Biological and Clinical Sciences Research Journal

Comparison of Bolster Versus Quilting Techniques on Outcome of Graft Take for Free Fibula Donor Site

Nida Sehar, Fizzah Arif, Mohammad Fazl Ur Rahman, Safdar Ali Shaikh — Sat, 31 May 2025 00:00:00 +0000

Donor site management following free fibula flap harvest is crucial to optimize healing and minimize morbidity. While bolstering and quilting are both commonly employed to enhance graft adherence, their relative efficacy in donor site graft take and complication rates remains uncertain, particularly in head and neck oncologic reconstruction. Objective: This study aims to directly compare the outcomes of quilt and bolster when applied specifically to the free fibula flap donor site, in regard to graft take. Methods: After the ethical approval from the institutional review board, this Single center, parallel, open labelled, randomized control trial was conducted at Plastic Surgery Department at Aga Khan University Hospital from 01/July/2024 to 31/dec/2024. Through non-probability consecutive sampling, 48 patients aged 18-70 years, both gender, who underwent free fibula flap for reconstruction of head and neck tumors at were included in this study. Patients with prior history of limb trauma, peripheral vascular disease, underwent free fibula for other illnesses, such as osteoradionecrosis or trauma or extremity tumors were excluded from the present study. Results: The average flap donor site defect size was 93.5 ± 27.7 cm² in the bolster group and 90.4 ± 23.8 cm² in the quilting group (p = 0.649). The majority of split-thickness skin grafts (STSGs) in both groups were harvested from the contralateral leg—92% in the bolster group and 100% in the quilting group—while only 8% of STSGs in the bolster group were taken from the same leg (p = 0.162). The mean percentage of graft take was 86.2% ± 5.9 in the bolster group and 85.8% ± 7.5 in the quilting group, showing no significant difference (p = 0.812). Donor site complications were observed in 13% of patients in each group (p = 0.98), indicating comparable complication rates between the two techniques. Conclusion: Both bolstering and quilting techniques yield comparable outcomes in terms of graft take and complication rates at the free fibula donor site.

Comparison of Results of Standard Versus Accelerated Casting Method for Relapsed Club Foot Deformity

Sat, 31 May 2025 00:00:00 +0000

Relapsed idiopathic clubfoot remains a significant clinical challenge in pediatric orthopedics, particularly in low-resource countries like Pakistan. While the standard Ponseti method with weekly casting is well-established, the accelerated casting method, requiring more frequent cast changes, offers potential advantages in reducing treatment time without compromising outcomes. Objective: To compare the effectiveness, complication rates, recurrence, and parental satisfaction between standard weekly casting and accelerated bi-weekly casting methods for relapsed clubfoot deformity in a tertiary care hospital in Pakistan. Methods: A prospective comparative study was conducted at the Department of Orthopedics, Benazir Bhutto Hospital, Rawalpindi, from September 15, 2024, to March 15, 2025. A total of 80 children with relapsed idiopathic clubfoot were divided into two equal groups: 40 treated with the standard Ponseti method and 40 with the accelerated method. Outcomes included a number of casts, treatment duration, Pirani score improvement, complication rates, recurrence at 6-month follow-up, and parental satisfaction using a 5-point Likert scale. Data were analyzed using SPSS v25.0, with independent t-tests and chi-square tests applied where appropriate. Results: Both groups achieved comparable deformity correction as reflected by similar final Pirani scores (0.7 ± 0.4 in standard vs. 0.6 ± 0.3 in accelerated, p = 0.312). The accelerated group required significantly fewer casts (5.1 ± 0.9 vs. 6.9 ± 1.1, p < 0.001) and shorter treatment duration (2.6 ± 0.5 weeks vs. 6.9 ± 1.1 weeks, p < 0.001). Complication and recurrence rates were low and statistically similar in both groups. Parental satisfaction was significantly higher in the accelerated group (mean score 4.4 ± 0.5 vs. 3.8 ± 0.7, p = 0.002). Conclusion: The accelerated Ponseti method is a safe and effective alternative to standard casting for relapsed clubfoot, offering faster correction and higher caregiver satisfaction without increasing complications or recurrence. Its adoption may enhance compliance and reduce treatment burden in the Pakistani healthcare setting.

Comparison Study Of Minimally Invasive Plate Osteosynthesis (MIPO) Vs Open Reduction And Internal Fixation (ORIF) For Comminuted Distal Tibia Fracture

Sat, 31 May 2025 00:00:00 +0000

Comminuted distal tibia fractures are complex injuries that require precise management due to limited soft tissue coverage and high risk of complications. Two commonly used fixation techniques are minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF). Each method has distinct biomechanical and biological implications that influence healing outcomes. Objective: To compare the functional and radiological outcomes of MIPO versus ORIF in the treatment of comminuted distal tibia fractures. Methods: This prospective comparative study was conducted at the Department of Orthopedic Surgery, CMH Rawalpindi, from 15 June 2024 to 14 Feb 2025. A total of 60 patients were divided into two groups of 30 each, treated with either MIPO or ORIF. Functional outcomes were measured using the AOFAS score, and radiological union was assessed through serial X-rays. Results: The MIPO group showed significantly higher mean AOFAS scores (88.5 vs. 80.9), faster union times (15.2 vs. 17.6 weeks), and fewer complications compared to the ORIF group. Conclusion: MIPO is a superior technique for comminuted distal tibia fractures, offering better outcomes with fewer complications.

Comparison of Functional Outcome After 2 Weeks Immobilization Versus No Immobilization After Reduction of Acute Shoulder Dislocation

Sat, 31 May 2025 00:00:00 +0000

Acute anterior shoulder dislocation is an injury that happens mostly in people who are active and younger. After reducing the dislocation, immobilizing the joint is an accepted treatment, but the ideal time for removal is argued, since some studies report that early movement may help you recover faster. Objective: To analyze whether resting the shoulder is better than moving it after a closed reduction for first-time anterior shoulder dislocation. Methods: The study was carried out in the Orthopedic Surgery Department of CMH Rawalpindi between 15 June 2024 to 14 Feb 2025. The study grouped sixty patients into two groups. Group A was repaired and then confined to bed for two weeks; Group B was not immobilized and was encouraged to move as soon as possible. Constant-Murley and DASH scores were used to measure function at 2, 6, and 12 weeks after reducing the fracture. Results: Group B consistently had better mean scores for Constant-Murley and DASH at 6 and 12 weeks, with p < 0.01 (statistical significance). No differences in rates of redislocation were noticed between the groups. Conclusion: Early mobilization without immobilization after anterior shoulder dislocation results in superior short-term functional outcomes and may be a viable alternative to traditional immobilization.

Awareness and Knowledge of Liver Diseases in Relation to Demographic Variables in the General Population of Pakistan

Saira Ashraf, Ayesha Malik, Rafi Ud Din — Sat, 31 May 2025 00:00:00 +0000

Liver diseases are a growing public health concern worldwide, yet public awareness and understanding of these conditions remain inadequate. Objectives: To assess the level of awareness and knowledge regarding liver diseases among patients and examine how these vary according to demographic factors such as age, gender, education, and residence. Methods: This cross-sectional, observational study was conducted at the Gastroenterology Outpatient and Indoor departments at Combined Military Hospital Lahore from 1^st February 2025 till 30^th April 2025. All patients meeting the inclusion criteria will be asked to fill out a standard questionnaire, the regional liver index study, and some questions from previously done research assessing the patients' knowledge, attitude, and practice regarding chronic liver disease. Data were collected using a structured questionnaire. Results: Out of 200 participants, 75% reported general awareness of liver diseases, with hepatitis being the most recognized condition (60%). However, only 19% of respondents demonstrated good knowledge, while 43% and 38% had moderate and poor knowledge. Knowledge levels were significantly associated with education level (p < 0.001) and place of residence (p = 0.03), but not with gender (p = 0.22). Only 28% were aware of the hepatitis B vaccine. Traditional media and the internet were the most cited sources of information. Conclusion: It is concluded that although awareness of liver diseases exists among the population, specific knowledge remains limited, particularly among individuals with lower educational levels and those in rural areas. Targeted educational initiatives are needed to bridge this knowledge gap and improve liver health outcomes.