BACKGROUND: Local and locoregional flaps are very useful in reconstruction of head and neck defects. Each case should be judged on its merits and selection of flap (local or locoregional) should be done by considering various factors. AIM: To study the etiological factors, type, distribution, management of head and neck defects (post traumatic, post malignancy & congenital) by using local and locoregional flaps and the overall cosmetic effect and function of both donor as well as recipient sites. MATERIAL AND METHODS: 40 patients were studied in a multispecialty hospital admitted in the trauma unit or as OPD patients. After stabilization, especially in trauma patients, patients were fully investigated and treatment protocol was made and reconstruction was done as per protocol. RESULTS: In this study, the mean age of patients was 29.8 years. The main cause of head and neck defects was post traumatic (58%) followed by malignancy (23%), infections (10%) and others (9 %). The mean age for post traumatic defects was 26.42 years. In post malignant defects, Basal cell carcinoma was the major cause of defect (50%) followed by oral malignancy (54%). All the patients with oral carcinoma were tobacco chewers and 50 % were alcoholic. Middle third of face (67%) was most common site for defect followed by scalp (14%), upper third (7%) and lower third face (6%). In the middle third of face, nose (38%) was commonest site of defects followed by cheek (34%) and ears (28%). Local flaps were used in 38% of defects as compared to locoregional flaps (62%). Advancement flaps were mainly done for cheek defects (70%). Rotation and transposition flaps were done mainly for scalp defects. Most common locoregional flap done was median forehead flap (27%) followed by deltopectoral flap. CONCLUSION: Local and locoregional flaps are still very useful in reconstruction of head and neck defects. This is in accordance with Gille's rules of reconstruction i.e." like replaces like". Treatment of the head and neck defects should be individualized. Each case should be judged on its merits and selection of flaps (local or locoregional) should be done by considering various factors like type of defect, site of defect, amount of associated injuries, and the condition of adjacent skin.
BACKGROUND: Burn injuries are a major cause of morbidity and mortality in children. These are the third most common injury causing death in children, following motor vehicle accidents and drowning accidents. AIM: To study the Epidemiological parameters for assessment of morbidity & mortality rate in pediatric burns and to form effective preventive strategy. MATERIAL AND METHODS: The study was done at the Department of Surgery, PIMS, Jalandhar. Total 50 patients (n=50) up to age of 12 years, were included in the study retrospectively. Data regarding age, sex, demographic distribution, seasonal variation, Total body surface area (TBSA) involved, type and place of burn injury, parent's occupation, family size and mortality rate were noted and analysed. RESULTS: Total 50 patients (n=50) of which 32 were males and 18 females were included in the study. Mean age of burn injuries was 3.6 years. Scalds burns were the most common cause of burns followed by thermal burns. It involved mostly upper limbs (67%), anterior trunk (56%), lower limbs (53%), face (4%), and posterior trunk including buttocks (16%). The time lapse from injury to presentation to hospital ranged from 1 hour to 3 weeks. Total body surface area burnt was ranged from 2-60%. Mean hospital duration was 12.4 days. Complications ranged from wound sepsis in 11 patients (22%), contractures of fingers in 3 patients (6%) and hypertrophic scarring in 8 patients (16%). After healing of wounds, patients were advised pressure garments and oil massage and night splint age regularly for six months. CONCLUSION: Children constitute a vulnerable group of burns. Most injuries occur in the home setting where effective control measures can be adopted. Advances have also made in resuscitation, intensive care, antimicrobials, vascular access, nutritional support, and skin banking. Splintage, physiotherapy, massage and pressure garments also help in reducing the morbidity and overall long term burden over the society at large.
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