Background: In Western part of Nepal the post traumatic lower leg and bone injuries with infected, open wound is common occurrence. Aim: It was to find out whether Gastrocnemius muscle flap is a viable option for pretibial defects. However variations in vascular anatomy of pedicle, use of reverse flow soleus muscle flap based on posterior tibial artery, leads to high failure rate and sacrificing major leg vessels. Method: Use of soleus muscle flap supported by perforating arteries, branches of posterior tibial vessels is option to cover small defects. The flap with careful newer modification to preserve vascularity, is used in 32 cases of pretibial defects. Observation: All 32 flaps survived with two cases in post operative phase, needing a flap elevation debridement of underlying bone and other skin grafting. Result: None of the case showed any vascular insufficiency, graft muscle loss or any functional loss. Use of muscle flap a viable option in pretibial defects.

Introduction: Face and neck burn deformity is the most common deformity after deformity of hand. Flame burn and chemical burn are the common causes for the all types of burn contractures. Burn contractures involving the anterior neck represent a surgical problem for the Plastic surgeons. Objective: To evaluate the outcome of patients who underwent reconstructive surgery for face and neck burn deformity. Materials and method: The study was conducted in the department of surgery in plastic surgery unit, NGMC between February 2013 to June 2015. During this period 36 patients underwent reconstructive surgery. Result: In 36 patients, there were 12 males and 24 females. The age of patients ranging from 11 years to 56 years. The overall results were satisfactory in 34 cases and not satisfactory in 2 cases, The clinical satisfaction degree was 94.44% in overall evaluation. The average follow up period was from 3 months to 1 year. Conclusion: Among the different types of contractures, neck contractures are also very frequently treated. Common surgical procedure is release of contracture and application of skin graft, the other techniques are applied like expanded or without expansion island flaps, free flaps. Finally the main objective of the different surgical approaches is to obtain the better functional and aesthetical result.

Background: Proximal hypospadias with chordee is the most challenging variant of hypospadias to reconstruct. During the last 10 years, the approach to severe hypospadias has been controversial.Materials & Methods: This is a hospital based observational study conducted in the plastic surgery unit of department of surgery at Nepalgunj Medical College and Teaching Hospital Kohalpur from 2012 March to 2016 September. All patients underwent single staged procedures using Snodgrass technique.Results: Thirty three patients were operated. Twenty four patients had no complications. Single fistula was present in 6(18.18%) patients. Two (6.06%) patients had 2 fistulae; one at the original site of the hypospadias and the other was sub-coronal. One (3.03%) patient had moderate meatal stenosis, which was successfully treated by repeated dilatations.Conclusion: Single Staged procedure using the principles of Snodgrass's technique; is a versatile operation that can be used for the proximal hypospadias. It decreases the rate of fistula formation; disruption; stenosis and gives a satisfactory cosmetic appearance. JNGMC,  Vol. 14 No. 2 December 2016, Page: 50-52

Introduction: Keloids are characterized by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clipsand cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of following resection is a challenge to the surgeon. Material and Methods: A total of 46 patients with keloid were treated at the plastic surgery department of the Nepalgunj Medical College between January 2013 to March 2017. The patients were divided in two groups. Group A consisted of 24patients with keloid in their ear where complete excision of keloid was done with tension free repair and was supplemented withintralesion triamcinolone injection at the time of operation and thereafter as and when needed. Group B consisted of 22 patients. Out of these 15 patients had keloid over the anterior chest wall and rest 07 had keloid over the deltoid region. These cases receivedintralesional triamcinolone only, a total of 5 such injections at month interval as a tension free repair after excision was notconsidered feasible. Results & Conclusion: Patients in Group A underwent surgical excision and intra and post operative intralesionalsteroids and patients in Group B received 4 weekly intraregional injection of triamcinolone injection 40 mg. Out of 24 keloid in Group A two developed post-excision recurrence during a mean follow-up period of 24 months. However they regressed with subsequent local injection of steroid. The group B consisting of scar over the deltoid region and anterior chest wall were not found suitable for excision as a tension free repair (a must to prevent recurrence) was not considered possible. Complete Excision of keloids with tension free suture and local steroid injection is a simple & favored technique for the management of keloid, it preserves contour &skin quality and has a low recurrence rate. Unfortunately all cases are not suitable for total surgical excision. In such cases, steroid locally has to given locally at monthly intervals. The keloids regresses, but atrophy and depigmentation at the site of injection are the complications.