Objective: To determine the superbug infection in a burn centre, its impact on mortality/morbidity and to review all preventive/therapeutic steps taken to fight this menace. Study Design: Retrospective cross sectional study. Place and Duration of Study: Department of Burns & Plastic Surgery, Army Burn Centre, Combined Military Hospital Kharian, from Oct 2018 to Sep 2019. Methodology: A detailed retrospective audit of departmental data was carried out. Parameters like direct admission vs transferred patient, percentage of burns (Total Burn Surface Area-TBSA%), records of all burns related deaths and all culture/sensitivity reports were analysed using SPSS-20. As a standard practice in our unit blood, tracheal secretions and pus culture specimens of all patients are collected at the time of admission and then periodically fresh samples are taken every week or earlier when-ever required. Results: Out of 515 patients, 283 (54.95%) were children under the age of 12 years. The overall survival rate improved by 13.43% as compared to last year. Out of 584 bacteriology reports 396 (67.81%) were positive and 188 (32.19%) were negative. On culture 508 organisms were isolated, majority of which were Carbapenem Resistant Pseudomonas, Acinetobacter, Enterobacteriaceae and Methicillin resistant staphylococcus aureus. Conclusion: Multi drug resistant superbug infection is a worldwide menace. The best clinical practices, strict contact isolation, enhanced environmental cleaning and judicious use of appropriate antibiotics are the main strategies in this war. Need for newer more effective antibiotics cannot be overemphasized.

Objectives: To compare the centrifuged fat versus filtered and washed fat for facial fat grafting in terms of patient satisfaction and subjective/objective appearance. Study Design: Comparative prospective study. Setting/Duration of Study: Department of Plastic Surgery, CMH, Rawalpindi Pakistan, from Aug 2017 to Jan 2020. Methodology: A total of 64 patients (32 in each group) requiring facial fat grafting who fulfilled the sample selection criteria were included in the study. Patients who had received facial cosmetic surgery previously had systemic comorbid or were suffering from active infections were excluded. Group-A patients received centrifuged fat grafts, while Group-B patients received filtered and washed fat grafts. All patients were followed for patient satisfaction and subjective/objective appearance. Results: In Group-A, 23 (71.9%), 3 (9.4%), and 6 (18.7%) patients were happy, just satisfied and unhappy with the overall results of the procedure, respectively, while these numbers were 25 (78.1%), 3 (9.4%), and 4 (12.5%) in Group-B (p=0.785). Patients’ evaluation of their general appearance post-procedure (scored out of 10) showed a mean score of 6.53 ± 2.46 in Group-A and 6.72 ± 2.19 in Group-B (p=0.749). Scoring for a general appearance by an expert panel showed a mean score of 6.72 ± 2.16 in Group-A and a mean score of 7.13 ± 1.81 in Group-B (p=0.418). Conclusion: There is no difference between centrifugation and filtration/washing of fat grafts for facial grafting regarding patient satisfaction and subjective/objective appearance.

Objectives: To compare the inclusion and exclusion of the sural nerve in fascio-cutaneous flap repair for lower extremity reconstruction in terms of flap survival, flap size, recovery of skin sensation and complications. Study Design: Prospective comparative study Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Mar 2020.Methodology: A total of 54 patients (27 in each Group) requiring distal lower limb flap reconstruction and meeting the inclusion and exclusion criteria were included. Patients with a higher probability of flap complications and those with complications during the procedure were excluded. Group-A patients underwent fascio-cutaneous flap repair with sural nerve preservation, while Group-B patients underwent the same technique, but the sural nerve was transected and raised with the flap. All patients were followed for flap survival, flap size and degree of sensory recovery and flap-related complications. Results: Varying degrees of return of sensation were seen in 25(92.6%) patients of Group-A after six months, which was 23(63.1%) in Group-B (p<0.001). Flap survival was comparable in both groups: 26(96.3%) and 25(92.6%) patients in Groups A and B, respectively (p=0.552). The complications were also comparable, 4(14.8%) in Group-A and (25.9%) in Group-B, which was not statistically significant (p=0.209). Conclusion: Preservation of the sural nerve results in little or no sensory loss in the lateral part of the foot, with complication rates and flap survival comparable to cases where the nerve is sacrificed.Keywords: Distally based sural fascio-cutaneous Flap, Distal lower limb flap coverage, Sural nerve preservation.