Background and objectives:Vaginoplasty is a procedure for the reconstruction of vaginal canal. Various surgical techniques have been described for vaginal reconstruction with variable success. The aim of this study was to assess the use of sigmoid colon in vaginal reconstruction of patients with disorders of sex development. Methods:Eleven patients were included in this study from January 2009 to December 2016. All patients underwent karyotyping, pelvi-abdominal ultrasonography, endocrine and psychiatric assessment. Sigmoid neo-vaginoplasty was the procedure chosen for all the cases. Surgical and functional outcomes were assessed post-operatively over a period of 6 month to 6 years. Results:The preoperative diagnosis included 9 cases of aplasia of the Mullerian ducts or Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), 1 androgen insensitivity syndrome (AIS) and 1 pseudohermaphrodite case. The mean age of the study population was 22.5 years (range 15-30 yrs). No intra-operative or early postoperative complications occurred. The mean vaginal length achieved was 13.0 cm (range 10.5 -15 cm). Long term follow-up showed introital stenosis in 2 cases (17%) which resolved well to vaginal dilatation. One patient had pelvic abscess and treated by surgery. Sexual satisfaction was achieved in 10 cases, as 1 case was unmarried. Conclusion:For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal reconstruction. It is a safe technique and provides the patient with a cosmetic neovagina of adequate caliber with satisfactory functional outcome.
The aim of this study is to assess the outcome of Pedicled extended Lateral arm flaps (PELAF)
Background: Diabetic patients frequently suffer from chronic non-healing ulcer on the sole of foot as a result of combined peripheral neuropathy and arterial insufficiency. Many of them end up in amputation. The aim of this study was to see the outcome of diabetic patients presenting with ulcers that showed no signs of healing in sole of the foot for 3 months or more treated with combination of peripheral vasodilators and surgical reconstruction.Methods: A cross sectional study of 249 patients who presented to Plastic surgery department in BIRDEM fromJanuary 2013 toDecember2015 was done. The patients who had existing associated chronic medical illness like Chronic Kidney Disease (CKD) requiring dialysis, malignancy, Status Asthmaticus and foot ulcer withWagner grade 4 and 5 and patients receiving drugs that cause immunosuppression like chemotherapeutic agents, steroids, and methotrexates were excluded from the study.Results: All patients presented with non-healing ulcerations average size of which was 1.48 cm (range, 0.68 to 4 cm) of more than 3 months in various parts of sole of the foot complicated by peripheral neuropathy and/or arterial insufficiency. After the use of peripheral vasodilators, these patients underwent a variety of surgical reconstructions such as simple skin graft, local flaps, regional flaps and distant flaps. In follow up of 3 to 36 months, 194 patients (77.91%) achieved good results, 55(22.08%) patients’ required secondary procedure such as flap revision, debridement or Split thickness skin graft (STSG) due to post operative complications.Conclusion: We conclude that chronic non-healing ulcers in diabetic patients can be successfully treated by combined approach of surgical reconstruction and peripheral vasodilators.Birdem Med J 2018; 8(2): 108-113
Cervical agenesis or dysgenesis (fragmentation, fibrous cord and obstruction) is an extremely rare congenital anomaly. Conservative surgical approach to these patients involves uterovaginal anastomosis, cervical canalization and cervical reconstruction. In failed conservative surgery, total hysterectomy is the treatment of choice. We report what we believe to be the first successful end-to-end uterovaginal anastomosis of an unusual case of congenital cervical agenesis. A 25-yearold female presented complaining of primary amenorrhea and primary subfertility for the same duration. At laparoscopy, complete separation between the cervix and the body of the uterus was found and hanging from surrounding supports. Both ovaries and fallopian tubes were anatomically positioned. There was another muscular tissue of 2 cm in diameter at the pouch of Douglas which was attached with lateral pelvic wall by transverse cervical ligament. Upon readmission, laparotomy was performed under general anesthesia in a semilithotomy position allowing both abdominal and vaginal approaches. Uterovaginal anastomosis was done by the restoration of the genital tract by direct suturing of the isthmus uteri to the vagina. Insertion of a 16F Foley catheter transvaginally through the vaginal opening into the endometrial cavity and was inflated with 5 ml of fluid into the catheter balloon. There were no postoperative complications. Foley catheter was kept in situ for 21 days. Patient had her first menstruation on 11th day of surgery and that was continued for 5 days with regular flow. Consecutive 3-cycles follow-up has been done and the patient is having her normal menstruation. In the presence of cervical anomaly with functional uterus and intact vagina, uterovaginal anastomosis is feasible and effective and should be applied as a first-line treatment option. How to cite this article Mahmud N, Mahtab NT, Chowdhury TA, Deb AK. Successful Uterovaginal Anastomosis in an Unusual Presentation of Congenital Absence of Cervix. J South Asian Feder Menopause Soc 2014;2(2):105-110.
Managing war injury is no longer the exclusive preserve of military surgeons. Increasing numbers of non-combatants are injured in modern conflicts, and peacetime surgical facilities and expertise may not be available. Although all resources are not always available, adherence to the basic management principles following ATLS guideline, can be made in injured patient care in any situation ranging from single person "Buddy" first aid through to major hospital multiple member trauma teams. This article addresses the management of war wounds including mass casualties by non-specialist surgeons with limited resources and expertise. The Initial measures for treating war casualties are similar to those for any severe injury. The warfare Injured patient management is performed into the following levels: a .Management at the site of incident. b. Management en-route to the hospital. c. Hospital management. The primary objectives of injury patient management are: 1. Rapid and accurate assessment of the patients' condition. 2. Resuscitation and stabilization. 3. Ensuring a smooth and rapid hospital transfer. Management is divided into four phases: a. Primary survey b. Resuscitation. c. Secondary survey and d. Definitive care. These proceed sequentially, with the exception that the primary survey and resuscitation should be started at the site of incident & usually proceed simultaneously, with life threatening situations being managed as soon as they are found. A repeat of the secondary survey (Tertiary survey) may also be performed 24 hours later. DOI: 10.3329/jbcps.v27i1.4241 J Bangladesh Coll Phys Surg 2009; 27: 30-38
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