In infants and children, the fingertip injuries occur frequently by accident which result causing infliction which ranges from a little cut to a fracture and also the finger amputation thus requires an immediate treatment intervention to avoid deformities. Different therapeutic approaches have been used involving surgical or conservative treatment. The conservative treatment is considered to be superior choice for management of these injuries so this research was designed to evaluate the functional and aesthetic outcomes of conservative approaches for treating fingertip injuries. Methods: This research consists of 30 children admitted to Ziaudin Hospital, Karachi with Allen's type II and III of fingertip injuries divided into three groups based on the treatment approach including Platelet Gel treatment group (group I), Fucidic acid treatment group (group II), Hyaluronic acid treatment group (group III). Results: All the conservative treatment approaches showed promising improvement regarding the range of motion, healing time, aesthetic and sensory outcome, complications, and subjective satisfaction. However, the platelet gel group exhibits significantly short healing time (p=0.003) in comparison to Fucidic acid and Hyaluronic acid treatment group Conclusion: It was concluded that conservative treatment is one of the effective approach in management of fingertip injuries in paediatric population providing better functional, sensory and aesthetic outcomes. Keywords: Fingertip injuries, Conservative treatment, Outcomes

Background: Thumb defects induced by trauma lead to significant functional disability. The goal of this study was to identify the safety, versatility, and limitations, benefits, and functional outcomes, range of motion and reestablish sensory experience. These characteristics, in addition to a secure soft tissue cover, are needed for thumb restructuring. Study design: This was a retrospective study carried out in the Plastic Surgery Department of Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi from November 2021 to December 2022. Methods: The total 17 participants with traumic thumb defects which insert and treated with island flaps. The participants included 5 females and 12 males, the age group was 20-50 years and the average age (36 years). All patients were evaluated for the occurrence of early post-operative complications in terms of flap necrosis. Results: The operative time was 1 hours. The 15 participants underwent island FDMA flap except 2 participants which show necrosis but without again treatment recover. To evaluate the esthetic and functional outcome by Kapandji score, 2-PD, SS score and esthetic outcome follow by one year. Regarding the functional recovery Kapandji, 2-PD, the esthetic and subjective satisfactory score outcome was evaluated and show significant changes p<0.005. Conclusion: FDMA is one of the best choices for reconstituting distal thumb injuries, and it is a simple technique that has the potential to enhance the island's survival and lowering the rate of distal necrosis. The FDMA flap provides good functional results while causing little donor-site morbidity. Keywords: Cortical reorientation, Metacarpal artery, Island Flap, Two point discriminate.

Background and Aim: Hypertrophic scars are painful and can develop after surgery or trauma, with symptoms varying from an intractable allodynia to minor itch. Extraneural and intraneutral structures could be involved in painful scars issue. The standard treatment for hypertrophic scars is intralesional steroid injections. The present study aimed to investigate the lidocaine analgesia for pain relief in post-traumatic hypertrophic scars. Place and Duration: Burn Centre Dr Ruth K.M. Pfao Civil Hospital, Karachi and the department of Plastics and Burn Surgery, Bolan Medical Complex Hospital, Quetta during the period from October 2020 to September 2021. Methodology: Thirty-five patients with post-traumatic hypertrophic scars were enrolled in this study. Steroids were injected through scars with or without Lidocaine (-10°C) applications for 15 seconds. Ethical approval was taken from the institutional ethical committee. In this experimental protocol, two arms were used. In the first arm, two scars on the same patient's body were randomly assigned as control or experimental scars. Patients were used as their own controls because everyone experiences pain differently. Scars were injected into patients once a month, and pain intensity scores were recorded after each injection. A visual analog score (VAS) was used for the evaluation of pain severity or degree in each individual. Results: Of the total 35 hypertrophic scars patients, about 23 (65.7%) and 12 (34.3%) were females and male respectively. The overall mean age was 32.67±5.83 years. All the hypertrophic scars patients with age ranges from 20 to 65 years were enrolled. Of the total lesions, the presence of hypertrophic scars on the arms, shoulder, back, and chest were 7 (20%), 3 (8.6%), 9 (25.7%), and 16 (45.7%) respectively. The visual analogue score for control and pretreated was 2.8±1.42 and 7.91±1.29 respectively. The VAS pain score was significantly associated (p<0.1) with difference in VAS score of control and pretreated scars. Conclusion: The present study found that lidocaine analgesia provides significant pain relief in post-traumatic hypertrophic scars prior to steroid injection. It also provides a safe and effective way for enhancing the management of disease and patient compliance. Keywords: Hypertrophic scars, Lidocaine Analgesia, Pain relief, Steroid Injection.

Background: Hypospadias is a congenital abnormality of the urethral meatus opening which is located anywhere along the length of the penis except the tip of the glans. The management of this congenital disease is surgical and comprises orthoplasty, urethroplasty, glanuloplasty and cosmetic correction. Urethroplasty is the key step of surgical correction of hypospadias. . Tubularized incision plate (TIP) urethroplasty by dorsal flap is frequently used for distal hypospadias. The reason for the preference is usually wide acceptability of low post-surgical complications and optimum cosmetic results. Other techniques include urethral plate augmentation and urethral plate replacement. Aims: The aim of this study is to assess the effectiveness of dorsal flap assisted TIP urethroplasty in patients with hypospadias of recruited population. The effectiveness will be measured against postoperative outcomes such as wound rupture, wound necrosis, meatal stenosis, and urethrocutaneous fistula formation. Methodology: This prospective study was conducted on 11 primary hypospadias cases undergoing TIPU in Dr Ziauddin Hospital, Karachi for the period of one year from November 2020 to October 2021. The inclusion criteria included infants with distal and midshaft hypospadias with sufficient width of the urethral plate. Whereas individuals with proximal hypospadias or other factors complicating the surgical procedure were excluded from the study population. Result: The total number of participants included was 11 children. The age of participants varied between 18 – and 28 months with a mean age of 24.2 ± 3.1 months. The meatus opening was seen at the distal end near the coronal sulcus in 8 participants whereas 3 participants showed preoperative meatus opening in the distal third of the shaft. An immediate follow up was done at 2 weeks intervals to assess wound health and situation. 1 out of 11 infants showed wound dehiscence which was immediately corrected. A late follow up was carried out after 2-3 years, no case presented with significant complications such as urethrocutaneous fistula or stenosis of the meatus. Conclusion: the study shows measured the post-operative complications followed by TIP urethroplasty using a dorsal flap. Immediate complications showed a single case of wound dehiscence. Whereas all long term follows up after 2-3 years showed no significant complications. After predisposing the clinical outcomes of this research against and in favour of pre-existing literature, it is concluded that dorsal flaps assisted TIP urethroplasty is a safe surgical procedure and is effective in terms of avoiding postoperative complications in individuals with hypospadias. Keywords: Dorsal flap, Hypospadias, Tubularized incised plate urethroplasty