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Objectives: To compare the inclusion and exclusion of the sural nerve in fascio-cutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation and complications. Study Design: Prospective comparative study Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Mar 2020. Methodology: A total of 54 patients (27 in each Group) requiring distal lower limb flap reconstruction and meeting the inclusion and exclusion criteria were included. Patients with a higher probability of flap complications and those with complications during the procedure were excluded. Group-A patients underwent fascio-cutaneous flap repair with sural nerve preservation, while Group-B patients underwent the same technique, but the sural nerve was transected and raised with the flap. All patients were followed for flap survival, flap size and degree of sensory recovery and flap-related complications. Results: Varying degrees of return of sensation were seen in 25(92.6%) patients of Group-A after six months, which was 23(63.1%) in Group-B (p<0.001). Flap survival was comparable in both groups: 26(96.3%) and 25(92.6%) patients in Groups A and B, respectively (p=0.552). The complications were also comparable, 4(14.8%) in Group-A and (25.9%) in Group-B, which was not statistically significant (p=0.209). Conclusion: Preservation of the sural nerve results in little or no sensory loss in the lateral part of the foot, with complication rates and flap survival comparable to cases where the nerve is sacrificed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the successful outcome of flap versus no-flap in O'Conor & Sokol technique for simple vesicovaginal fistula (VVF) repair. METHODS: This quasi-experimental study was conducted in department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, Pakistan from March 2015 to December 2019. During this study period, 64 eligible patients, selected through non-probability convenient sampling technique were assigned to two Groups. Group A included 34 patients who underwent VVF repair through O'Conor & Sokol technique without interposition flap while Group B comprised 30 patients with VVF repair with interposition flap. Patient getting completely dry with no urinary incontinence at primary endpoint of 6 months was labelled as successful outcome. All the pre-operative, per-operative and postoperative data was collected on structured proforma and analyzed on SPSS version-21. RESULTS: The mean age of the patient was 33.8±7.8 years in group A and 35±6.3 years in group B. About 76.5% (n=26/34) patients in group A and 80% (n=24/30) patients in Group B developed VVF due to obstetrical trauma. Overall, O'Conor and Sokol technique of VVF repair was successful by curing urinary incontinence in 95.3% (n=61/64) patients. Successful outcome for O'Conor & Sokol technique was achieved in 94.1% (n=32/94) patients in Group A and 96% (n=29/30) patients in Group B, at 6 months of follow-up (p>0.05). CONCLUSION: There is no significant difference between interposition flap and noflap in outcome of simple VVF repair through O'Conor & Sokol technique. The decision of interposition can be individualized depending upon preference of surgeon. [ABSTRACT FROM AUTHOR]

Objective: To assess the single most important factor affecting the survival of keystone perforator flap. Study Design: Case series. Place and Duration of Study: Combined Military Hospital, Quetta Pakistan, from Mar 2021 to Sep 2022. Methodology: Patients presenting at Plastic Surgery OPD, where resultant wound defects were covered by a keystone perforator flap for wound coverage, above ten years of age were included in the study. They also included proximal forearm self-harm patients. Operated patients were followed up post-operatively for three weeks, and success and complications were noted. The single most important factor for flap complication was noted. Results: Eleven patients were studied that fulfilled the inclusion criteria. The age range was 11-59 years. Two were cases of pilonidal sinus, 1 was squamous cell carcinoma (SCC) forearm, and 1 was carbuncle back. All the remaining 7 were of self-harm scars/ wounds of the proximal forearm. Two patients developed partial peripheral flap necrosis that later healed with granulation tissue. The reason for partial flap necrosis was recognized to be shearing forces due to early/excessive post-op mobilization. Conclusion: The keystone perforator flap transposes pliable adjacent tissue, giving the patient the same look and skin texture as the original tissue. The most important factor affecting flap survival in this small case series was shearing forces, and measures to immobilize the operation site could improve results. [ABSTRACT FROM AUTHOR]

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 improved 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. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: To compare with and without flap removal of partially impacted mandibular third molars in terms of mean pain and mean swelling on the second post-operative day. Study Design: Quasiexperimental study. Place and duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from May to Nov 2021. Methodology: Sixty cases (30 in each Group) with partially impacted mandibular third molar with mesioangular impaction aged 18-45 years were included. Random allocation of patients was done to the removal with flap (Group-A) and without flap (Group-B). On the second post-operative day, the outcome of pain and swelling in patients was measured based on the Visual Analogue Scale (VAS between 0 to 10 cm points for pain and swelling on a scale of 0 to 3). Results: The mean pain score was 5.67±1.30 in Group-A (with flap) versus 2.97±1.25 in Group-B (without flap) (p-value, <0.001). The mean swelling score was 5.40±1.16 for Group-A (with flap) versus 2.97±1.15 for Group-B (without flap) (p-value, <0.001). Conclusion: The surgical extraction of the partially impacted mesioangular mandibular third molar without buccal flap reflection and bone ostectomy resulted in less post-operative pain and swelling than surgery with buccal flap reflection and bone ostectomy. [ABSTRACT FROM AUTHOR]

Background: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. Objective: To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Patients and Methods: Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Results: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (25 patients); oropharynx/ hypopharynx, (7 patients); and neck or face (5 patients). Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients (67.59%) had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. Conclusions: The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed. [ABSTRACT FROM AUTHOR]