Background: Hand surgical cases in Bangladesh are managed both by orthopedic and plastic surgeons. There are very limited number of hand surgeons available in the country. Tertiary referral centers especially in the city of Dhaka cater for most of the hand surgery patients treated in the country. Objective were to understand the needs of the community for hand surgery. Methods: This rretrospective study spanning July, 2017 to June, 2018- used data from the operation register of the Burn and Plastic surgery department, DMCH (Dhaka medical college and hospital) and hand surgery department, NITOR (National institute of traumatology and orthopedics). Results: Of the sample of 2000 cases, 1000 data were collected from Dhaka medical college hospital, of which 670 (67%) were routine cases and 330 (33%) were emergency department cases. Of the 1000 cases from NITOR including 317(31.7%) routine cases and 683 (68.3%) cases from emergency department. Demography of the population 76% male and 24% female cases from DMCH; and 80% male and 20% female from NITOR. In Burn and Plastic surgery department of DMCH the percentage of diagnosed cases-acute burn (55%), acute trauma (9.5%), PBSC (21.5%), post trauma deformity (9%), and congenital cases (5%) and in NITOR- acute burn (1%), acute trauma (68%), PBSC (9%), post trauma deformity (20%), and congenital cases (2%) respectively. Conclusions: This study shows the needs of the community for hand surgery and the portfolio of cases performed would be guide for an evidence-based approach to the development of services and training of hand surgeon in Bangladesh.

Introduction: Perforator propeller flap is a suitable option to cover soft tissue defects in the distal leg and ankle which preserves the main vascular arteries of the lower extremity and muscle function. The aim of this study is to evaluate the use of perforator propeller flaps for coverage of soft tissue defects around the distal leg and ankle. Methods: This prospective study was donebetween December 2018 to November 2019in the Department of Burn & Plastic Surgery of National Institute of Traumatology and Orthopedic Rehabilitation ( NITOR), Dhaka. Total 32 patients with small to medium sized soft tissue defect over distal leg and ankle underwent reconstruction with perforator propeller flaps. Sixteen patients had defect over tendo achilles area, 6 had defect over lateral malleolus,7 over medial malleolus and medial aspect of distal third leg and only 3 had defect in front of ankle. Average Flap length and width were 12.72 (+4.19) & 5.63 (+1.78) cm respectively. Flap rotation was measured 180 degrees in 84.37% of the cases. The propeller flaps were based on a single perforator and it was observed from the posterior tibial artery in 62.5% and peroneal artery in 37.5% of the cases. Results: 81.25% of the flaps completely survived. Total flap loss was observed in one case (3%) while partial flap loss occurred in 6.2% cases. Marginal flap necrosis and epidermolysis were observed in 6.2% and 3% cases respectively. Conclusions: Propeller flapshavereliable vascular pedicle as well as greater freedom in design and arc of rotation that extend the possibility ofreconstructing difficult wounds with local tissues and minimal donor-site morbidity. J Bangladesh Coll Phys Surg 2021; 39(2): 87-93