11 research outputs found
Free scapular flap for reconstruction of upper extremity defects
Get PDFObjective: To determine the functional outcome of free scapular flaps performed for reconstruction of complex upper extremity defects. Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, from 1998 to 2001. Subjects and Methods: All those patients in whom free scapular flap was done for reconstruction of upper extremity defects, were included. The important variables included demographic data, etiology of soft tissue defects, site and size of defect, complications, percentage of wound coverage by flap. Patient satisfaction, objective assessment of flap and range of motion of involved joints was determined. Results: There were 9 males and 2 female patients with mean age of 31.54 +/- SD11.86 years. The causes of tissue defects were road traffic accident in eight cases, bomb blast injury in 2 and industrial injury in one case. Eight scapular flaps were performed to reconstruct the defects over the hand, wrist and forearm; two flaps for defects of arm and shoulder and one for elbow coverage. Average defect size was 18 cm long and 11 cm wide. Donor site was closed primarily in all cases. Based on cosmetic appearance, coverage of required defect, performance of activities of daily living and functional range of motion of involved joints, 7 cases were graded excellent and 4 cases were good. Conclusion: Scapular flap provided good robust coverage, which helped to do an early reconstruction and rehabilitation in our cases. Scapular flap can be considered workhorse for reconstruction of upper extremity defects
An experience with free scapular flap for reconstruction of lower extremity defects at Aga Khan University Hospital Karachi
Get PDFBackground: Reconstruction of large composite tissue defects with exposed vital structures and weight bearing surfaces are extremely difficult for reconstructive surgeons. Coverage of such difficult defects can be achieved with free tissue transfer provided microsurgical expertise is available. This study was carried out to determine the outcome of free scapular flaps performed for lower extremity defects. Methods: Clinical records of the patients were reviewed and important variables included demographic data, etiology of soft tissue defects, site and size of defect, complications and percentage of wound coverage by flap. Patient satisfaction and objective assessment of flap coverage and motion of involved joints was made. Results: There were 13 male patients with mean age of 30.46 years. The causes of tissue defects were road traffic accident in 8 cases, industrial accidents in 2 and 3 cases had bomb blast, gunshot and gas gangrene one in each case respectively. Nine scapular flaps were performed to reconstruct the defects around the foot, ankle and lower leg; two flaps for amputation stumps and two flaps for defects around the knee and popliteal fossa. Post flap surgery, 3 cases had vascular compromise which required urgent exploration of anastomosis. Two cases were revived and one flap did not survive. With respect to cosmetic appearance, coverage of required defect, performance of activities of daily living and functional range of motion of involved joints, 6 cases were graded excellent and 7 cases were good. Conclusion: In our cases of lower extremities defects, scapular flap helped to salvage the limb. In conclusion scapular flap is a versatile flap which can be used for lower extremity defects
Delayed supramalleolar flap: An innovative technique for enhanced viability
Get PDFBackground: Delaying flap rotation for 48 to 72 hours leads to opening of choke anastomotic vessels linking adjacent vascular territories. This mechanism enhances flap circulation. Lateral supramalleolar flap with larger dimensions or vascular variations can potentially have survival problems. The purpose of this study is to assess the outcome of delayed lateral supramalleolar flap.Methods: This descriptive case series was conducted at Aga Khan University Hospital, Karachi from May 1999 to December 2004. Eight cases of delayed lateral supramalleolar flap were identified through medical records maintained through Health Information Management Systems (HIMS). A detailed questionnaire was developed addressing variables of interest.Results: Eight patients required flap delay for 48 hours out of 25 patients, who underwent lateral supramalleolar flap for coverage of foot and ankle soft tissue defects. There were six male (75%) and two female (25%) patients with average age of 31.25 years ranging from 5-52. The reasons for delaying lateral supramalleolar flap were larger flap dimension in four (50%), absent peroneal artery perforator in three (37.5%) and one patient (12.5%) had poor circulation in immediate postoperative period. All the patients required two stage procedure and had excellent coverage of defects. No flap failure occurred subsequent to the delay procedure.Conclusions: Flap delay enhanced survival and extended the viable dimensions of lateral supramalleolar flap. Compromised circulation in larger flaps and flaps with vascular variations can be improved by delaying flap transfer to the recipient site for 48 hours following its elevation
Restoration of glenohumeral motion in erb\u27s palsy by tendon transfers
Get PDFBackground: Children with erb\u27s palsy have significant functional disability, mainly related to the shoulder. The objective of this study was to analyze the functional outcome of tendon transfers performed for restoration of shoulder motion in patients with Erb\u27s palsy.Methods: This descriptive case series was conducted at Aga Khan University Hospital from May 1999 to December 2003. Ten patients who had functional deficit of shoulder elevation were operated by a single surgeon. The surgical procedure; modified Sever L\u27Episcopo procedure was uniform in all cases. The data was collected through patient interviewing and medical records maintained through Health Information Management System (HIMS). Mallet class was recorded preoperatively and postoperatively.Results: Ten patients; seven females (70%) and three males (30%), with average age of 75 months at operation were included in this series. Right shoulder was affected in seven cases (70%) while left in three cases (30%). Preoperative mallet class for global abduction improved from 3 to 4; for global external rotation from 2 to 4 and for ability to bring the hand to mouth and neck from 1 to 3. Post operatively mallet class improved in all aspects to 4 and 5; statistically significant on paired t-test with p value of less than 0.005. There was a significant improvement in abduction, forward flexion and external rotation as compared to -preoperative values; statistically significant on paired t-test with p value of less than 0.005.Conclusion: Tendon transfer improves the functional status of shoulder in late cases of Erb\u27s Palsy with significant improvement in mallet class, cosmesis and patient satisfaction. A motivated patient, compliance and aggressive rehabilitation are important outcome parameters
Long term clinical and functional outcome of lateral supramalleolar flap for soft tissue coverage of foot and ankle defects: Largest case series at a tertiary care hospital
No full textBackground: Reconstruction of defects around foot and ankle is challenging issue. We wanted to assess the clinical and functional outcome of lateral supramalleolar flap for coverage soft tissue defects around the foot and ankle. Methods: This analytic case series was conducted at Aga Khan University Hospital, Karachi. The data was collected from medical records and patient interviewing. Patients with soft tissue defects around foot and ankle and coverage with supramalleolar flaps were included. The various parameters of interest (causes, flaps dimensions, vascular variations, and outcome) were included in the prestructured proforma the data was analyzed with SPSS version 25. Results: Forty-seven patients were included in the study from May 1999 to December 2019. The male to female ratio was 35:12. The mechanism of injury was varied. Eighteen cases were pedicle island flaps whereas two were peninsular rotation flaps. The maximum flap size harvested was 20 cm × 8 cm distal flap necrosis occurred in one patient requiring split thickness skin graft. In eight patients’ flap was rotated as ‘delay flap’. In 12 cases the peroneal artery perforator was absent, the flap being based on inferolateral collateral artery from anterior tibial artery. Majority of the patients fall in excellent category based on self-designed assessment tool. Conclusion: The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, only two patients requiring defattening for cosmetic reasons. Microvascular expertise was required for a predictable outcome
Outcome of Judet's quadricepsplasty for knee contractures and the effect of local infiltration of epinephrine on reducing blood loss
Get PDFObjective: To evaluate the effectiveness of Judet's quadricepsplasty for treatment of knee contractures and to identify the effect of local infiltration of epinephrine on blood loss associated with this procedure.
Methods: A retrospective cohort study was conducted in which all cases of knee contractures managed with Judet's quadricepsplasty from 1st January 2009 to 31st December 2013 were included and were divided into two groups. The epinephrine group included patients who were infiltrated with diluted epinephrine (1:400,000) along with xylocaine, around the operative field 15 min prior to the incision time, while the control group did not receive any infiltration. Judet's outcome, blood loss, drop in hemoglobin and required blood transfusion were noted for all patients and compared between both groups.
Results: Most common preceding pathology identified for the development of knee contractures was periarticular fracture while ilizarov application was the most common etiology. Both groups were found similar in all preoperative characteristics except preoperative flexion contracture (p = 0.02). All functional outcome measures including Judet's outcome were similar in both groups. In contrast, duration of surgery (p = 0.01), blood loss (p = 0.02), drop in hemoglobin (p = 0.01) and number of transfusions (p = 0.03) were significantly reduced in epinephrine group.
Conclusion: Judet's quadricepsplasty is a useful procedure to increase the range of motion of rigid knees and local infiltration of epinephrine is effective in decreasing the amount of subsequent blood loss and transfusion requirements
Long-Term Clinical and Functional Outcomes of Distally Based Sural Artery Flap: A Retrospective Case Series
Get PDFBackground: Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome. Methods: A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect site and size, size of flap, hospital stay, complications, outcome of flap and functional status of limb. Data analysis was performed by using SPSS version 25.0. Results: We included 89 patients out of 106, with 92 distally based sural artery flaps. The flap coverage was divided in two groups: group I for leg (n=41) and group II for foot (n=51). The mean flap dimension in leg was 9.98 ± 2.2 cm and 12.15 ± 3 cm in foot. Postoperatively functional outcomes were assessed using a self-designed tool and graded as excellent in 79 cases (leg=38; foot=41), good in 10 cases (leg=2; foot=8), fair in 3 cases (leg=1; foot=2) and poor in zero cases. All flaps survived uneventfully. Conclusion: The reverse sural artery flap is versatile and reliable, and can be performed easily with good knowledge and using a microsurgical technique. It is useful for the reconstruction of soft tissue defects around the lower third of the leg, dorsum of the foot, malleoli and hind foot. The functional range of motion of the ankle is not compromised because of the flap's supple and pliable nature. The reverse sural artery flap is ideal for the coverage of the foot, ankle and lower one third of the leg. This flap is insensate and not suitable for the weight-bearing area of the heel
Management of stress fractures of the proximal tibia in patients with advance knee osteoarthritis. A case Series.
No full textPurpose: To evaluate the outcome of one stage long stem total knee replacement of patients with stress fracture of the proximal tibia of the knee joint.Materials and Methods: Record of 15 patients, 14 females and one male who underwent one stage long stem total knee replacement from the year January 2008 till December 2014 were reviewed retrospectively. Outcome variable was fracture healing which was seen clinically (pain free and postop ambulation) as well as radiologically (union of three out of four cortex).Results:Mean age of the patients were 65 years and the mean BMI was 31. Of the 15 knees 13 had varus malalignment and 2 had valgus malalignment. The mean duration of fracture healing was four and a half months and the mean duration of follow-up was 26 months. All the patients were ambulated full weight bearing with walker. One patient had non-union at fracture site which required bone grafting.ConclusionLong stem total knee replacement is an effective method of treating tibial stress fractures associated with advance osteoarthritis as it not only restores the normal mechanical alignment but also facilitates fracture healin
Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial
No full textBackground: Hip fractures carry a substantial risk of complications and death. This study aimed to report the 90-day incidence of mortality, major perioperative complications and in-hospital timelines after a hip fracture in the Spanish HIP ATTACK-1 trial cohort, comparing with the non-Spanish cohort.Methods: Prospective cohort study of Spanish patients nested in the HIP ATTACK-1 trial. The HIP ATTACK-1 was an international, randomized, controlled trial (17 countries, 69 hospitals, 7 in Spain, highest recruiting country). Patients were randomized to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. Participants were ≥45 years of age who presented with a low-energy hip fracture requiring surgery.Results: Among 534 patients in the Spanish cohort, 69 (12.9 %) patients died at 90 days follow-up, compared to 225 (9.2 %) in the non-Spanish cohort (p = 0.009), mostly due to higher nonvascular related mortality. A composite of major postoperative complication occurred in 126 patients (23.6 %). The most common perioperative complications were myocardial injury (189 patients, 35.4 %), infection with no sepsis (86 patients, 16.1 %) and perioperative delirium (84 patients, 15.7 %); all these complication rates in Spain were significantly higher than the non-Spanish patients (29.2 % p = 0.005; 11.9 % p = 0.008 and 9.2 % p \u3c 0.0001, respectively). Spanish cohort patients were older and had more comorbidities than the non-Spanish cohort, evidencing their greater frailty at baseline. Among Spanish patients, the median time from hip fracture diagnosis to surgery was 30.0 h (IQR 21.1-53.9) in the standard-care group, with 68.8 % of patients receiving surgery within 48 h of diagnosis. This median time was lower in the non-Spanish cohort (22.8 h, IQR 9.5-37.0), where 82.1 % of patients were operated within 48 h.Conclusions: In the HIP ATTACK-1 trial, 1 in 8 patients died 90 days after a hip fracture in Spain. The most common complication after a hip fracture was myocardial injury, followed by infection and delirium. Spanish patients had worse outcomes than non-Spanish patients. Research needs to focus on new interventions such as accelerated surgery and perioperative troponin measurement with the appropriate investment of resources, to prevent and identify early these complications with a goal of improving mortality for this high-risk population
