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Background and Objective: A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. Methods: This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. Results: The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). Conclusion: This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with nasal reconstruction and to give a standardized algorithm for nasal reconstruction. Study Design: Descriptive cross sectional. Setting: Burns and Plastic Surgery Center, Peshawar. Period: January 2019 to December 2022. Material & Methods: Data was obtained from patient records after approval from IREB. Patients with multiple co-morbidities and small defects (<1.5cm) were excluded from this study. Defects were classified based on anatomic areas of radix, dorsum, sidewall, alar and lower third nasal defects. Cases were cross tabulated regarding site for the reconstructive options to generate the treatment algorithm. Results: A total of 51 cases were included in the study including 30 (58.8%) male patients. Mean age of patients was 48.12+21.89SD. Skin malignancies were the most common (n=35, 68.6%). Nasal ala was the most common site reconstructed in our study (25.5%) followed by nasal dorsum and sidewalls. Medium size (41.2%) was the most common. In 64.8% (n=33) cases, forehead based flaps were used to reconstruct the nasal defects (Table-I). In 5.9% cases we observed flap congestion. In 19 (37.25%) cases, patients presented with additional soft tissue defects which needed reconstruction (Table-II). Reconstructive options are presented as an algorithm based on the defect site (Figure-1). Conclusion: In this study we shared our experience with the readers regarding reconstruction of the nasal detects. We have formulated an algorithm for reconstruction of these defects that will simplify reconstruction in such cases. [ABSTRACT FROM AUTHOR]

Objective: To share our experience with reconstruction of the head and neck defects and to standardize the reconstruction options for such defects. Study Design: Descriptive Cross Sectional study. Setting: Burns and Plastic Surgery Center, Peshawar. Period: November 2018 to December 2022. Material & Methods: Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (< 3 cm), medium (4 cm to 8 cm) and large (> 8 cm). Data was analyzed using SPSS. Results: Over the study period, 112 (70%) male and 48 (30%) female patients, with mean age of 44.36 + 21.35, were operated. The main cause of head and neck defects, were malignant lesions; 60% (n=96) cases. The most common site of was nose, either alone or in combination with surrounding areas. In 54 (33.4%) cases, the reconstructed defects were of medium size, followed by large defects (n=52, 32.5%). In 79 (49.4%) cases, the defects were reconstructed with local flaps, followed by pedicled flaps; 70 (43.8%) cases. Free flap reconstruction was performed in 11 (6.9%) cases. The most common free flap was fibula based (n=4). Complications were observed in 4.4% cases. Conclusion: The most common defects in head and neck region are on nose. In most cases the etiology is lesion excision. Other common defects encountered are scalp, eyelids and ear. Most of the defects can be covered with local flaps with very low complication rate. [ABSTRACT FROM AUTHOR]

Objectives: To describe the demographics, reconstructive options for different area and defect sizes and the functional outcome of upper extremity reconstruction. Study design: Descriptive study Setting: Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar Duration: 6-years Material and Methods: This study was performed from 2018 to 2021 in the department of Burns and Plastic Surgery. All the patients with upper extremity defects, for which reconstruction was performed, were included in the study after informed consent. The data was collected from hospital record and functional outcome was assessed based on the Toronto Extremity Salvage Score (TESS) questionnaire after 6-months of reconstruction. All the data was organized and evaluated with the help of statistical soft ware. Results: A total of 67 patients were included in the study including 51(76.1%) male and 16(23.9%) female patients with age ranging from 5 weeks to 65 weeks (mean 30.27+14.9 SD). Right upper extremity was affected in 61.2 % (n=41). The main cause of injury was electric burns and machine injuries, accounting for 26.9% each. Hand was the mainly affected region. The most commonly performed flap in our series was retrograde posterior interosseous artery flap (n=14, 20.9). Insignificant partial flap necrosis was observed in 3 (4.5%). Post-operative TESS score ranged from 40% to 99% with a mean of 85.4+14.9SD. Conclusion: There are multitude of options available for upper limb reconstruction. Functional outcome should be assessed using standardized tools like Toronto Extremity Salvage Score (TESS). This will lead to standardization of treatment modalities in such patients. [ABSTRACT FROM AUTHOR]

Objectives: To determine the reliability and versatility of forehead flap in terms of frequency of complications and uses. Study design: Cross-sectional observational study Settings: This study was performed from January, 2014 to December, 2018 in the departments of Plastic and Burns Hayatabad Medical Complex, Peshawar and Khyber Teaching Hospital, Peshawar. Material and Methods: After approval from the ethical committee, the data was collected of all patients in whom forehead flap was performed, was collected from hospital's record. The data were analyzed and organized to assess the demographics, etiologies of defects covered, type of flap used and frequency of complications. The results were projected in the form of tables and figures. Results: A total of 26 patients, including 17 (65.4%) male and 9 (34.6%) female patients with age ranging from 10 years to 70 years (mean 47+1.89) met the inclusion criteria. Nose was the most common site of defects with the main etiology of surgical excision of malignancies. The paramedian variant of forehead flap was performed in 69.2% which was used as island in 15.4% cases. We observed insignificant partial necrosis of the forehead flap in 3.8% case. In 76.9% case the donor forehead defect was closed primarily. Conclusion: The forehead flap is a very reliable flap for nasal and upper facial defects with good aesthetic results and low complication rates. [ABSTRACT FROM AUTHOR]

Objective: To compare the conventional pyodine dressing with honey dressing in terms of recovery time and outcome (healed or ended up with amputation) in diabetic foot ulcers. Methodology: This quasi-experimental study was performed in surgical "C" ward, Lady Reading Hospital Peshawar from November 2007 to November 2008. All Wegner's grade I-IV, unilateral diabetic foot ulcer patients were admitted and their blood sugar profile, cardiac and renal status were investigated. Patients were assigned to group A and B with simple convenience method. After ample wound debridement group A and B were treated with daily conventional Pyodine dressing and Honey dressing respectively and their recovery time, outcome were recorded during the 10 weeks follow up period. Results: A total of 100 patients with 50 patients in each group A and B were enrolled in the study with mean age 56+8.0 years and male to female ratio of 1.7:1. Recovery time was significantly quicker in the Group B (Honey Dressing) as compared with the group A (conventional Pyodine dressing) with a p-valve of <0.0001. Healing rate was 69% and amputation rate was 31% as a whole. Healing rate was 66% in the Group A in comparison with 72% in the group B while amputation rates were 34% and 28% in the group A and B respectively with no statistical significance with a p-value of 0.6658. Conclusion: Honey dressing is more effective than conventional Pyodine dressing in terms of recovery time in the treatment of diabetic foot ulcer. [ABSTRACT FROM AUTHOR]