Introduction: The term “acute abdomen” denotes any sudden spontaneousnon-traumatic disorder whose chief manifestation is in the abdominal area. There is frequently a progressive underlyingintra-abdominal disorder, the correct early diagnosis and treatment of which is essential for a favorable outcome.Objectives: (I) To find out the most common causes of acute abdomen. (II) To compare the preoperative assessmentwith postoperative diagnosis. Design: A Non-interventional Analytical (Comparative) study. Setting: Emergencydepartment of Combined Military Hospital Kharian. Period: Oct 2001 to Mar 2002. Patients & Methods: Total of 220patients who presented with acute abdomen. Results: The most frequent cause was found to be Acute Appendicitis,followed by Nonspecific abdominal pain, acute cholecystitis, acute intestinal obstruction and perforated duodenal ulcer.Preoperative diagnosis was wrong in 9.5% (n=21) of cases. Conclusion: Acute appendicitis was found to be the mostcommon cause of acute abdomen and the single most important cause of acute abdominal pain causing greatdiagnostic difficulties. the preoperative diagnostic accuracy can be increased especially in female of child bearing ageby using modern diagnostic tools especially laparoscopy.
Objective: To assess short and long term aesthetic and functional outcomes of nasal ala reconstruction by three staged folded forehead flap. Study Design: Prospective study. Place and Duration of Study: Plastic and Reconstructive Surgery Department of Combined Military HospitalBahawalpur and Quetta, from Dec 2014 to Dec 2018. Methodology: Total of 29 patients were enrolled through consecutive sampling technique. Nasal ala defects were reconstructed by three staged frontal forehead flap under general anesthesia. Follow up visit at 2 weeks bleeding, wound Infection, partial skin graft loss and partial flap necrosis was documented. Follow up at 24 weeks, functional outcome of nasal reconstruction was assessed by history and clinical examination for nasal obstruction and/or crusting. Patients’ subjective satisfaction about aesthetic outcome of nasal reconstruction was documented on 5 point likert scale. Objective aesthetic assessment of reconstruction was done on 2D photograph by two independent surgeons. Results: Twenty six (89.66%) males and 3 (10.34%) females participated in study. The mean age was 35 yearsrange 16 to 64 years. Follow up at two weeks revealed postoperative bleeding in 2 (6.8%), wound infection in 1(3.4%) and partial flap loss in 1 (3.4%) patient. At 24 weeks follow up all patients had patent nasal ala. Subjectiveand objective assessment of nose shape was documented. Conclusion: Use of three staged folded forehead flapis useful method of reconstruction for full thickness defects of nasal alaewith good functional and aesthetic outcome.
Objective: To observe the short and long-term outcomes of the soleus muscle rotation flap for coverage of soft tissue defects of proximal and middle leg. Study Design: Case series Place and duration of study Departments of Plastic and Reconstructive Surgery of Bahawal Victoria Hospital Bahawalpur, Combined Military Hospital Bahawalpur, and Combined Military Hospital Quetta from December 2014 to February 2020.. Materials and methods In total, 36 patients were enrolled for the study through consecutive sampling. Data was processed using SPSS-17. All patients were reviewed at first and second week (early morbidity), and then at six months (late morbidity) from operation. During early follow up, they were examined for hematoma at donor site, wound infection, sural nerve injury, graft loss, and flap necrosis. In late follow-up, patients were examined for reduced knee mobility, muscle weakness, sensory abnormalities, hypertrophic scarring, hyperkeratosis, and soleus muscle contractures. Results The studied patients consisted of 30 (90.9%) men and 3 (0.9%) women. The mean age was 35 years (range: 16 to 64) years. Hematoma was the commonest complication. It occurred in 6.1%. Wound infection, partial loss of flap, partial loss of skin graft and wound infection occurred in 3.03% patients. Late follow up revealed reduced knee mobility in 9.09% patients (n=3) and bothersome contraction of soleus muscle in same number of patients. Conclusion The soleus flap is reliable, versatile, and very useful for provision of supple soft tissue coverage for defects in upper and middle leg.
Objective: To present the early and late outcomes related to donor site morbidity of Free Fibular Flap. Study Design: Prospective observational study. Place and Duration of Study: Plastic surgery department, Combined Military Hospital Rawalpindi, from Jan 2009 to Jan 2020. Methodology: In total 361 patients were enrolled for the study through consecutive purposive sampling. All patients requiring free fibula flap for reconstruction of the defect were included in the study. However, the patients with Diabetes Mellitus, Smoking or peripheral vascular disease were excluded from the study. The patients were asked to visit on second week and then at three months for late outcomes. The results were entered SPSS-24 for analysis and interpretation of data. Results: Out of total 361 patients enrolled for study 293 (81.16%) were male and 68 (18.83%) were female. The men age was 51.43 years SD 14.6 (range 4 year to 68 years). In early outcomes, graft loss 29 (8.03%) and sensory deficit 19 (5.26%), are the commonest adverse outcomes. Results of late follow up revealed chronic pain in 29 (8.03%), ankle instability in 24 (6.64%), gait abnormality in 29 (8.76%) and claw toe in 33 (9.14%) patients. The American Orthopedic Foot and Ankle Society (AOFAS) score was 88.45%. Majority (52.63%) patients were very satisfied. Conclusion: The free Fibula is excellent choice for reconstruction of a wide range of osseous defects with minimum donor site morbidity and high satisfaction rate among the patients.Keywords:
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