Radial forearm free flap: A dynamic flap for single-staged multiple subunit reconstruction

We report the case of a middle aged patient with biopsy proven squamous cell carcinoma of buccal mucosa who presented to us in Aga Khan University Hospital Karachi in April, 2017 and required reconstruction of buccal mucosa, upper lip and lower lip. As per protocol of our institute the lesion was excised by the head and neck surgeon and the defect was reconstructed by our team. The defect was large comprising of buccal mucosa including the left oral commissure, upper lip and the lower lip. It was reconstructed via a free flap and a radial forearm free flap. A specially designed radial forearm free flap was harvested and used for reconstruction which resulted in a good aesthetic and functional outcome

Outcome of Laproscopic Cholecystectomy in Acute Cholecystitis

Objective: To compare the outcome of early laparoscopic cholecystectomy in acute cholecytitis due to cholelithiasis as compared to interval cholecystectomy in terms of conversion rate, operative time and complications.Study design:  Descriptive studyPlace of study: Department of general surgery, Pakistan Atomic Energy Commission General Hospital, H-11/4 Islamabad.Duration of Study: January 2016 to June 2017.Methodology: Patients were divided into two groups. Group A had acute cholecystitis and were admitted through emergency room or surgical OPD and were operated in the same index admission on earliest possible list thus waiting time for surgery was one to four days approximately. While group B, had all elective cases, without any evidence of acute cholecystitis, mainly booked through OPD. All the patients included in both groups, were studied for initial diagnosis, duration of symptoms, duration of surgery, conversion to open cholecystectomy, per operative and post-operative complications and duration of hospital stay.Results: A total of 360 patients were operated in the hospital for cholelithiasis during the said period. Standard four ports were employed for the surgery. Group A (acute cholecystitis) had total 112 patients while group B (non-acute cholecystitis) had 248 patients. Of these 112 patients in group A, there were 77 males and 35 females.  In group B, there were 112 male and 248 female patients in group B. The mean operating time for group A was 64±13 min. whereas for group B the mean duration was 60± 12 min. The average amount of blood loss during surgery for group A was 45 ml ± 33 ml and for group B was 30ml + 20ml.Conclusion: Early laparoscopic Cholecystectomy, for acute cholecystitis is cost effective, has shorter total length of hospital stay and reduces the risk of repeat cholecystitis

Comparison of Bupivacaine and Dexmedetomidine versus Bupivacaine Alone in Transversus Abdominis Plane Block for Post-Operative Analgesia

Objective: To study the effects of adding dexmedetomidine to bupivacaine in transverses abdominis plane block in comparison with using bupivacaine alone. Materials and Methods: This was a prospective comparative study that was conducted in the Anaesthesia Department, CMH, Lahore over a period of six months from 1st June 2020 to 30th November 2020. Fifty patients of the American Society of Anesthesiologist Class I and II with an age range between 40 to 60 years were divided into two groups. Group B received 20ml of 0.25% bupivacaine with 2ml of normal saline on each side in the transversus abdominis plane block while group BD was given 20ml of 0.25% bupivacaine with dexmedetomidine 0.5mcg/kg on each side (in a volume of 2ml). Post-operative pain was assessed with a visual analogue scale. Rescue analgesia was given when a score of greater than 3 was observed using this scale. Time to first rescue analgesia was noted. Total opioid consumption in the first 24 hours was also recorded. Patients were observed for postoperative hypotension and bradycardia.Results: The mean-time for the first dose of analgesia for group B and BD was 302.92 ± 24.01 and 419.28 ± 31.97 minutes respectively with a p-value of 0.001. The mean of the total consumption of opioids in 24 hours post-operatively for group B and BD was 14.20±2.36 and 10.40±1.38 mg respectively with a p-value of 0.001. Hypotension was not seen in any patient in either group. Only one patient developed bradycardia and he belonged to group BD. P-value was 0.327.Conclusion: The addition of dexmedetomidine to bupivacaine for transversus abdominis plane block for postoperative analgesia significantly prolongs the duration of analgesia and reduces the postoperative opioid requirements

Versatility of the anterolateral thigh flap : an AKUH experience.

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects of various soft tissue and bulk requirements. Adequate outcomes were achieved pertaining to the reconstruction of the soft tissue defects. Anterolateral thigh flap can be used to reconstruct soft tissue defects almost anywhere and almost of any complexity

Quality of Life in Patients with Stoma

Objective: To determine the quality of life of patients with stoma at tertiary care Hospital. Methodology: This prospective study has been conducted at the general surgery department, Pakistan Institute of Medical Sciences hospital Islamabad (PIMS). The study was conducted from September 2019 to February 2020. All the patients having age more than 12 years, underwent intestinal stoma formation and either gender were included for study. Patients were interviewed regarding their routine activities after stoma and the impact of it on their social life including working status, sexual activities and life satisfaction. All the information of patients including demographic data was documented via self-derived proforma. Analysis of data was done by SPSS version 20. Results: Total 46 patients were studied having a stoma and were interviewed regarding their quality of life. The patient's mean age was 44.93+6.78 years. Out of all 34.8% were working currently and rest of the patients were still on bed rest.  34.8% were satisfied with sexual life. 71.7% were depressed after stoma surgery and 52.2% were hopeful about their future. 63% were socialised with peoples as before, 58.7% replied that stoma has affected their recreational activities and 52.2% answered that they can’t travel in any way. However according to overall satisfaction, 32.6% of patients were disagreeing, 34.8% were agreeing and 30.4% were undecided. Conclusion: It was concluded that almost half of the patients were satisfied and they are performing social and daily life activities however almost half of the patients needed psychological, financial, and relative support. Key words: Stoma, Quality of lif

Use of cephalic vein for venous anastomosis in head and neck reconstruction: A case series

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap. Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon. Results: There were 6 patients in whom the cephalic vein was used as a recipient vessel. The cephalic vein was used in 2 cases where a tumor was involved with the internal jugular vein, in 1 case where a previous neck dissection had been done, in 1 case where internal jugular vein had iatrogenic damage, and in 2 cases a salvage procedure was done. In all cases, the cephalic vein was rotated above the clavicle. The cephalic vein easily reached the free flap vein and had a good caliber. There were no failures in any of the patients. Conclusion: The cephalic vein is a good option for venous anastomoses in patients in whom there is a paucity of recipient vessels in the neck

MANAGING AND IMPLEMENTING CHANGE SUCCESSFULLY WITH RESPECT TO COVID-19: A WAY FORWARD FOR SMES

The pandemic has changed the way of doing things in the entire world. To survive in situations, we need change. All the organizations are trying their level best to implement change successfully, however, all of them are facing severe issues. The purpose of this study is to identify the major hurdles in implementing change and identifying a way out to cope with the situation based on available literature on SMEs and change management. This study follows a synthesized literature review methodology and is a kind of review paper. In this research, literature that has been written on crisis management and especially over the COVID 19 has been reviewed. In this review analysis, previous studies regarding change management and the importance of SMEs in economic sustainability have been discussed. The paper is a review of existing literature and will identify how the organizations can survive through implementing change successfully. The study is significant for SMEs in the entire world. The study is useful for understanding the issues that are related to managing and implementing change in small and medium enterprises especially while facing contingencies. Finally, in this research, future researchers are guided to empirically test the factors identified in the findings of the study

Comparison of Effectiveness of Topical Versus Oral Nifedipine for Treatment of Chronic Anal Fissure

Objective: To compare the effectiveness of topical and oral Nifedipine in the treatment of chronic anal fissure.Patients and Methods: In this randomized control trial total of 124 patients with chronic anal fissure (CAF) were selected through OPD and divided randomly into two equal groups. In Group A the topical Nifedipine (2%) was applied, while in Group B the oral Nifedipine 10mg TDS was used. Both groups were compared in terms of pain and healing measured one month after starting treatment.Results: Mean age of the patients was 38.81±11.81 years. In both groups there was statistically significant difference for the age but no difference was found regarding gender and baseline visual analogue scale. Group A had better healing rate and pain relieve as compared to Group B. There was no difference between groups regarding the effectiveness of treatment.Conclusion: The topical Nifedipine has better healing effects as compared to the oral Nifedipine. The oral form is better in relieving pain after one month of treatment. There was no difference between oral and topical form in terms of overall effectiveness