Hameedud Din, Muhammad Ibrahim Khan, Shahid Hussain, Muhammad Saaiq.
Early experience of Sural flap in reconstructive surgery among Earthquake Survivors of October 08, 2005 Earthquake.
Ann Pak Inst Med Sci Jan ;2(3):153-7.

[s] Objective: To document plastic surgery services and evaluate effectiveness of sural flap in the context of an earthquake disaster. Study Design: Descriptive study. Place and Duration: This study was carried out in the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad over a period of three months (October 08, 2005 to January 07, 2006) Subjects and Methods: A total of 433 adult earthquake survivors who were admitted to our department and underwent some surgical procedure were prospectively included in the study. Children below 14 years of age and those patients who did not consent to participate in the study were excluded. Initial assessment and diagnosis was made by history, physical examination and necessary investigations. The sociodemographic profile of the patients, type of injury, type of surgical procedure undertaken, complications encountered and outcome in terms of success or otherwise were all recorded. The data were subjected to statistical analysis. Results: Out of 433 patients, 60 % (n=260) were females while 40 % (n=173) were males. The mean age was 32 ± 17 years and over 50 % of the patients were in the 3rd , 4th and 5th decades of their life. Leg injuries were the commonest ( 53 % of all ) followed by hand and arm/forearm injuries 12 % each. 43.4 % (n=189) of the patients were managed with skin grafts, 15.93% (n=69) with flaps and 40.41 % (n=175) patients underwent various other procedures such as k-wire fixation for metacarpal 1 phalangeal fractures , fasciotomies for hand and forearm compartment syndrome, digital amputation and excision of untidy wounds. Though our success rate was remarkably high, we had our share of bad luck as well. There were three cases of total and five cases of partial skin graft failure. Two of the 21 sural flaps developed minor infection that necessitated frequent saline irrigation of the wound. One free flap ended in total loss and the patient had to be subsequently managed with a long sural flap. Conclusion: Sural flap constitutes the most reliable and robust plastic surgical tool in the management of soft tissue defects of distal leg, ankle and foot in the context of a mass disaster such as earthquake.

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