Objectives: The objectives of the study are to determine the consistency of the proximal perforator in terms of its presence and location prospectively using preoperative color doppler and per operative confirmation in patients requiring anterolateral thigh flap. Study Design: Descriptive Case Series. Setting: Department of Plastic Surgery at Jinnah Hospital Lahore. Period: From April 2017 to October 2017. Material & Methods: A total of 60 patients requiring anterolateral thigh flap were recruited for the study. Consistency of the proximal anterolateral thigh flap perforator was labeled if AK/AP ≤ 0.45. Findings were confirmed per operatively. Results: Presence of proximal perforator was consistent in 51 (85%) individuals with mode of 0.42 (AK/AP ratio) ± 0.04cm SD. Similarly per operative presence of the proximal perforator was consistent in 54 (90%) individuals with mode of 0.42 (AK/AP ratio) ± 0.04cm SD. Conclusion: Proximal perforator is highly consistent in its presence and place in our population requiring anterolateral thigh flap.

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

Background: Honour amputation is a common cause of nose amputation in Pakistan, especially in dahawalpur region. Skeletal support is always a problem in major nasal amputations. It needs multiple delays and extra support later on, with all traditional techniques. Patient and Method: We reported three cases of amputation of the nose. We used sliding septal technique to reconstruct the central cartilaginous support of the nose. In this technique we used the remaining septum as a free graft. Ten patients were treated with this technique with excellent results. Nasal lining was provided either with septal artery mucosal flap or with nasolabial flap. Forehead flap was the only flap to provide external cover. Nostril rim were grafted with trimmed choncial cartilage primarily. In three patients debulking procedures were done later on , but no skeletal procedures. Result: This technique has given an excellent skeletal support and a nice tip projection with no delays or extra support later on. Patient satisfaction rate was 100%. Summary: Sliding septal technique is a very reliables, cost effective technique. It provides an excellent tip support in a single procedure, without sacrificing other precious material like rib or bone.

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Objectives: To evaluate the frequency of fistula formation after Bracka’s repair for hypospadias. Study Design: Retrospective Case study. Setting: Department of Plastic and Reconstructive Surgery, Shaikh Zayed hospital Lahore and Bahawal Victoria Hospital Bahawalpur. Period: 05 years (2014 -18). Material & Methods: Sixty patients of primary hypospadias underwent two staged Aivar Bracka’s repair. Age of patients, type of hypospadias, presence and extent of chordee, donor skin (preputial, post auricular) used, complications and fistula formation were recorded. Leakge of urine from repair site (Primary/Secondary) was noted as fistula formation after 03 weeks postoperatively. Results: A total of 60 patients underwent two staged Bracka’s repair. There were 32 patients (53.33%) with distal hypospadias, 16 patients (26.67%) with mid penile and 12 Patients (20%) with proximal hypospadias. Chordee was present in 33 Patients (55%). Prepucial skin was used in 46 Patients (76.66%) and post auricular skin in 14 Patients (23.34%) as a donor graft. Four patients (6.66%) developed fistula. 03 patients (5.00%) developed fistula at primary site and 01 patient (1.66%) developed at secondary site. Post auricular skin was used as a donor graft in all 04 patients developing fistula. Conclusion: Two staged Bracka’s repair is a versatile technique and reliable procedure for hypospadias repair with minimal complications and is applicable to all types of hypospadias due to excellent functional and cosmetic outcome.