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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]

Aim: The aim of this article is to share our experience of thumb reconstruction based on the defect and irrespective of the aetiology, and to work towards standardising the treatment for thumb defects. Material and method: This study was conducted at the Burns and Plastic Surgery Centre at Hayatabad Medical Complex from 2018 to 2021. Thumb defects were divided into small (<3 cm), medium (4–8 cm) and large defects (>9 cm). Patients were evaluated for complications post-operatively. The data for defect size and defect site was cross-tabulated for reconstructive options with the help of SPSS. Different flaps were performed depending on the site and size of the defect, which were arranged in a schema to develop an algorithm. Results: After scrutinising the data, 35 patients qualified for the study, comprising 71.4% (25) males and 28.6% (10) females. The mean age (and SD) was 31.17 +15.8 years. The right thumb was affected in the majority of the study sample (57.1%), and the majority were affected by machine injury or post-traumatic contractures, affecting 25.7% (n = 9) and 22.9% (n = 8), respectively. Injuries to the first web space and distal to the IPJ of the thumb were the most common, accounting for 28.6% (n = 10) each. A first dorsal metacarpal artery flap was the most common flap, followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n = 2, 5.7%) with a complete flap loss in 1 patient (2.9%). Based on the cross-tabulation of flaps against the size and location of defects, an algorithm was developed to help standardise reconstruction of thumb defects. Conclusion: Thumb reconstruction is critical in restoring the patient’s hand function. This classification-based, structured approach for thumb reconstruction will help hand surgeons in taking decisions and selecting effective coverage options with minimal complications. Most of these defects can be covered with local, simple flaps without the need for a microvascular reconstruction. [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]

Objective: We aim to look at the epidemiology of lower limb trauma and study the post-operative functional outcome. Study Design: Descriptive study Sett ing: Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar Duration: six years Material and Methods: After approval from the ethical board, data was collected from hospital records. Data regarding patient demographics, site, anatomic location of injury, and type of reconstructive procedure done was collected. Complications including partial (significant or insignificant) or complete necrosis was documented. Toronto extremity Salvage (TESS) score was calculated. Results: A total of 73 patients underwent lower limb reconstruction with mean age of 28.7+12.5 SD. Road traffic accidents (RTA) were the main cause of lower limb trauma (45.2%). There were 54.8% defects with associated fractures, most commonly tibia. The mean duration of presentation for reconstruction was 5.3 week +10.23SD. Total of 81 flaps were performed (68 pedicled and 13 free micro-vascular flaps). 35-patients required bony stabilization. Infection (8.2%) was the most common complication. Partial Flap necrosis was observed in 4(5.5%) cases, out of which 3(4.1%) were significant partial necrosis. Mean Toronto Extremity Salvage Score (TESS) was 84.8+13.6 SD. Discussion: Mostly younger male population are involved with lower limb trauma. Most patients had delayed presentation due to under developed infra-structure in the tribal areas and issues with timely referral from peripheral health care facilities. Most of the small and medium defects can be closed with local flaps. However large defects with bone involvement required free microvascular flaps. Post-operative outcome was good using TESS score. Conclusion: Robust referral system and single stage orthoplastic procedures should be adopted. Multi-center studies need to be conducted and liaison with orthopedic department is paramount to improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Hypospadias is a common congenital anomaly of the urogenital system, with an incidence of 1:300, in males. Hypospadias is defined as an anomaly involving the ventral aspect of the penis. Urethro-cutaneous (UC) fistula complicating hypospadias repair appears the most common problem. The incidence of Urethro-cutaneous fistula varies from 4% to 28%. Objective: To determine the frequency of urethrocutaneous fistula in post Aivar Bracka repair meatal stenosis. Materials and Methods: This study was conducted at Department of Plastic and reconstructive Surgery unit, Hayatabad Medical Complex Peshawar, from march 2014 to march 2016. Study design was descriptive cross-sectional study and the duration of the study was 2 years in which 82 patients were observed by using WHO formula for sample size, expected prevalence of 22% of fistula, 95% confidence Interval and margin of error of 9%. Non-probability consecutive sampling technique was used for sample collection. Results: In our sample, 72% patients were in age range 3-6 years, 28% patients were in age range 7-10 years. Mean age was 3 years with SD±1.31. Overall 20% patients had urethrocutaneous fistula. Stratification of urethro-cutaneous fistula with age distribution was analyzed, showing that 12 patients with urethro-cutaneous fistula were in age range 3-6 years and 4 patients were in age range 7-10 years. The difference in fistula frequency between the two age groups was statistically significant (p < 0.01). Conclusion: Our study concludes that 20% of patients with meatal stenosis develop urethrocutaneous fistula After aivar bracka repair, and the frequency is higher in the younger age group. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is one of the most common congenital anomalies occurring in males. It is a condition in which the urethral opening, called urinary meatus, does not form completely to the tip of the penis. Instead, this opening may be located anywhere along the penis. Incidence rates of hypospadias differ greatly by urologic centres. Studies reported 0.4% (1/250) to 0.8% (1/125) incidence rates in all newborn male infants. This study will help us finding the complications, mainly meatal stenosis, after repairing distal hypospadias as well as the surgical procedures preferred by our Pakistani surgeons for it. Objectives: To determine the frequency of meatal stenosis after two stage Bracka's technique procedure repair for distal penile hypospadias. Study Design: Descriptive study. Setting: Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar. Period: 1st June 2014 to 31st May 2015. Methodology: All male patients ranging from 1-20 years old, patients with distal penile hypospadias without chordae since birth were included. Along with meatal stenosis after Bracka repair procedure for distal penile hypospadias was recorded on a predesigned proforma. Results: In this study 53.4% patients were in age range 1-5 years, 34.7% patients were in age range 6-10 years, 10.2% patients were in age range 10-15 years. Mean age was 6.17 years with SD ±3.34. In which 11.4% patients had meatal stenosis while 88.6% patients didn't had meatal stenosis. Conclusion: Our study concludes that the frequency of meatal stenosis in our setup was 11.4% after two staged Bracka repair for distal penile hypospadias. [ABSTRACT FROM AUTHOR]

Background: There is a growing trend of free flaps for the defects of head and neck region. Free flaps not only require a lot of time, monitoring and expertize, but they are also risky in malnourished patients with multiple co-morbidities. Our aim is to explore the complications of supraclavicular flap in those patients who might not be good candidates for a free flap. Aim: Our aim is to look at the reliability of supraclavicular flap. Methods and Materials: This case series was conducted from March 2008- December 2014 at Plastic Surgery Department at Hayatabad Medical Complex, Peshawar. Results: We did thirty cases of supraclavicular flap for head and neck defects. The common causes were malignancies, vascular malformations and trauma. Mean age of the patients and mean operative time was 45.57±13.5 years and 84.5±19.9 minutes, respectively. In one case there was total flap necrosis. Two patients had distal flap necrosis. Donor site morbidity was present in 13.3% cases. Conclusion: Supraclavicular flap is a reliable flap in terms of anatomy and low post-operative morbidity. It is easy and quick to do and can be used to cover variety of head and neck defects. [ABSTRACT FROM AUTHOR]

Objectives:To estimate the frequency of fistula after two stage repair of cleft palate. Material and Methods: This observational descriptive study was carried out at department of plastic and reconstructive surgery PGMI, Hayatabad Medical Complex, Peshawar from December 2013 to February 2015. A total of 50 patients having complete cleft palate with or without lip were selected. Patients were diagnosed on the basis of history and oral examination. Informed consent was taken from parents. Width of the cleft was measured preoperatively. Two steps repair was done by a single surgeon with a time lapse of six months. Results: 6 patients developed clinically significant oro-nasal fistula. All these fistulas occurred at the junction of hard palate and soft palate within 3 weeks' time. Conclusion: The overall rate of true fistula developments was 12% over a mean follow up period of 6 months. The incidence of true fistulas that were symptomatic and subsequently required surgical repair was 10%. Fistula rates were higher for more wide clefts but were not affected by gender or age. [ABSTRACT FROM AUTHOR]

Objective: The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects., Methodology: This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (&lt; 3 cm), medium (4-8cm) and large defects (&gt; 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction., Results: After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects., Conclusion: Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.