terms of functional as well as aesthetic outcomes. The ROE questionnaire proves to be a valid tool for estimating patient satisfaction in our population. There is a need for further training and education of surgeons in Pakistan to improve the functional and aesthetic disabilities of nasal deformities.

IntroductionTraumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons’ tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. The aim of our study was to compare the functional results after secondary procedures by administering the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire to patients who had successful upper limb replantation and revascularization.Materials and methodsThis prospective observational study involved 40 patients who had a partial or complete amputation of the upper limb and underwent secondary procedures to correct function after successful replantation and revascularization surgery. The patients’ functional outcomes after various secondary procedures were recorded using the QuickDASH questionnaire.ResultsThe mean QuickDASH score for thumb injuries was 42.3 pre-surgery but improved to 29.5 after secondary procedures, which was statistically significant (CI 11.12-14.87, p<0.01). The mean difference in the QuickDASH scores for finger injuries was also statistically significant: 45.5 preoperation and 33.7 postoperation (CI 9.89-13.70, p<0.01). For wrist injuries, the mean QuickDASH score was 52.8 presurgery and was 46.3 postoperatively (CI 1.81-6.58, p=0.0023). The QuickDASH scores of the patients with arm and forearm injuries showed no statistically significant improvement, with a preoperation score of 58.3 declining to 55.2 (p=0.98). The overall replantation and revascularization scores were 49.725 and 41.175 pre and postoperation, respectively (CI 8.35-8.75, p<0.01).ConclusionThe study finds that the level and mechanism of injury are important predictors of the functional outcomes of the replantation and revascularization of amputated upper-limb appendages. Most replanted and revascularized upper limbs have numerous functional limitations, and achieving good functional results requires one or more secondary procedures, whose type depends on various factors such as the injury type and mechanism. The QuickDASH results for functional outcomes before and after secondary procedures indicate that it is an easy-to-use, reliable, and effective measure of functional outcomes.

Introduction Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds which can be difficult to manage. Management of these patients typically requires a multidisciplinary approach by a plastic surgeon, orthopaedic surgeon and infectious disease control team. Despite the advent of numerous new techniques and technologies, negative pressure wound therapy (NPWT) remains a cornerstone to the management of complex wounds. We present our experience with NPWT in this study. Methods This is a retrospective study of 380 patients who were treated with NPWT in the last 10 years at a single center. We receive hundreds of infected wounds of limbs each year which are either post-traumatic or post-debridement. Frequency of dressing change, C-reactive protein levels, bacterial cultures, complication rate and cost of apparatus in each case were noted. All patients received systemic antibiotics during the treatment.

Objective: to evaluate management outcomes of post-sternotomy wounds. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2020 to Dec 2021. Methodology: We reviewed 35 patients who had developed sternal wound infections post-cardiothoracic surgery. Outcomes of the study were measured using the SF-36 Quality of Life questionnaire. Results: Our patients presented with either Pairolero Type-II 11(31.4%) or Type-III 19(54.2%) sternal wound infection. Preoperatively patients scored 296.667±69.40 in physical functional, 100.00±30.51 in limitations due to physical health, 16.67±37.90 in role limitation due to emotional problems, energy/fatigue scored 43.53±23.70, emotional well-being 163.33±23.54, social functioning as 11.40±11.66, pain score 31.25±19.90 and general health 131.67±35.31. The improvement in scores was noted in all domains postoperatively. Physical functioning mean scored as 790.00±48.07, role limitations due to physical health scored as310.34±67.32, role limitations due to emotional problems scored as 266.67±47.94, energy/fatigue 284.67±18.71, emotional well being 448.67±18.71, social functioning 185.83±12.60, pain score 164.17±22.01 and general health 316.67±34.95. Thirty-four (97.1%) out of 35 patients recovered well postoperative, with a maximum follow-up of 4 years and a minimum follow-up of 1 year. One patient expired on the sixth day of muscle flap coverage of the wound due to cardiac arrest. Conclusion: A positive prognosis can be obtained by this treatment protocol.

Objective: To study the speech outcomes in patients undergoing tongue reconstruction after tumour resection in terms of intelligibility and to examine the factors influencing the outcome. Study Design: Prospective observational study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad, Jan 2015 to Jan 2020. Methodology: A total of 109 patients diagnosed with tongue cancer meeting the inclusion criteria were included in the study. All the participants underwent tumor resection followed by adjuvant radiotherapy (unless refused by the patients). Patients were followed for six months and then underwent speech evaluation via the Functional Intra-oral Glasgow Scale score and Likert scale. Results: Thirty (27.5%) patients could be clearly understood at all the times, while 27 (24.8%) and 42 (38.5%) required some and frequent repetition, respectively. Nine (8.3%) patients could only be understood by close relations and one patient was completely unintelligible. Advancing age (p=0.01), male gender (p=0.01), tumour stage (p=0.004), presence of comorbidities (p=0.004) and degree of resection (p=0.004) had a significant statistical relationship with speech outcome. Addiction (p=0.32), adjuvant radiotherapy (p=0.97) and the development of complications (p=0.59) had no effect on speech. Conclusion: The provision of a mobile reconstructed tongue gives speech intelligibility in a majority of the patients however, the degree of speech recovery is directly dependent on advanced age, disease stage, the presence of comorbidities and degree of resection.