methodology: This prospective observational study was conducted at Department of Plastic Surgery and Department of Orthopedics and Traumatology, Liaquat University of Medical & Health Sciences, Jamshoro over the period of two years from January 2008 to December 2010. A total of forty patients were included in this study after obtaining informed consent.

 Results: Male female ratio was 2.1:1. Age ranged from 1-40 years. Most of patients were children. Majority of patients belonged to rural areas and were uneducated, with lower socioeconomic status. Accidental flame thermal injury was most frequent. Most patients presented with mild to moderate type of contracture. Hand function improved better with full thickness skin graft. Major complications were local infection and graft failure.

Conclusion: Most of hand mutilations are preventable or could be reduced considerably in severity by proper initial post burn splitting, positioning, early surgery and rehabilitation of hand.

Full Text: http://medicalchannel.pk/downloads/vol17/no4/020-An%20Assessment%20of%20Patients.pdf

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Surgical Treatment of Equinovarus Deformity of Foot in Children with Cerebral Palsy

// August 25th, 2011 // No Comments » // My Publications, Research

Introduction:Foot deformities e.g., ankle equinus, equinovarus and equinovalgus, are common in patients with CP. Varus deformity which is usually accompanied by equinus, is commonly caused by an abnormal posterior tibial muscle,anterior tibial muscle or both. If left untreated, may cause severe fixed foot deformity .Various methods of treatment have been reported.

Material and Method:Twenty patients (25 feet) were included in this study.The patients were assessed clinically and patients with forefoot varus and aquinus were treated by split transfer of tibialis anterior to the cuboid and patients with hind foot varus and equinus were treated by split transfer of tibialis posterior tendon through interosseous membrane, to the lateral cuniform. Percutaneus lengthening of tendocalcaneus was performed in all patients. The outcome was analyzed.

Results:The age range at the start of study was between six to ten years (mean 8years.), and at the last follow up was eight to fourteen years (mean 11.5 years). Mean follow-up was 3.5 years.The range of varus deformity was 15 0to 200 and range of equinus was between 160 to 250. Split transfer of tibialis anterior tendon was performed in seven patients (8feet) presenting with fore foot varus and equinus. Split transfer of tibialis posterior tendon was performed in thirteen patients (17 feet) presenting with hind foot varus and equinus. Percutaneustendocalcaneuas lengthening was done in all cases. Open release of planter fascia was performed in fourteen feet as there was mild cavus deformity. The results were graded according to Kling’s clinical criteria. The results were excellent in fourteen feet, good in 7 feet, and poor in four feet. Poor results were seen in four of our patients with marked tendocalcaneus shortening, as the deforming force was not successfully determined clinically in these cases. Most of our patients had excellent results.

Conclusion: split tibialis anterior tendon transfer to cuboid in patients with forefoot varus and split tibialis posterior tendon transfer through interosseous membrane to lateral cuniform in patients with hind foot varus, are good and rewarding procedures. However accurate diagnosis of deforming muscle i.e, tibialis anterior or tibialis posterior is essential to produce good results.

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Treatment Modalities for Reconstruction of Pilonidal Sinus Defects

// August 25th, 2011 // 2 Comments » // My Publications, Research

Objective: To determine outcome of reconstruction of pilonidal sinus with different treatment modalities following excision at Liaquat University Hospital.

Methods: A prospective descriptive study conducted from March 2006 to February 2010 at Department of Surgery & Department of Plastic Surgery, Liaquat University of Medical & Health Sciences, Jamshoro. A total of 22 male patients with primary pilonidal sinus were admitted in Department of Surgery and Department of Plastic & Reconstructive Surgery, LUMHS Jamshoro were included in the study.

Results: All patients were male with median age of 25 years. Majority of patients i.e. 14 (63.63%) were between age 20-29 years. Primary closure was performed in 3 cases (13.63%); double opposing rhomboid flap was performed in only one case (4.54%). Local advancement flap was performed in 4 cases (18.18%). Rhomboid flap was done in majority of cases i.e. 12 cases (54.54%). Bi-lobed flap was done in 2 cases (9.09%) only. No flap necrosis was observed. Wound infection was found in 3 cases (13.63%). Seroma was observed in one patient (4.54%). Hematoma formation was observed in 2 cases (9.09%). Recurrence of pilonidal sinus was observed in 3 cases (13.63%). Conclusion: Lesions heal faster with primary closure than with open healing in pilonidal surgery but risk of recurrence is increased. Rhomboid flap & double opposing rhomboid flap were found to be a good choice for moderate sized wounds.

Medical Channel 17(2)

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Frequency of Hyperinsulinism at Liaquat University Hospital

// January 14th, 2011 // No Comments » // My Publications, Research

ABSTRACT:

OBJECTIVE: To determine the frequency of hyperinsulinism at Liaquat University Hospital, Jamshoro

STUDY DESIGN: Prospective analytical study.

PLACE AND DURATION: Department of Plastic & Reconstructive surgery and outdoor patient Department, Liaquat University Hospital, Jamshoro Pakistan from January 2008to January 2009.

PATIENTS AND METHODS: Fifty consecutive cases of hirsuitism diagnosed on the basis of Ferriman Gallway score of > 8 from age 15-45 years, fasting insulin levels werechecked along with blood pressure, fasting blood sugar, body mass index and waistcircumference. The patients of age more than 45 years and fasting blood sugar of morethan 125 mg/dl were excluded from this study.RESULTS: 25 (50%) out of 50 hirsutes were found with hyperinsulinism, mean fastinginsulin level 20.3680 SD± 3.71637  μu/ml. The hirsute patients with and withouthyperinsulinism were compared on the basis of fasting insulin level, BMI, blood pressure,fasting blood sugar and waist circumference. Their p-values were calculated and foundsignificant for fasting insulin level and fasting blood sugar.

CONCLUSION: Hirsutes are more prone for development of diabetes mellitus type 2 infuture due to hyperinsulinism and insulin resistance and needs proper surveillance.

Medical Channel: Oct-Dec 2010. Vol. 16, No. 4; 574-77

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Surgical reconstruction of Scalp

// January 14th, 2011 // No Comments » // My Publications, Research

ABSTRACT:

BACKGROUND: Scalp reconstruction after ablative surgery can be challenging. A useful reconstructive algorithm is lacking. The purpose of this study was to evaluate our experience and to identify an appropriate reconstructive strategy.

METHODOLOGY: This was a prospective observational study conducted in the Department of Plastic & Burn Surgery over a period of four years. Etiology of scalp defects, reconstructive methods, independent factors and outcomes were evaluated. A total of 7 procedures were performed in 38 patients. Techniques for reconstruction included primary closure, grafts, and Local flaps.

CONCLUSION: Important tenets for successful management of scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local scalp flaps with skin grafts remain the mainstay of reconstruction in most instances.

Medical Channel: Oct-Dec 2010. Vol. 16, No. 4 578-81

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Distally based Sural artery flap, an armamentarium of Plastic Surgeon

// August 28th, 2010 // No Comments » // My Publications

ABSTRACT
BACKGROUND: Reconstruction of soft tissue defect distal 3rd  of leg is challenging to both plastic and orthopedic surgeons, especially in a setup where microvascular free flap facilities are not available to due to cost constraints. Lower extremity is prone to trauma and is vulnerable due to its location and low vascularity. In this study we evaluate the role of sural artery flap in management of lower extremity trauma.
METHODOLOGY: This prospective interventional study was conducted from March 2007- February 2009 at the Department of Plastic & Reconstructive Surgery and Burns Unit, Liaquat University of Medical & Health Sciences, Jamshoro. Sample was collected by non probability convenience sampling. A predesigned proforma was used to collect the data. SPSS 17 was used for data analysis.
RESULTS: Age of 35 inducted patients’ ranged from 13-57 years with Mean±SD age of 31±7.7 years. There were 29 males (82.85%) and 6 females (17.14%). All flaps were survived; partial tip necrosis was seen in 3 patients (8.57%). Mode of injury was road traffic accident in 30 patients (85.71%). Two young males (5.71%) were with spoke wheel injury. Two patients (5.71%) had pressure sore wounds. One patient (2.85%) has exposed calcanium due to burn injury.
CONCLUSION: Sural artery flap is an outstanding choice for management of soft tissue defects of lower extremity, specially exposed calcanium and malleolus due to its excellent blood supply and ease of performance.
Medical Channel Vol 16, No 3, 2010
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Surgical correction of nipple inversion, our experience.

// August 28th, 2010 // No Comments » // My Publications

ABSTRACT:
OBJECTIVE: To evaluate and present our experience of surgical correction of nipple inversion.
PATIENTS & METHODS: During the study period of from March 2006 to December 2009, 13 female patients, with diagnosis of nipple inversion directly reported at OPD and admitted to Department of plastic & Burn Surgery; Liaquat University of Medical & health Sciences, Jamshoro. 02 patients were referred from other hospital of the province, admitted through our outpatient department. A well informed consent was taken before inclusion of the patients in the study. The counseling consists of the fact that patients with grade one or grade two are most likely to retain the ability to breastfeed in contrast to the grade three inversions. Data was stored and calculated by SPSS 17.
RESULTS: The Mean±SD age of patients in this series was 26±4.3 years. In all patients single breast was affected. In 9 patients inversion of nipple found on right breast while in 4 patients presented with inversion of nipple of left breast. When examined 2 patients were having grade 1 inversion, 8 patients grade 2 and 3 patients were having grade 3 inversion of nipple. On mean follow up period of 18 months, 8 women (61.55%) were able to feed their newborn successfully. The nipple projection was maintained in 11 patients, while mild dropping of nipple seen in only 2 patients. However during the entire period of follow up, no recurrence found in any case.
CONCLUSION: The inverted nipple still represents a challenge for plastic surgeons. We found that with simple technique, the scar is inconspicuous, functional element remain intact. In the case of a failure, it can be redone easily without major scarring.
Medical Channel: vol 16, No 3, 2010
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Hypospadias repair – An experience at a tertiary care hospital

// May 10th, 2010 // 1 Comment » // My Publications

ABSTRACT:
INTRODUCTION: Hypospadias is a congenital anomaly of male urethra. Out 250 live births 1 patient is affected. More than 600 surgical procedures are being adopted to correct this deformity. All of these procedure aims to correct the abnormal anatomy and to create a sound urethra. This retrospective study was done to compare the effects of Bracka’s technique with Wehrbien-Smith technique in the management of hypospadias in our setup.
METHODOLOGY: A retrospective comparative study was carried at the Department of Plastic & Reconstructive Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, from April 2006 to May 2009. Forty four patients with moderate to severe form of hypospadias and in whom either Bracka’s or Wehrbien-Smith procedure was performed, were included in the study. All variables of interested including type of hypospadias, complications including fistulae, stenosis, stricture, and graft or flap necrosis were noted on a predesigned proforma and data was later on analyzed through SPSS 17.
RESULTS: Age of the patients ranges from 4 – 22 years with mean age of 11 years. Majority of the patients suffered from proximal penile form of disease 40%. Fourteen cases of penoscrotal and perineal hypospadias 31% and 13 cases of mid penile hypospadias 30% were included in the study. The complications rate was common with Wehrbien-Smith as compared to Bracka’s. An increased incidence of urethrocutaneous fistula 27.77% was found patients who underwent Wehrbien-smith technique.
CONCLUSION: Bracka’s Two-Stage repair for hypospadias offer superior results as compared to Wehrbien-smith’s technique as complication rates in patients who underwent Bracka’s two stage repair is significantly lower than Wehrbien-smith’s technique specially in terms of fistulae formation.
Medical Channel APRIL – JUNE 2010 16(2): 326-27
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Outcome of surgical reconstruction of myelomeningocele defects – a study of 25 patients

// May 10th, 2010 // No Comments » // My Publications

ABSTRACT
OBJECTIVE: To evaluate the outcome of various reconstructive procedures performed for reconstruction of myelomeningocele defects.
METHODOLOGY: This prospective descriptive study was conducted at Departments of Neurosurgery and Plastic & Reconstructive Surgery, Liaquat University Hospital, Jamshoro between June 2008 and May 2009. A total of 25 newborns admitted with myelomeningocele during the study period and repaired with various local flaps and skin grafting were included in this study.
RESULTS: Out of Twenty five patients, 12 (48%) were males and 13 (52%) were females, age ranged from 1-48 months. Fifteen patients (60%) had defect in thoracolumbar region; ten patients (40%) had defects in lumbosacral region. ventriculoperitoneal shunts for hydrocephalus was placed in 8 patients (32%). Primary closure of defect was performed in 4 patients (16%), 3 patients (12%) were treated with rhomboid flap, Limberg flap was used to cover defects of 2 patients (8%), Lumber flap was used in 3
patients (12%), hatchet flap was used to close the defect of one patient (4%), double reverse flap was used to cover the defect in 5 patients (20%) and split thickness skin grafting was used in large defects of 7 patients (28%).
CONCLUSION: Skin grafting is a excellent choice for treatment of wounds where the defect size is huge because there is diminutive morbidity associated with this method, local flaps are fine option for coverage but care should be taken to keep the suture line away from dural repair line to avoid dehiscence.
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Changes in sensory and motor functions after surgical management of cervical prolapsed intervertebral disc by the anterior approach

// March 22nd, 2010 // No Comments » // My Publications

OBJECTIVE: To compare the changes in the sensory and motor functions after the, anterior surgical approach for cervical prolapsed intervertebral disc.

METHODS:  From June 2007 to December 2008, in the Department of Neurosurgery, Liaquat University of Medical & Health Science, Jamshoro, Sindh, Pakistan, 20 patients subjected to surgical intervention for prolapsed cervical intervertebral disc by the various methods of anterior cervical dissectomy that is with or without graft and with or without plating were studied for one and half year of period. All our patients were investigated by magnetic resonance imaging along with routine investigations. A predesigned proforma was used to collect the data, and analyzed with Social package of statistical analysis (SPSS) version 17.0.

RESULTS: Out of fifty patients forty six showed immediate improvement in pain. Other four patients became pain free in 12 weeks follow up. All forty patients who presented with sensory deficit showed improvement in sensory symptoms to various degrees in few weeks to few months. Out of forty patients 16 showed improvement in sensory deficit i.e. numbness after two weeks. Out of thirty seven patients thirty two showed improvement in motor deficit in 12-20 weeks period.

CONCLUSION: Decompression of the cervical spine by the anterior approach whether combined with bone grafting or not is an effective approach and is much safer than the posterior decompression method.

Medical Channel. Volume 15 - Number 4 Suppl

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