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Introduction: Free flaps offer a great variable of available tissues to cover larger, multifocal or multistructural defects. The choice among different free flap is dependent upon their recipient site requirement. Reconstruction with latissimus dorsi flap is now versatile tool in coverage. It can resurface large wound with reliable vascularity, consistent anatomy ,long pedicle length, opportunity for tailoring of flap. It has less donor site morbidity and has very little post-operative complications. Objective: To evaluate the versatility of free Latissimus dorsi flap for soft tissue reconstruction. Materials and methods: A prospective, observational study design was used in Department of Plastic Surgery of Dhaka Medical College and Hospital. Here 20 patients with soft tissue defect of variable sizes over lower limb, head neck and trunk underwent coverage with microvascular surgery. The study was carried out from July 2017 to June 2018. Result: Regarding the age distribution, the mean age was 35.65with an SD of + 10.81. The lowest age was 20years and the highest age was 56 years, Male female ratio was 3:2.The major cause (65.0%) of soft tissue defect of the samples was RTA. The flap was used to reconstruct the soft tissue defect over lower leg in 13 (65%)cases, on scalp 05 (25%) cases and over anterior trunk in two cases. The mean flap dimension was 229.25cm2 and its range was between 120 – 384 cm2. The standard myocutaneous flap was harvested in 80% cases, chimeric (10%) and partial Latissimus muscle flap in two cases. The donor site in all the 20 (100%) cases was closed primarily. The outcome of reconstruction was excellent in 16(80%), good in 02 (10%) cases and poor in 02 (10%) cases. There was no significant complication during the three months postoperative period. Conclusion: The Latissimus dorsi flap is a versatile option for resurfacing the soft tissue defect in different areas of the body with variable flap components and with minimal donor site morbidity. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 142-152

Introduction: Pilonidal sinus is a commonly encountered problem with multiple surgical options. With Z- plasty, primary closure ensues faster healing while the alteration of local anatomy reduces recurrence. The extremely low recurrence rate following Z-plasty for pilonidal sinus results from the fact that the operation was planned with the true physiology of the disease in mind. It is the deep natal cleft which predisposes to pilonidal sinuses and this architecture is altered with multiple Z -plasty. Materials and methods: A prospective, observational study was conducted into department of Plastic Surgery and burn, Dhaka Medical College and Hospital. Here 18 patients with pilonidal sinus were treated by Z – plasty between 2013 to 2018. Result: There was only one recurrence during the follow up time. There were no necrosis of flaps and no wound dehiscence. Conclusion: The Z-plasty technique is an effective procedure for treating pilonidal sinus in terms of both faster healing and lower recurrence rate. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 164-171

Object: To isolate and identify the microorganisms from the burn patients admitted to the National Institute of Burn and Plastic Surgery Unit in Tertiary Medical College Hospital, Bangladesh. A total number of fifty wound surface swab samples of first and second-degree burn patients were collected and the microbial analysis as well as the study of antibacterial susceptibility was conducted. The study showed the bacterial isolates were found. 45 (90%) of wound swab were positive among 50 and only 5 samples (10%) were negative in bacterial growth, which presented invasive burn wound infection from both sex age groups marked 12 - 60 years. The total viable count TVC-11651 CFU/plate was found and the highest amount in the second-degree burn patients. The results showed that Pseudomonas aeruginosa was common in all positive samples 6636 CFU/plate (57%) followed by Staphylococcus aureus 4070 CFU/plate (35%), Klebsiella spp. 450 CFU/plate (5%), Proteus spp. 243 CFU/plate (2%), and E. coli 162 CFU/plate (1%). Most of the pathogens were found to be drug-resistant while several isolates were noted to be multi-drug resistant. The growth of multidrug-resistant organisms should be considered as a serious risk factor in a burn unit. Aggressive infection control measures should be applied to limit the emergence and spread of multidrug-resistant pathogens.

Background: Surgical management of simple mandibular angle fracture is a very crucial process.Objective: The purpose of the present study was to compare the post-operative outcomes of intermaxillary fixation and open reduction with internal fixation of simple mandibular angle fracture.Methodology: This randomized control trial was conducted in the Department of Oral and Maxillofacial Surgery at Dhaka Dental College & Hospital, Dhaka and Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to December 2010 for a period of one (01) year. Among all patients admitted/attended to the hospital IPD with fracture of mandibular angle with or without other associated fracture sites were selected as study subjects. After recruitment of the patients, they were assigned either as group A or group B after randomization. In group A the patients of this group were treated by open reduction and internal miniplate fixation with additional placement of intermaxillary fixation; in group B the patients of this group were treated by open reduction and internal miniplate fixation without any additional placement of intermaxillary fixation. During follow up period stability of fracture segments, post reduction alignment and inter-incisal opening were recorded.Result: A total of 30 patients presented with mandibular angle fractures were included in the study. They were allocated in two groups named miniplate osteosynthesis with Inter-maxillary fixation group (n=16) and without inter-maxillary fixation group (n=14) randomly. Time required to accomplish the surgical procedures was significantly high (p=0.000) group A (99.38±15.26 minutes) than group B (55.38±6.34 minutes). Among them 01 patient developed instability after inter-maxillary fixation. And 01 patient developed such in other procedure; however this difference is not statistically significant (p=0.724). In post operative radiography the mean score of post reduction alignment was slightly higher in group A than group B which was 2.50±0.516 and 2.214±0.426 respectively (p=0.107). The inter-incisal opening in baseline was 14.69 and 18.14 in group A and group B respectively. However, in review 3 it was found 36.19 and 37.64 in group A and group B respectively (p=0.0001).Conclusion: In conclusion significantly less operative time was required to accomplish the operative procedure in without IMF group as well as there was also a significant difference of inter-incisal opening between two procedures in subsequent review findingsJournal of National Institute of Neurosciences Bangladesh, 2018;4(2): 108-112