Objectives. To determine the demographics and analyze the management and factors influencing the postoperative complications of hypospadias repair. Settings. Hayatabad Medical Complex Peshawar, Pakistan, from January 2007 to December 2011. Material and Methods. All male patients presenting with hypospadias irrespective of their ages were included in the study. The data were acquired from the hospital's database and analyzed with Statistical Package for Social Sciences (SPSS). Results. A total of 428 patients with mean age of 8.12 ± 5.04 SD presented for hypospadias repair. Midpenile hypospadias were the most common. Chordee, meatal abnormalities, cryptorchidism, and inguinal hernias were observed in 74.3%, 9.6%, 2.8%, and 2.1% cases, respectively. Two-stage (Bracka) and TIP (tubularized incised urethral plate) repairs were performed in 76.2% and 20.8% of cases, respectively. The most common complications were edema and urethrocutaneous fistula (UCF). The complications were significantly lower in the hands of specialists than residents (P-value = 0.0086). The two-stage hypospadias repair resulted in higher complications frequency than single-stage repair (P value = 0.0001). Conclusion. Hypospadias surgery has a long learning curve because it requires a great deal of temperament, surgical skill and acquaintance with magnifications. Single-stage repair should be encouraged wherever applicable due to its lower postoperative complications.

Objective:To compare the rate of complications of Plastibell and bone cutter circumcision technique and recognition of top worries and satisfaction rate in the mind of parents before and after the procedure of Plastibell device (PD) circumcision in infants less than 6 months of age.Methods:It was a descriptive prospective study conducted at department of surgery Sheikh Zayed Hospital, Rahim Yar Khan. Two hundred parents of infants of less than six months of age were recruited for this study. Infants were divided into two equal groups. Group I included Plastibell circumcision technique and Group II included Bone Cutter Circumcision technique. Data was analyzed using SPSS Version 17. Independent sample t-test and chi-square test was used to compare quantitative and qualitative variables respectively. P-value <0.05 was taken as significant difference.Results:Total number of two hundred infants were included in this study. Most common worries of parents about Plastibell Device circumcision were; fear of fever (42.0%). Fear of pain and bleeding (66.0%). Plastibell Device method was associated with less operation time and bleeding as compared to bone cutter method (P-value <0.0001 and <0.0001 respectively). Incidence of complications other than bleeding and infection was 3.0% in bone cutter method and 1.0% in Plastibell device method. Pain score was significantly less in plastibell device group (p-value <0.0001). Post-operatively, 98% parents showed complete procedural satisfaction in Plastibell group versus 87% parents in bone cutter one month after surgery (P-value 0.003). About 4% parents in bone cutter method group showed cosmetic displeasure versus only 1% parents in plastibell device group.Conclusion:The study concluded that Plastibell Device circumcision is a safer technique for circumcision and is associated with highest level of parent’s satisfaction.

Objective: We aimed to compare the rate of complications of Gomco and Plastibell circumcision techniques ininfants. Study design:Prospective Randomized Clinical TrialStudy. Place and duration of study:Department of Pediatric Surgery, Sheikh Zayed Hospital, Rahim Yar Khanfor six months from August 2020 to July 2021. Patients and method: A total of 80 patients were enrolled in the study, equally divided into two groups. Group 1 included patients undergoing circumcision via the Gomco technique, while group 2 circumcised with the Plastibell method. All healthy male patients aged one day old to 4 years of age were included. Patients with any congenital abnormalities, e.g., urethral or penile shaft abnormality, local infection, hypospadias. Jaundice and bleeding disorders were excluded. All procedures weredone under local anesthesia, postoperatively topical antibiotic was prescribed to each patient. Data was entered and analyzed using SPSS 25.0. Frequencies and percentages were expressed for qualitative variables like gender and postoperative outcomes, i.e., bleeding, penile edema, and redundant skin. Mean ± S.D represented quantitative variables like age, weight, and BMI. A Chi-square test was used to compare the complication rate between both groups. A p-value ≤0.05 was considered significant. Results: In the Gomco technique, there was no Penile edema, surgical site infection, hematoma, and need for Repeat surgery/manipulation. We found that bleeding was more common in Gomco compared to Plastibell. On the other hand, penile edema, reductant skin, slipped ring, and the need for repeated surgery/manipulation was more often in the Plastibell technique. Conclusion: We propose using the Gomco method for circumcision because of its lower rate of complication and better aesthetic outcome than the Plastibell method. Keywords: Circumcision, Gomco, Infant, Plastibell.

Background: The pectoralis major myocutaneous pedicle flap (PMMPF) has been considered to be the "workhorse" of pedicled flaps in head and neck reconstruction. Despite the use of free flaps, this flap is still considered the mainstay of head and neck reconstruction. The flap is usually associated with a high incidence of complications compared with the free fasciocutaneous flaps yet its size, viability, and versatility make it a valuable tool for extending the limits of resectability and reconstruction. It is type V muscle flap with the dominant vascular supply from the pectoral branch of thoracoacromial artery. Objective: To share our experience of pectoralis major myocutaneous pedicle flap in selected cases of head and neck reconstruction. The indications, type of reconstruction and complications of the flap utilization were evaluated. Patients and Methods: Between March 2005 and August 2010, a 37 head and neck reconstructive procedures using the PMMPF were carried out. The indications for the flap use were defects due to resection of stage II-IV cancer in the head and neck region. The site, stage of the disease and the postoperative complications were all documented. Results: Pectoralis major myocutaneous pedicled flap reconstructions were used to reconstruct defects in the following sites: oral cavity (25 patients); oropharynx/ hypopharynx, (7 patients); and neck or face (5 patients). Of the 37 PMMPF reconstructions, 30 flaps were carried out as primary reconstructive procedures, whereas 7 flaps were "salvage" procedures. Twentyfive patients (67.59%) had complications. A higher complication rates were associated with the utilization of the flap as a salvage procedure, number of co- morbidities, and in oral cavity reconstructions. Conclusions: The pectoralis major myocutaneous pedicled flap is still an acceptable method of head and neck reconstruction. It is fast, reliable, provides safe repair and is indicated especially where bulk is needed.

Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.