A total of 1034 patients presented to our department, with age ranging from 1 to 86 years, with a mean age of 20.84 ± 15.469 SD . Of the total study population, 855 (82.7%) were male patients and 179 (17.3%) were female patients, with male to female ratio of 4.8:1 . The affected male (79.1%) and female (82.7%) patients were mainly in the first three decades of life .
Graphical presentation of the age of the study population
Gender distribution of the study population
Of the total study population, 51.5% (n = 532) presented from Peshawar district and 13.3% (n = 138) presented from Khyber Agency. Trauma to the upper limbs was the most commonly found, affecting 492 (47.6%) patients, followed by head and neck injuries in 273 (26.4%) patients .
Body region affected by the plastic surgical trauma
Upper limb trauma
Upper limb trauma was the most common among patients who presented to our unit, with 441 (89.63%) male and 51 (10.4%) female patients. Of the total 492 cases with upper limb trauma, 232 (47.15%) presented in 2011. Two hundred and seventy-five (55.9%) patients presented from Peshawar district industrial area. The most common mechanism of injury for the upper limb was MI affecting 37.6% (n = 185) patients. The BBI affected 5.1% patients . One hundred and fifty-one (30.7%) patients sustained different types of amputations, making it the most common type of injury, followed by avulsion injuries and lacerations accounting for 68 (13.8%) and 60 (12.2%) cases, respectively . Wound excision and closure was the most common surgical procedure performed in patients with upper limb trauma, accounting for 210 (42.7%) patients, followed by skin grafting and tendon repair performed in 81 (16.5%) and 77 (15.6%) patients, respectively . Flap reconstruction in upper limb trauma was performed in 53 (10.8%) patients. The complication rate for upper limb trauma was 5.1% (n = 25), including partial graft loss, wound contracture and flap necrosis accounting 1.2% (n = 6) each.
Region versus mechanism of injury cross-tabulation
Nature of injury versus region cross-tabulation
Surgical procedure versus region cross-tabulation
Head and neck trauma
The head and neck trauma was the second most common, affecting 273 (26.4%) patients consisting of 203 (41.3%) male and 70 (25.6%) female patients . Geographical distribution of the head and neck trauma was similar to that of upper limb trauma, with 60.4% (n = 165) presenting from Peshawar district. Of the total 273 patients, 84 (30.7%) presented in 2011. The major mechanism of head and neck trauma was RTA affecting 100 (36.6%) patients, followed by FI with 70 (25.6%) patients . One hundred and seventy-eight (65.2%) patients sustained lacerations . The most frequent surgical procedure in the head and neck trauma patients was wound excision and closure performed in 212 (77.65%) cases, followed by flap reconstruction performed in 38 (13.92%) cases . Wound contracture was the most common complication that developed in 4 (1.5%) patients.
Lower limb trauma
A total of 226 (21.9%) patients presented with lower limb trauma, with a male predominance (78.8%). Eighty-three patients (36.7%) presented in 2011. Seventy-seven patients (34.1%) belonged to Peshawar district. The major mechanism for lower limb trauma was RTA accounting for 159 (70.3%) patients. Avulsion was the most common type of injury in lower limbs sustained by 102 (45.1%) patients. Skin grafting was performed in 130 (57.5%), followed by flap reconstruction in 40 (17.7%) patients. Partial graft loss was the main complication, followed by flap necrosis in 6 (2.6%) and 2 (0.9%) cases, respectively.
Trunk and perineum
The perineum and trunk were affected in 8 (0.8%) and 6 (0.6%) patients, respectively . The main mechanism of trunk trauma was FAI with 2 (33.3%) patients, followed by BBI and RTA in 1 (16.7%) patient each. The main mechanism of injury for perineum trauma was IT (post-circumcision glans trauma) affecting 3 (37.5%) patients . The most common trauma in the perineum region was penile amputation in 4 (50%) cases. Of the total four penile amputations, two were caused by inadvertent circumcision (IT), one was a result of knife injury and the other an animal bite (donkey bite). The main trauma of the trunk was laceration affecting 3 (50%) patients . One patient presented with necrotising fasciitis of the chest and abdomen, who unfortunately expired due to cardiorespiratory arrest secondary to septicaemia.
Surgical procedures performed for plastic surgical trauma
Of the total 1034 patients, 29 (2.8%) presented with injuries of more than one region of the body. The mechanism of injury was RTA in 20 (68.96%) patients. Lacerations and avulsions were the main injuries affecting 11 (37.9%) patients each.
Mechanism of injuries
RTA was the most frequent cause of trauma for all age groups, affecting 32.9% (n = 340) of our patients . In the lower limb trauma 70.35% and in the head and neck trauma 36.6% patients were affected by RTA [Tables and ].
Age distribution of mechanism of injury
MI were the mechanism of injuries in 200 (19.3%) cases, making them the second most common cause of trauma in our series. MI mainly affected upper limb region, accounting for 37.6% (n = 185) cases out of the total 492 upper limb trauma cases.
BBI affected 62 (6%) patients and the highest number (n = 29, 46.8%) presented in 2009.
Bites affected 2.6% (n = 26) patients, with DB and HB being the most common, affecting 1.4% and 0.8% patients, respectively. Amputation was the main type of injury that was presented in 12 (46.2%) patients. For the DB and HB, head and neck region was affected in 92.9% (n = 13) and 100% (n = 8) patients, respectively. In the other animal group, there was one case of donkey bite on the perineum with penile amputation [Tables and ].
Type of injuries
Lacerations were the most common type of injury among those presenting to the plastic surgery department, affecting 272 (26.3%) patients. The second type of injury was avulsion of skin and soft tissues in 238 (23%) patients. One hundred and eighty-nine (18.3%) patients presented with amputations, including mostly finger tip amputations [Tables and ].
Type of surgical procedures performed
Wound excision and closure was the main surgical procedure performed in 473 (45.7%) patients in this series. Skin grafting (full thickness and split thickness) was performed in 232 (22.4%) patients. One hundred and thirty-two (13.2%) patients underwent flap coverage. Isolated tendon repair was carried out in 79 (7.6%) patients, tendon and nerve repair was performed in 5 (0.5%) patients and nerve repair alone was conducted in 7 (0.7%) patients. Bone fracture fixation was performed in 30 (2.9%) patients [Tables and ].
Postoperative complications (morbidity and mortality)
As a whole, complications were observed in 45 (4.35%) patients. Of the total number of patients, 206 underwent skin grafting of whom 12 (5.82%) developed partial skin graft loss. Flap necrosis was observed in 6.9% (n = 7) of the total 102 patients in whom flap reconstruction was performed. Tendon repair was carried out in 72 patients, of whom 1 (1.4%) patient developed tendon rupture and 4 (5.5%) developed contracture with limitation of range of motion. The surgical site infection was noted in 4 (0.4%) patients. Mortality rate was 0.3% (n = 3) secondary to septicaemia due to development of necrotising fasciitis .
Frequency of complications for the plastic surgical trauma