Osteoplastic thumb reconstruction in a case of neglected hand burn

In this article we report a case of neglected hand burn with total loss of thumb with additional first web space and wrist contracture of the nondominant hand of a young female. Osteoplastic technique was applied for thumb reconstruction with additional fillet flap and posterior interosseous flap for first web space and thenar area. In this era of microsurgical reconstruction this simple and basic technique can still be useful in selected cases. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18691 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 32-35

Breast Augmentation in Bangladesh with Silicone Gel Implants -A Short Term Experience

Background:. The primary breast augmentation surgery was not popular for a long time in Bangladesh but with the gradual economic and educational development, as well as availability of silicone gel implant and skilled surgeons, the demand, popularity and acceptance of this surgery is increasing. Objective:This study was done to assess the efficacy of the implants in 30 consecutive patients who presented for breast augmentation . Methods:Data were prospectively collected for all patients who underwent bilateral breast augmentation between July 2011 to November 2012 . Breast augmentation was performed by placing textured, round, silicone gel implant in subglandular position via inframammary approach. The 30 patients included in this series were analyzed according to demographic details, preoperative findings, postoperative patient and observer satisfaction scores, and complications. Standard pictures were taken before surgery and during follow-up visits over 6 month; standardised objective measurements of breast and chest were also taken. The test statistics used to analyze the data were descriptive statistics and repeated measure ANOVA .A Visual Analogue Scale (VAS) was used to evaluate the subjects’ global impression of clinical improvement and one independent observer visually reviewed pre and postoperative result to grade aesthetic results Results: Observers evaluation by predefined criteria (volume, shape, consistency, inframammry fold and scar) rated 60 % of patients with excellent outcome, 30% good, 10% fair and none had poor score .A significant percentage (63.3%) of the 30 patients rated their satisfaction as very good and nine (30%) patient rated as good. None of the patients responded the result as poor or as very poor. No serious complications such as implant malposition or significant capsular contracture were observed Conclusions: We conclude that round textured cohesive gel implants provide excellent results, are well accepted by patients and most short-term postoperative adverse effects following cosmetic implantation are clinically insignificant and do not require treatment. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18689 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 20-28

Use of Muscle Flaps in Burn Reconstruction

Electric burns are deep burns that by once-only or continuing stimulation of the nerves and striated muscles causes massive muscle contractions which can cause ruptures, ligamentous tears, fractures, and joint dislocations.High resistance of bone to the passage of electric current results in periosteal necrosis. Deep burns particularly electric burns when exposes structures valuable for important functions like joints, demands reconstructive options consisting robust viability and huge vascularity. The study was conducted in Department of plastic surgery and burn, Dhaka Medical College Hospital,Dhaka from June, 2011 to January, 2012. 18 patients were included in this series. Among them in ten patients gastrochnemius flap was applied, Lattissimus dorsi muscle flap was applied in 4 cases, Trapezius flap was applied in 2 cases and each of the other two patients were treated with Tensor fascia lata and Transverse Rectus Abdominis myocutaneous flap. Fifteen patients were adult and three patients were from paediatric age group. 88% of flaps were primarily used to cover exposed structures (bones and joints) and others were used to correct deformities. Complications include partial graft loss (3), joint stiffness(3), wound infection(1) and flap loss(1). Though these flaps are very commonly used in trauma reconstruction, their use in reconstruction in burn patients are included in this series. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18690 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 29-31

Various Methods of Reconstruction of Axillary Burn Contracture

Post burn contracture is a burn sequel, which was not properly treated in initial burn management. Deep partial and full thickness burn of axillary region can result in scar contracture which limits shoulder abduction and extension. The axillary contracture has functional morbidity along with aesthetic disfigurement. Difficulties in rehabilitation of shoulder abduction during the initial period and the contractile evolution of the scar contribute to this problem. The goal of the surgical correction of axillary scar contractures is to provide a maximum release with minimum or no local anatomic distortion. 42 patients with post burn contracture of the axillas were operated in the Department of Burn and Plastic Surgery Unit, Dhaka Medical College Hospital and in National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka in the period between November 2007 & December 2011. Among them 26(61.9%) were males and 16(38.1%) were females. Age ranged from 6 to 38 years with a mean age 14.7 years. Unilateral axilla were involved in 34 patients(81%) and bilateral axilla was involved in 8 patients(19%). 18 cases (42.8%) had contracture of anterior axillary fold, 12 cases (28.5%) cases had contracture of posterior axillary fold, 8 cases (19%) had contracture of both folds and 4 cases (9.5%) had contracture involving axillary dome. Pre operative X-ray of shoulder joints of affected axilla revealed normal joint spaces. The operative procedure was chosen according to the pattern of scar and state of surrounding skin. Surgical procedures included release of post burn axillary contracture by recontructive procedures single Z plasties were done in 2 cases(4.7%), multiple Z plasties were done in 12 cases(28.6%), five flap plasty was done in 1 case (2.4%), local fascio cuteneous flaps were done in 25 cases(59.5%), parascapular flap was done in 1case (2.4%) and split thickness skin grafting was done in 1 case (2.4%). Axilla was immobilized with plaster cast for two weeks. The rate of complication was 9.5%. All of them were minor. Functional improvement was quite satisfactory, except for one case of skin grafting which had re-contracture. Choice of surgical procedure for reconstruction of post burn axillary contracture can be made according to the pattern of scar contracture and the state of surrounding skin. The choice of a flap should have priority to skin graft because of the superior functional and cosmetic results of flaps. Long term splinting and physical therapy are mandatory to prevent re contracture. Proper pre-operative planning, appropriate surgical method, post operative immobilization, physiotherapy and follow up can make good outcome of post burn axillary contracture reconstruction. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18686 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 16-19

Soleus muscle flap for the coverage of pre-tibial defect of middle third of leg

Soft tissue defects of the lower limb are a challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Early reconstruction by soft tissue to cover exposed bone significantly reduces the risk of infection, nonunion and subsequent amputation. A Prospective, observational study was carried out in the Department of Plastic Surgery & Burn Unit, Dhaka Medical College Hospital and Department of Plastic Surgery, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, from September 2011 to March 2013. 30 cases were selected by purposive continuous sampling who had soft tissue defect in front of the middle third of the legs only. Proximally based soleus muscle transposition flap was done by standard operative procedure under spinal anaesthesia or general anaesthesia and under tourniquet control. After 2 months of operation, final follow-up was done. Regarding the outcome of flap surgery, 18 (60%) cases were found excellent. 7 (23.33%) cases were good, 3 (10%) were fair and 2 (6.66%) were poor. In the final follow up, according to the preset criteria for evaluation of wound coverage by soleus muscle flap, the satisfactory result (excellent and good) was 83.33%. Unsatisfactory (fair and poor) result was in 16.67% cases. Effective coverage of pretibial defect of middle third of leg by soleus muscle flap with satisfactory outcome was seen in this study. DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18685 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 10-15

A Short Review on Microtia and Bangladesh Perspective

not available DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18683 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 01-03

Surgical Closure of Sacral Pressure Sores by Gluteal Skin Flap.

Pressure sores are an ancient medical problem; even found during autopsies of Egyptian mummies. This prospective study was carried out in the Department of Plastic Surgery, Dhaka Medical College & Hospital (DMCH), Dhaka between January 2012 to December 2012 to evaluate the outcome of surgical closure of sacral pressure sores by Gluteal skin flaps. Twenty two patients admitted into DMCH with stage III & IV sacral pressure sores were included. Over two-thirds (68.2%) of the ulcers were in Stage-III and over three-quarters (77.3%) had signs of local infection. The average horizontal and vertical lengths of the defects before excision were 10.4 and 8.8 cm respectively which increased to 12.6 and 10.6 cm respectively after excision of dead and devitalized tissues. The average medial advancement of the flap was 6.3 cm. Postoperative flap-monitoring did not reveal infection, seroma or hematoma in any of the patients. Only 2(9.1%) patients had marginal flap loss. Marginal flap losses developed in two cases were excised and direct-suturing (secondary closure) were done. More than 90% of the patients exhibited good outcome. The study concluded that Gluteal skin flap produces good result in majority of the patients with large sacral sores with almost no complications or recurrences. The Gluteal skin flap has the advantages of muscle sparing, less donor site morbidity, versatility in design and less effort to harvest DOI: http://dx.doi.org/10.3329/bdjps.v4i1.18684 Bangladesh Journal of Plastic Surgery January 2013, 4(1): 05-09

Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

Scalp Reconstruction Following High Voltage Electric Burn

Background: Scalp reconstruction following high voltage electric burn can be challenging. A useful Reconstructive algorithm is lacking. The purpose of this study was to evaluate our experience and to identify an appropriate reconstructive strategy. Methodology: This was a prospective observational study, conducted in the Burn unit of Dhaka Medical College Hospital & Department of Burn & Plastic Surgery,Sir Salimullah Medical College & Mitford Hospital over a period of five years. Reconstructive procedures, independent factors and outcomes were evaluated. A total of 7 procedures were performed in 30 patients. Techniques for reconstruction included skin grafting, outer table drilling & skin grafting, Bipedicle flap, Single rotation flap, Double opposing rotation flap, Transposition flap, Tissue expansion & primary closure. Conclusion: Important tenets for successful management of scalp defects are durable coverage, adequate debridement, preservation of blood supply, and proper wound drainage. Local scalp flaps with skin grafts remain the mainstay of reconstruction in most instances. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18251 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 49-52

Subungual Glomus Tumor- Clinical Presentation And Treatment

Glomus tumor is a rare condition and constitutes only 1 % of all soft tissue tumor of body. Glomus tumor is familiar for its unusual presentation and long standing symptoms due to delay in diagnosis. Authors have presented the clinical behavior and treatment of 7 patients with subungual soft tissue mass. Following surgical excision, all patients cured of symptoms, at the end of follow up, no recurrence occurred; post operative nail deformity was insignificant. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18250 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 45-48