Background: Burn cases are highly prevalent in developing countries like Pakistan. If not managed timely they can result in lifetime complications as well as morbidity. Aim: To compare the supraclavicular artery flap method with skin graft. Place and duration of study: Department of Plastic Surgery, Allama Iqbal Memorial Hospital, Sialkot from 1st September 2015 to 31st August 2019. Methodology: In this comparative study forty four patients were enrolled and half were operated by supraclavicular artery flap method and other half by skin graft procedure. The patients were followed for their skin contour, colour matching and neck extension improvement and recurrent neck contracture after a year. Results: Mean age of the patients was 29.5 years with 75% as females. Only one patient had recurrent neck contracture from supraclavicular artery flap group while 81.8% of skin graft showed recurrent neck contracture Conclusion: Supraclavicular artery flap is a better management approach in post neck contracture burn patients. Key words: Supravlaciular artery flap, Skin graft, Neck contractures

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

<p><strong>Background and Objective</strong>: Plastic surgeons face challenging conditions when dealing with soft tissue injuries or defects involving the lower part of the leg and the proximal part of the foot. The objective of the current study is to compare single-staged reverse sural artery flaps with two-staged interpolated flaps in distal lower limb injuries.</p> <p><strong>Methods</strong>: It was a prospective study carried out at the Department of Plastic Surgery, Allama Iqbal Memorial Teaching Hospital, Sialkot, Pakistan, over 5 years from 2015 to 2020. Sixty-eight (n = 68) patients with distal lower limb soft-tissue defects were enrolled and randomly allotted a two-stage interpolated flap design (group A) or single-stage reverse sural artery flap design (group B). The measured outcomes included the frequency of flap-tip necrosis, epidermolysis, partial or total flap loss, and additional procedures needed for managing these complications.</p> <p><strong>Results</strong>: Out of all the patients, 72% were of male gender and 28% were females with a mean age of 38.38 &plusmn; 10.76 years. In group A, there were 6% of the cases where tip necrosis was the only impediment as compared to 17% in group B. In patients of group A, epidermolysis was seen in 12% as compared to 35% in group B whereas only 6% of patients in group A required secondary procedures for flap tip necrosis as compared to group B (47%). Paired t-test was used to calculate the statistical significance of the outcome between the two groups (p-value of 0.0491).</p> <p><strong>Conclusion</strong>: The two-staged interpolated flap procedure results in fewer complications as compared to a single-staged reverse sural artery flap procedure. However, the shorter hospital stay in single-staged flap design is satisfying for the patients who did not report any complications with this procedure.</p>