Background of the study: Pressure sores are major cause of morbidity and mortality in the patients of the long term care facility. Infected pressure sores are very difficult to treat. Managing pressure sore needs care and expertise. Objectives: To study the bacteriological status of pressure sore by qualitative and quantitative culture and to find out the sensitivity pattern of the isolated bacteria to the various antibiotics. Methods: 50 patients were included in this study. Wound swabs were collected from pressure sore and deep tissue specimen sampled from pressure sore for quantitative culture in 1st and 3rd visit at 20 days interval. Patients with pressure sore were followed up for healing and their wound healing rate according to PUSH Tool 3.0 is correlated with the bacterial load in the pressure sore. Results were summarized in data table and analyzed. Results: Pseudomonas species were found to be most frequent bacterial isolate followed by E.Coli. Next leading isolated bacteria were Staph. Aureus and Proteus. Ceftazidime, Amikacin, Ciprofloxacin and Gentamycin showed higher percentage of sensitivity and organisms mostly resistant to Ampicillin,Amoxycillin, Co trimoxazole,Flucloxacillin, Ceftriaxone. Quantitative culture of the pressure sore revealed that 40.5% of the sore had bacterial load >105 CFU/ gm of tissue and 59.5% had bacterial load <105 CFU/gm of tissue on 1st visit. On 3rd visit quantitative culture of the pressure sore after 20 days showed decrease in frequency of >105 CFU/ gm of tissue to 21( 28.37%). No statistically significant decrease of bacterial load from 1st to 3rd visit noted. No significant difference in healing also noted in between two groups and in different bacterial species.DOI: http://dx.doi.org/10.3329/bdjps.v3i1.15002 Bangladesh Journal of Plastic Surgery 2012, 3(1): 19-23

Varying degrees of congenital ear deformity (microtia) occurs 1 in about 8000 to 10,000 live births. One of the greatest challenges in plastic surgery is total auricular reconstruction as it demands precise technique as well as artistic creativity. In Bangladesh, recent advancement in the technique of carving and sculpting rib cartilage  and better training for achieving finer anatomic details has given a break through in the surgical management of  deformed ear. Between January 2009 and January 2010, total ear reconstruction was done with a two-stage method using  autogenous costal cartilage in the Department of Plastic Surgery, Dhaka Medical College Hospital, Dhaka. In the first stage, lobule rotation, fabrication of the cartilage framework and its implantation were performed. In  the second stage, elevation of the auricle and formation of the tragus were done. A total of 10 cases with microtia comprising different age group have been operated. All of them underwent stage I operation; among them 8 patients went through stage II procedure while the other 2 are waiting for the same. Results: 10 patients, ranging in age between 8 and 25 years, were operated on using autogenous costal cartilage between 2009 and 2010. Six patients were males and four were females. Unilateral microtia was present in all of these patients (7 right, 3 left). Eight cases were with Grade III microtia; the remaining 2 cases presented with Grade II microtia. The follow-up period was one month to one year. Seven among 8 cases presented acceptable ear contour after second stage ear reconstruction. The cranioauricular angle of the reconstructed ears was also similar to that of the opposite ears. Unfavourable result was deformation of the constructed helix which occurred in one case. Though it is impossible to reconstruct an ear that appears exactly as the opposite one, the new ears which were  made were of correct size and in normal position with impressive finer three dimensional details that achieved patient’s satisfaction as well as surgeon’s professional gratification.Key words: Microtia; Two stage auricular reconstruction; Autologous costochondral cartilageBDJPS 2010; 1(2): 14-19

Phyllodes tumours are biphasic fibroepithelial neoplasms of the breast and each case represents a unique challenge. Even after apparent wide local excision of benign lesions, they recur and recurrences can occur even for 5-6 times. The ultimate end result is chest wall invasion and reconstruction then becomes an essential part of the curative surgical procedure. For a locally advanced breast malignancy, treatment is always palliative with simple coverage and oncologic support. But as Phyllodes tumour is of low aggressiveness, wide excision of even locally advanced malignant phyllodes can result in a good prognosis. Wide and extensive resection always invites the need of reconstruction, and surely it is a challenge when it is for a post-mastectomy recurrent lesion, where the role of plastic surgeons becomes essential. Two such cases are presented where disease control was only possible after full thickness chest wall resection.DOI: http://dx.doi.org/10.3329/bdjps.v1i1.6486Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1) pp.9-13

A prospective, randomized controlled trial was designed to compare the outcome of earlobe keloid management by intra-lesional excision with intraoperative and two dose post-operative steroid injections versus intra-lesional excision with two doses post-operative steroid injections. Total 87 patients having 100 earlobe keloids were enrolled in the study with 50 keloids in each group allocated by lottery, but only 69 completed two years follow up. The age of the patients ranged from 15 to 40 years and all were female. Trauma from piercing ear lobule for earring was the main cause of keloid initiation. Both the groups were homogeneous preoperatively regarding age of patients, pre-operative volume of keloids, pattern of previous treatment received, patient's skin complexion and patient’s family history of keloid.Intra-lesional excision keeping 1mm margin followed by intra-operative steroid injection was given in one group and without steroid injection in other group. Residual keloid volume (length, Breath, and height) was measured intra-operatively and post-operatively during follow up period by blindfolded observers. Any symptomatic relief as well as local and systemic side effects of steroids were also recorded.Main observation of this study after two years was 8.3% recurrence in intra-lesional excision with intra-and two dose post-operative steroid injections and 21.2% recurrence in intra-lesional excision with two dose postoperative steroid injections. This difference was not statistically significant (p = 0.177). But, the former protocol reduced recurrence significantly during 1st one year follow up. Residual keloid volume reduction was faster in former protocol in early post-operative period, but not in later period. Symptomatic improvement was also faster in the former protocol, in early post-operative period, but no difference in later period. Local side effects and systemic side effects of steroid were more or less equal in both protocols.The study demonstrates that additional intra-operative steroid injection has better effect in early post-operative period in managing earlobe keloid, but has no significant effect in long term follow up.DOI: http://dx.doi.org/10.3329/bdjps.v1i1.6489Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1) pp.24-28

The subcutaneous pedicled rhomboid flap is a technique that can release scar contractures without skin graft or additional flap. This study was planned to evaluate the efficacy of this technique. This prospective interventional study was conducted in the department of Plastic Surgery, Dhaka Medical College Hospital, over a period of 16 months. A total of 28 procedures of subcutaneous pedicled rhomboid flap were performed on 12 patients. The contractures were released successfully by the rhomboid flaps. The mean percentage gain in length of the scar band was 77.28%. Most of the cases had complication free recovery. The clinical results indicated that the subcutaneous pedicled rhomboid flap is an effective and versatile technique for releasing scar contractures in different parts of the body. DOI: http://dx.doi.org/10.3329/bdjps.v3i1.14998 Bangladesh Journal of Plastic Surgery 2012, 3(1): 3-6