Our Experience in the Surgical Management of Arterio-Venous Malformations of the head and neck

Introduction

Vascular anomalies comprise a diverse group of abnormalities in blood vessel morphogenesis that usually occur prenatally. Arterio-venous malformations (AVMs) are rare congenital vascular lesions accounting for 1.5% of all vascular anomalies, with 50% of them occur in the oral and maxillo-facial regions. Treatment of large, complex vascular lesions is a serious challenge for patients and surgeons because it can cause disfigurement and massive haemorrhage, which may be spontaneous or the result of surgical intervention. Our study aimed to demonstrate surgical management of massive AVMs of the head and neck.

Method

This retrospective study shows the treatment outcomes of 28 patients with massive maxillo-facial vascular malformations, who presented to our department for treatment from 1 January 2015 to 31 July 2022.

Results

Twenty-eight patients with a mean age of 17.32 ± 12.21 years (women: 15, men: 13) were enrolled in the study. Diagnosis included extra cranial AVMs of the head and neck region. Treatment modalities, in isolation or combination, included angioembolisation procedure, sclerotherapy, and surgery.

Conclusion

Management of AVMs is challenging owing to the replacement of normal tissue by the diseased ones and the high rate of recurrence. Hence, multi-modal approaches are needed for the effective restoration of tissues.

Outcomes of Vaginoplasty Using Pudendal Thigh Flap in a Tertiary Care Hospital

Objective: To evaluate the outcomes following vaginoplasty by pudendal thigh flap. Study Design: Retrospective longitudinal study. Place and Duration of the Study: Plastic surgery Department, Shifa International Hospital, Islamabad Pakistan, from Jan 2010 to Dec 2021. Methodology: Vaginal reconstruction was done using bilateral pudendal thigh flap in 20 patients with vaginal defects during eleven years, 2010-2021. Results: All patients were adults with an age range from 18 to 41 years. Five were married, and 15 were unmarried patients at the time of surgery. Out of the 20 patients, 10(50%) were diagnosed with Mayer Rokitansky Kuster Hauser syndrome, 9(45%) with isolated vaginal atresia and 1(5%) with s/p resection angiosarcoma. The mean vaginal length was 9.0±0.46cm, one year post-operatively. Two patients (10%) developed necrosis of the distal part of the unilateral flap followed by infection, which was managed conservatively, and the other was managed with the McIndoe technique. One patient developed a cutaneous fistula which was excised. All flaps survived completely in the rest of the 19(95%) patients. Conclusion: Vaginoplasty using pudendal thigh flap was a safe and reliable method for vaginal reconstruction and showed adequate functional and aesthetic results.

A spectrophotometric assay for lipid peroxides in serum lipoproteins using a commercially available reagent

A method is described for measuring lipid peroxides by means of the color reagent of a commercially available test kit for cholesterol estimation. In principle, this assay makes use of the oxidative capacity of lipid peroxides to convert iodide to iodine, which can be measured photometrically at 365 nm. Calibration curves were obtained using peroxides such as H2O2, t-butyl hydroperoxide, and cumene hydroperoxide. A stoichiometric relationship was observed between the amount of organic peroxides assayed and the concentration of iodine produced. Concentrations of lipid peroxides as small as 1 nmol/ml could be measured. The ability to estimate lipid peroxides of isolated low density lipoprotein was demonstrated.