Introduction: The management of compound trauma has always been challenging. Free aps are the rst choice when soft tissue cover cannot be provided by local aps. When facilities for microsurgery are not available or certain factors preclude the microsurgical anastomosis or in cases of free ap failure, the cross leg aps have a big role to play in lower limb reconstruction. We are presenting our retrospective study on 30 cases of distal leg and foot defects covered successfully by cross leg aps. The aim of this study is to highlight the usefulness of cross legAims and objectives: aps in lower limb reconstruction. A retrospective study was done on 30 patients from January 2015 toMaterial and methods: December 2021 who underwent perforator based fasciocutaneous cross leg ap for post traumatic soft tissue defects of distal leg and foot. The mechanism of injury, size and site of defect were recorded. All aps were planned in reverse and limbs were immobilised with external xator. Post-operative complications if any were noted. The patients were followed till the ap became stable. The mechanism of injury was road side accident in 26 cases, machine injury in 2 cases and fall fromResults: height in 2 cases. 19 patients had soft tissue defect of distal 1/3rd of leg and 11 patients had foot defects. 26(86.67%) patients underwent distally based fasciocutaneous cross leg ap and 4(13.33%) patients underwent conventional anteromedially based fasciocutaneous ap. All aps survived well. 2 patients had discharge and 1 had margin necrosis but were managed conservatively. The perforators based fasciocutaneous cross leg aps provide an easy, simple, reliable and viableConclusion: cover for distal leg and foot reconstruction.

BACKGROUND- Laryngoscopy and endotracheal intubation is known to cause hemodynamic changes which are usually increase in heart rate and blood pressure.Various drugslike beta blockers,opioids and alpha 2 agonists have been tried to attenuate these hemodynamic responses. AIMS-To compare the effects of Fentanyl and Nalbuphine in attenuating the stress response to directlaryngoscopy and endotracheal intubation. METHODS- After informed consent we studied 90patients,all posted for surgery under general anaesthesia between the age group of 15 to 60. We conducted the study over a period of 6months. Data was collected and analysed. Three groups of patients were made Group A – Inj. Fentanyl 2µg/kg ivGroup B– Inj. Nalbuphine 0.2mg/kg ivGroup C- Inj Normal Saline 10cc. Only ASA I and II patients were included in the study.Haemodynamic changes were noted by meticulous monitoring and analyzed. RESULTS-The hemodynamic stress response to laryngoscopy and endotracheal intubation in the form of increased heart rate,systolic blood pressure,diastolic blood pressure and mean blood pressure were less with Fentanyl as compared to Nalbuphine and Normal Saline.CONCLUSION-Fentanyl is more effective than Nalbuphine in attenuating hemodynamic stress response tolaryngoscopy and endotracheal intubation.

BACKGROUND: Post-operative nausea and vomiting (PONV) affects 30-40% of patients after general anaesthesia.[11] AIMS: To compare the effect of Ondansetron and Dexamethasone for prevention of nausea and vomiting in diagnostic gynaecological laparoscopy. METHODS: Ethical committee approval was taken. Consent was obtained. Patients were divided into 2 groups of 30 each. General anaesthesia was administered to all patients. Inj. Ondansetron 0.15 mg/kg i.v. was given to patients of group O. Injection Dexamethasone 0.2 mg/kg IV was given to patients of group D. Patients were monitored for nausea, vomiting, retching, pain score, side effects and requirement of rescue antiemetic. RESULTS: Inj. Dexamethasone is better than Inj. Ondansetron for prevention of P.O.N.V. in diagnostic gynaecological laparoscopy.