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   Table of Contents - Current issue
July-December 2020
Volume 16 | Issue 2
Page Nos. 45-93

Online since Friday, December 18, 2020

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Clinical outcome of microsurgical free flap procedures in Lagos, Nigeria p. 45
Bolaji O Mofikoya, Orimisan Belie, Andrew O Ugburo, Abdulwahab O Ajani
Background: Reconstruction of complex defects following radical tumour excision and post-traumatic defects has been made possible with the use of microsurgical free tissue transfer. It is associated with less donor site morbidity and hence and good surgical outcome in the reconstructed area. It is a routine procedure in the developed countries, however it is gradually evolving in the developing nations. Method: The records of all patients who had free flap reconstruction of their defects were retrieved from the unit database. The demographic characteristics, indications for surgery, choice of flap and the complications were documented. The data were analysed using appropriate statistical tools. Results: Free flaps represent 1.7% of all major flap surgeries performed. Among these patients, those between the ages of 21 and 30 years had highest number of free flaps accounting for 26% of the study population. Anterolateral thigh flap (ALT) was the most common donor flap. Venous compromise was more common among patients who developed complications. Conclusion: Despite many challenges facing successful microvascular surgery in the developing nation, formation of dedicated team and institutional support will improve the outcome of these procedures.
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A prospective randomized comparative study of facial scar modulation using topical silicone gel versus coconut oil p. 51
Vipin V Nair, Jerry R John, Ramesh Kumar Sharma
Context: Scar following facial trauma is an important problem affecting aesthetics and function. Aim: The aim of the study is to compare the usefulness of topical silicone gel versus coconut oil in facial scar modulation. Design: Prospective randomized comparative study was done between January and December 2016. Subjects and Methods: Seventy-four post-traumatic facial scar patients were randomized into three groups − Group A topical silicone gel only, Group B coconut oil only, and Group C both. Observational data were collected and photographs were taken at 2 weeks, 1 month, 3 months, and 6 months. Vancouver scar score and visual analog scale score were done for observational data. Photographs were analyzed by two independent blind observers at the end of the study. Results: Topical silicone gel gave superior results in reducing vascularity and pliability at 1 month and hyperpigmentation at 3 months. Coconut oil has better antipruritic effects at 1 month as compared topical silicone gel. Conclusions: Topical silicone gel is a superior product for initial management of facial scars compared to coconut oil.
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Ectrodactyly or lobster claw feet: our surgical experience p. 61
Chetan Satish
Introduction: Ectrodactyly, often the center of attraction due to the mystifying appearance, is a challenging surgical entity as more often the affected children seek cosmetic improvement and also want their feet to fit into normal footwear. Aims and objectives: Not much has been written in the literature of the surgical treatment of this rare entity. This article has been written to address the surgical options and treatment of this rare deformity. Results: We report a case series of five affected children treated in our institute over a period of 4 years. The cases were followed up for a period of 1 year, and there were no recurrence. Conclusion: Surgical descriptions for correction of this rare entity are few and this article aims to address this lacuna, helping in proper correction of this deformity.
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Penile and scrotal defects post-Fournier gangrene: reconstructive options and challenges in resource limited settings p. 65
Chinedu Nnaemeka Ilokanuno, Titus Osita Chukwuanukwu, Ezekiel Uchechukwu Nwankwo, Chidi Kingsley Oranusi
Introduction: Penile and scrotal defects following necrotizing fasciitis (Fournier gangrene) of the perineum in males can be a source of great morbidity and psychological concern to the patients inflicted with such a problem. In severe cases, it can result in mortality. Reconstruction of extensive defects/ulcers can be challenging in resource limited settings due to limited availability of tools such as doppler ultrasound/stethoscope, loupes, and operating microscopes for microsurgical procedures. Fournier gangrene is usually managed by the urologists in most centers in collaboration with the plastic surgeons for reconstruction of more extensive defects. Objective: The aim of the study was to review the penile and reconstructive options deployed for post-Fournier gangrene patients over a 3-year period (April 2017 to March 2020) in a tertiary hospital setting highlighting options utilized, indications for the respective options, and challenges encountered. Methodology: Case notes of Fournier gangrene patients offered penoscrotal reconstruction by the urology and plastic surgical teams within the period were retrieved, reviewed, and relevant data useful in achieving the above objectives extracted for analysis. Clinical photographs of some of the patients were included for illustration. Results: Twenty patients (20) that met the inclusion criteria were reviewed. Fourteen (70%) had defects involving both the scrotum and the penis, five (25%) involved the scrotum alone, while one (5%) had defect on the penis alone. Four (20%) had diabetes mellitus, three (15%) had HIV infection, and two (10%) had hypertension. Seventy percent (14) of the patients had secondary wound repair by direct closure, 5% (one) had split skin grafting alone, 5% (one) had a combination of split skin grafting and local advancement flap, and 20% (four) required the use of available locoregional flap [three being bilateral scrotal advancement flaps and one being bilateral pudendal thigh (Singapore) flap]. Healing was satisfactory in all the patients although two of them (10%) had surgical site infection whereas one (5%) had mild wound dehiscence, but all healed within 2 weeks. Conclusion: Post-Fournier gangrene defects can be reconstructed using several options, the choice of which is dependent on the size of the defect, elasticity of residual scrotal skin, status of defined locoregional pedicles, availability of modern diagnostic and operating equipment, and expertise of the surgeon. Collaboration between the urologists and the plastic surgeons is recommended for optimal outcome.
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Tessier 4 right-sided orofacial cleft deformity with associated congenital limb anomalies − a case report and literature review p. 72
Ajani Abdulwahab O., IO Fadeyibi, DT Omosebi, S Ilori Oluwatosin
To report the case of a four year old girl with Tessier 4 right-sided orofacial cleft deformity, type I left cleft foot and hypoplastic right thumb. The patient presented with right-sided congenital orofacial defect, left foot defect and abnormally small right thumb noticed at birth. The pregnancy, labor and delivery periods were uneventful. She subsequently had repair of the orofacial cleft and the cleft foot defects. The post-operative period was uneventful. The patient is currently being followed up in the clinic. Tessier 4 cleft, though a rare orofacial cleft deformity may occasionally be associated with other congenital anomalies as it is found in the index case.
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Harvesting human skin allografts for burn care in a developing country p. 77
AO Iyun, SA Ademola, OA Olawoye, AI Michael, RO Aderibige, OM Oluwatosin
The usage of fresh and glycerolized preserved human skin allograft in burn care is a challenge in a developing countries despites it’s benefits in improving morbidity and mortalities in burn patients. We present two case reports to demonstrates it’s usage. In our first case report, the skin harvested allograft was from a consented patient who was undergoing abdominoplasty. It was harvested as a full thickness skin graft from the panniculus. The harvested skin allograft underwent process of glycerolisation and was stored in 85% glycerol in a fridge at 4°C. The skin allografts were used on the donor site of a patient with 51 percent burns undergoing burn wound excision and skin grafting. The skin was secured with sutures and adherence of the skin allograft on the donor site was noted on the wound review on the third day. Evidence of rejection of some parts of the skin allograft (sloughing off of the skin) was noted by the 7th day post-surgery. The second case report, a two-year-old girl who presented with 37% total burn surface area predominantly deep dermal flame burn injury with suspected inhalation injury. She had tangential wound excision and split thickness skin grafting with both autograft and living donor allograft (donor was the mother). The donor was screened for human immunodeficiency virus (HIV) I and II, hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV). The autografts were meshed 6:1. Allografts were previously harvested from the thigh of the mother on the same day using a power dermatome and meshed 3:1. By the 12th day, there was a 60% loss of the allograft on the left thigh while there was 5% graft loss for the autograft. On the right thigh, there was a 50% graft loss for the allograft while there was a 2% graft loss for the autograft. Human Skin allograft can be used as an option for wound coverage in patients who have sustained burns.
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Abuse of parenteral opioid (pentazocine) amongst plastic surgery patients in a tertiary health institution in south-south Nigeria − a case series p. 83
CI Otene, IC Ohiaeri, DO Odatuwa-Omagbemi, R.E.T. Enemudo
Introduction: Parenteral opioid abuse is not uncommon amongst patients presenting for plastic surgery care, especially health workers. Pain is the commonest reason for initiating and sustaining the injections. Complications such as lymphedema, cellulitis, ulcers etc. are common sequelae of this psychosocial disorder. Aim: This is to review the pattern of pentazocine abuse; with the objectives of: reviewing the demographics, site, and complications of pentazocine abuse amongst patients presenting to the plastic surgery unit. Materials and Methods: Self-administered questionnaires were used to obtain information by direct interview of the patients. Pentazocine injections were specifically looked at while excluding oral opioids such as tramadol tablets. Results: Most patients (60%) are of SS genotype with pain from vaso-occlusive crisis as the inciting factor. Male: female ratio is 1:4. Forty percent (4 of 10 patients) are health professionals. Lymphedema was a complication in 50% (5 of 10 patients), ulcers in 90% (9 of 10 patients); ten percent (1 of 10) had a pre-existing ulcer before the injection following a road traffic accident (RTA). Upper limbs are affected in 60% and lower limbs in 70 % (one patient had traumatic ulcers on both legs). They all expressed desire to stop when pain ceases but still inject themselves occasionally. Conclusion: Pentazocine abuse is common amongst health professionals and SS genotype patients and can be complicated by lymphedema and associated ulcers when injected into soft tissue. There is a need to periodically evaluate health workers with regards to parenteral opioid abuse in order to ensure safety of patients left under their care.
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A case of aplasia cutis type VI (Bart’s syndrome) at University of Abuja Teaching Hospital Gwagwalada, Abuja, Nigeria p. 89
Amaka Patricia Ehighibe, Amina Ibrahim Abubakar, Philip Mari Mshelbwala
Aplasia cutis type VI, commonly referred to as Bart’s syndrome, is a rare genetic disorder characterized by congenital localized absence of skin commonly in the lower limbs, epidermolysis bullosa, and sometimes dystrophic nails. We present a 2-hour-old male infant who presented with congenital absence of skin over both lower limbs at birth. He developed blisters in keeping with epidermolysis bullosa 24 hours after birth. Examination and investigations revealed no systemic involvement. An assessment of aplasia cutis type VI (Bart’s syndrome) was made. He was managed conservatively and wounds showed progressive re-epithelialization.
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A Technical Innovation of Syringe Nipple Splint for Reconstructed Nipple p. 92
Shabeer Ahmad Wani, Luay Abdullah Al Salmi, Ovais Habib Matto, Hackle Joy Cabrias Caguimbay
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