Background: Gunshot injuries are range from minor superficial pellet injuries to devastating soft tissue and visceral injuries. The objective of study was to evaluate complete profile and outcome of gunshot injuries in tertiary care centre.Methods: This study was a prospective study. All gunshot injury patients who admitted in Department of Surgery, Moti Lal Nehru Medical College, Allahabad were included in study.Results: Result were analysed in terms of age, sex, rural-urban and religion wise distribution, etiology of injury, arms and ammunition, time elapsed in first aid, site of injury, associated injury, organ involved, Glasgow coma scale, injury severity score, revised trauma score, various blood and radiological investigations, treatment and complications.Conclusions: Gunshot injury was common in male patients, age group 21-30years, Hindu community and in rural areas. Most patients received injury by shotgun. Assault was most common cause followed by accidental injury. Majority of patients had Glasgow coma scale between 13-15, injury severity score below 20 and revised trauma score more than eight.  Mortality and morbidity were more common in patients with high injury severity score, low revised trauma score and Glasgow coma scale below 8. Abdomen was most common site involved in gunshot injury. Most of the patients were managed conservatively as these patients had external body surface injury. Laparotomy was done for intra-abdominal injury. Wound infection was the most common complication.

Background: Acute appendicitis is the most common reason for emergency abdominal surgery. Acute appendicitis is ranging from mild inflammation of mucous membrane to gangrene, perforation and peritonitis. Appendicular mass is one of its early complication developing in 2 to 6 % cases of acute appendicitis within 48 hours of attack. Objective of this study was to evaluate the outcome of early surgical exploration and its complications in respect to conservative management followed by interval appendectomy for the management of appendicular mass.Methods: A total 46 cases with clinical feature suggestive of appendicular mass presenting in MLN Medical college, Allahabad were included in study. All cases divided into two equal groups based on mode of management of appendicular mass. Group I (early exploration) and Group II (conservative followed by interval appendectomy).Results: Result will be analysed in terms of hospital stay, morbidity, complications and cost.Conclusions: Early exploration for appendicular mass had advantages of total curative treatment in the index admission, shorter hospital stay, minimal morbidity and ensures early return to work and higher compliance. Operative problems such as localization of appendix, adhesiolysis and bleeding are more pronounced and troublesome with interval appendectomy. Wound infection remains common postoperative complication of early appendectomy in appendicular mass but the rate of wound infection is not so high as to preclude this early operative approach.

Background: Surgical Site Infection (SSI) is second commonest nosocomial complication in surgical speciality. Majority of surgical wounds are contaminated by microbes, but in most cases, infection does not develop because innate host defense are quite efficient in elimination of contaminants. The objective of this study was to evaluate patient related risk factors in causation of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. This observational study was comprised of 952 subjects. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of age, sex, distribution of cases based on case scenario (elective v/s emergency), wound class, type of surgery (laparoscopic v/s open), smoking, diabetes, duration of surgery, complete hemogram before and after blood transfusion, number of blood transfusions, albumin, blood sugar level, discharge from surgical site, number of days of drains, stoma  and hospital stay.Conclusions: Surgical site infection in emergency cases were found to be higher as compared to elective cases. Occurrence of SSI proportionately increased with degree of contamination, duration of surgery and age of patients. Laparoscopic procedures showed fewer incidences of surgical site infection as compared to open procedures. Various factors showed statistically significant association with surgical site infections were diabetes, smoking, blood transfusions, haemoglobin and albumin levels. Presence of stomas and drains were associated with increased incidence of SSI but could not be proven statistically.

Background: Surgical Site Infections (SSIs) contributing to substantial rate of mortality, significant morbidity, considerable prolongation in length of hospitalization and added treatment expenses. The Centers for Disease Control and Prevention (CDC) has classified Surgical site infections (SSI) into superficial, deep, or organ/space SSIs. The objective of study was to evaluate pattern of surgical site infection in various abdominal surgeries.Methods: All patients who admitted in surgical OPD/emergency and undergoing abdominal surgical procedures were included in study. Patients were observed in wards and during follow up to assess signs and symptoms of surgical site infection.Results: Result were analysed in terms of etiology, distribution of cases based on case scenario, wound type, clinical features, number of re-explorations done after development of SSI, type of surgery (laparoscopic v/s open), type of organisms cultured, mortality, co-morbid condition, number of extra days in hospital after SSI and average amount spent after SSI.Conclusions: Surgical site infection is associated with high incidence of morbidity in terms of treatment cost and hospital stay. Average hospital stay, expenditure, co-morbidities and mortality were more in organ/space SSI. Superficial SSI is most common in both laparoscopy and open procedures. Deep and organ/space SSI not seen with laparoscopy. Superficial SSI were more common in clean and clean contaminated cases while superficial SSI was more common in contaminated and dirty cases. In superficial and deep SSI staphylococcus aureus was more common whereas in organ/space SSI E. coli and pseudomonas were common bacterial isolates.

Background: Wound of lower leg have a poor and delayed healing due to paucity of blood supply. Coverage of defects of leg and foot has always posed a problem for reconstructive surgeon. The objective of this study was to evaluate anatomical basis of various perforator-based flaps in lower limb and their clinical outcome and usefulness.Methods: All patients with post traumatic defects with exposed bones/tendons in the leg and ankle region presenting in MLN Medical college, Allahabad from August 2011 to July 2012 were included in the study.Results: A total 12 patients were included in study. Majority of cases are of compound fracture following accidents involving lower one third of leg. Majority of flaps were based on peroneal artery (5) and posterior tibial artery (5), only 2 flaps were based on anterior tibial artery. Maximum flap length was 21cm and maximum flap rotation was 180º. Complications occurred more in cases having maximum rotation. Result were good in 11 patients and satisfactory in 1 patient with coverage of the defect leading to healing of the wound. More time gap between injury and flap reconstruction leads to more complications and longer hospital stay. Graft site complication occur in 5 cases include partial flap necrosis, infection and venous congestion. There was no complication at the donor site.Conclusions: Perforator based flaps can be used for all large lower leg defects provided there is correct measurement and anatomical knowledge of various perforators, with good functional and cosmetic results.