Background: Acute appendicitis is the most common surgical emergency requiring operative intervention. Most of the cases are simple; however complicated appendicitis with perforation, abscess and gangrene of appendix is seen in up to 1/4th of adults and 1/3rd of cases in children. It is associated with post operative complications with considerable morbidity. The aim is to study the clinical presentation of complicated appendicitis, the intra-operative findings, post-operative complications and the overall surgical outcome.Methods: It is a cross sectional study of 35 patients who had complicated appendicitis and who were treated with surgery.Results: 83% of patients with complicated appendicitis were younger than 40 years of age, with children constituting about 43% of total cases. All the patients had typical right iliac fossa pain, with tenderness and localized guarding in 37%. Ultrasound diagnosed appendicitis in 80% of cases. Leukocytosis was seen in 71% with neutrophil shift in 85% of patients. 60% of patients had perforation and abscess formation, gangrene in 45% and mass in 37%. Post operative complications were noted in 51% of the patients, commonly paralytic ileus (46%) and wound infection (20%). There was no mortality in our study and the general overall outcome of treatment was good.Conclusions: Complicated appendicitis with gangrene, perforation and abscess form a considerable proportion of cases. Early surgical intervention is the definitive treatment after initial resuscitation. Overall morbidity is considerable, but mortality is less than 1% and the general overall outcome is good with early surgical intervention.
Background: Soft tissue defect management around the lower-third of the leg, ankle and dorsal feet with exposed tendons, bones and orthopaedic implants is a challenge faced by a majority of surgeons. A locally available, versatile, durable flap is the preferred option for coverage of such defects, in the absence of micro vascular surgery facility.Methods: This prospective study was conducted at Department of General Surgery, Kodagu Institute of medical sciences from March 2018 to May 2019, on 10 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested moderate sized reverse sural artery flaps, to cover the defects. After perforator marking with Doppler, flap was planned in reverse, and procedure was performed. Factors like size of defect, flap size, width of pedicle, comorbid factors and complications following surgery were taken into account for the study.Results: A majority of flaps provided a good coverage for defects and graft was well taken in donor site in all cases. One patient had marginal flap necrosis who was elderly and diabetic, he was managed conservatively, another patient had distal flap venous congestion which settled by itself with conservative management.Conclusions: Reverse sural artery flap (RSAF) cover is versatile, reliable and safe procedure, which was efficiently used to treat patients with wounds of distal leg, and foot.
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