TYPES OF SUTURING AND THEIR CLINICAL OUTCOME IN OPERATED PATIENTS IN A RURAL TERTIARY CARE SETUP

Introduction: The present study was aimed at different modalities of abdominal skin suturing techniques and their outcome in various abdominal skin incisions. Material and methods: All the patients above the age of 18 years irrespective of gender who were undergoing abdominal surgeries and getting sutured by either Simple, mattress, subcuticular or tension sutures were included in the study. The demography, diagnosis, type of wound & suture and its outcome was followed till day 14. Results: A total of 120 randomly selected cases with different abdominal incisions and different suturing techniques associated with co-morbid factors were selected. Majority of cases i.e, 40 (33.3%) belonged to inguinal hernia, followed by appendicitis, intestinal perforation, intestinal obstruction. Age of 61 to 70 was the most common age group. Most of the cases had clean wound (59) followed by clean contaminated (27) and contaminated wounds (28). The types of sutures observed were simple, mattress, subcuticular and tension, which were done in 30, 24, 30 and 31 patients respectively. Among these the least complications were seen with subcuticular followed by simple type of sutures. The groups of the types of suture used were not comparable due to difference in the type of wound and disease in the patients. Conclusion: Although every type of suture has its own advantages, disadvantage, indications and contraindications, simple and subcuticular sutures have better outcome as compared to other forms of suture. Key words: Abdominal incisions, Clinical outcomes, Suturing techniques

Use of dorsalis pedis artery flap in coverage of distal lower leg defects

Soft tissue defect in the distal one third of leg have always posed a challenge for reconstructive surgeons. Such wounds are difficult to manage due the tenuous blood supply, limited subcutaneous cover over the tendons and bones. The aim of our study is to investigate the outcome of Dorsalis pedis artery flap for the coverage of such defects. In the present study, we share our clinical experience with the use of dorsalis pedis artery flap for the coverage of defect in the distal one third leg. This is a series of 4 cases where dorsalis pedis artery flap was used to cover lower one third defect. One case had focal squamous cell carcinoma due to long standing post burns contracture in distal one third of leg anteriorly. Other 3 cases had chronic non healing ulcer in the malleolar region. Patient outcome was assessed according to patients’ age distribution, duration of surgery, hospital stay, and post-operative complications. All 4 patients had excellent outcome with no major donor site complications, infection, and graft loss. Donor site was closed with split thickness skin graft. One patient developed a minor raw area over the dorsum of foot which healed secondarily. Although a potential risk in applying this flap is insufficient venous drainage, no problems with blood inflow or outflow were encountered in the present case series. The flaps survived, and the patient had good postoperative outcome. Hence dorsalis pedis flap can be used for the coverage of the distal foot as a good option

Medial plantar artery flap: a versatile workhorse flap for foot reconstruction, our experience

Soft tissue defect in the foot is commonly seen as it is more prone to trophic ulcers since it is the main weight bearing area of the body. Reconstruction of the weight bearing area of the foot requires the provision of a stable, supple, durable and preferably sensate skin coverage. Following Sir Gilli’s principle of replacing like with like, medial plantar artery flap provides an anatomically similar, glabrous skin for coverage on the plantar surface. In the present study, we share our clinical experience with the use of medial plantar artery flap for coverage of soft tissue defect over sole of foot. At our institution, a total of 10 patients presented with soft tissue defect of the sole, underwent medial plantar artery flap coverage. All the 10 patients were diagnosed cases of type 2 DM. patient outcome was assessed according to patients’ age distribution, duration of surgery, hospital stay, and post operative complications. Out of all the 10 patients, 5 were male and 5 were female. All the flaps healed uneventfully without major complications like partial flap necrosis. Donor site was covered with split thickness skin graft. There was suture site dehience in 2 cases which healed with secondary healing. Medial plantar artery flap has been described as an optimal reconstructive option for this type of soft tissue defect.