Complex lower extremity injuries pose a significant challenge in terms of management especially when the distal leg is involved. This is compounded by the fact that many patients in this environment who sustain fractures present to traditional bone setters before presenting to the hospital often with complications. We present a 26 year old man with severe right leg injury following a road traffic accident who presented to us at Ntasiobi Specialist Hospital, Enugu, Nigeria for amputation through a traditional bonesetter. He had comminuted fractures of the tibia and fibula with periosteal stripping and an extensive soft tissue loss affecting the distal ½ and about ⅔ of the circumference of the right leg. This degree of injury required free flap reconstruction which was not feasible. We used external fixator to stabilize the bones and improvised negative pressure dressing with a delayed distally based posterior calf fasciocutaneous flap for wound cover. The limb was salvaged though with some challenges but patient was satisfied with the outcome.

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Background: Radial forearm free flap is the work horse in head and neck reconstruction. The venous drainage of the flap is by both superficial and deep group of veins. Aim of the Study: To compare the efficacy of venous drainage by single superficial vein (cephalic vein) with dual vein (cephalic vein & venae comitantes) in radial forearm free flaps and its impact on flap survival. Patient and methods- A total of 154 patients undergoing radial forearm free flap for reconstruction following resections of head and neck cancer were studied prospectively . In group 1 (75 cases) only cephalic vein was used as the draining vein and in Group 2 (79 cases) both cephalic vein & one venaecomitantes were used as the draining vein. Patients with non availability of cephalic vein as a result of chemotherapy or injury were excluded from the study. Data were retrieved frompatients' files and analyzed using SPSS computer software version 15.0. Observation and Results: The flap survival rate was 97.33% (73/75) in Group 1 versus 98.73% (78/79) in Group 2. The result is analysed statistically by using SPSS computer software version 15.0. and the P value > 0.50 (c² with Yates' correction=0.00206555, df=1) stastically not significant. Conclusion: Though two vein anastomosis may provide a more fail safe theoretical advantage, single superficial vein (Cephalic) provides effective and adequate drainage with less operative time and no additional morbidity.

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Background: Penile anomalies especially hypospadias are one of the most common genitourinary anomalies seen in newborns, and they pose a great deal of psychological stress to their mothers. This study examined our experience in the management of hypospadias. Patients: and Methods A retrospective study of all patients (Group A) managed for hypospadias from 2004 to 2013 was conducted. Data obtained included patients’ demography, their clinical presentation and management. These were analysed and compared with a similar study (Group B) conducted in this hospital four decades earlier between 1966 and 1977. Results: Forty-eight patients belonging to Group A had repair of hypospadias in comparison to the 42 patients in Group B. The mean age at presentation in Group A was 2.7 ± 4 years, and the anomaly was discovered at birth in all the patients. In contrary, Group B had 32 (76.2%) patients who presented immediately after birth and 10 (23.8%) patients who were either adolescents or adults (12–36 years) with a mean age of 18.9 years. Anterior hypospadias occurred more commonly in both groups; 10 (20.8%) patients were circumcised in Group A and 4 (9.5%) patients in Group B. Surgical site infection was the most common post-operative complication observed in both groups. The type of surgical repair was observed to have significantly influenced the outcome of surgical repair in patients in Group A (χ² = 14.13, P = 0.05). Conclusion: Proper and successful management of hypospadias can be enhanced in this environment with adequate media advocacy directed at prompt recognition of this anomaly and avoidance of circumcision when hypospadias has been identified.

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We hereby report a case of avulsion amputation of the hand through the distal carpal row. The severity of the injury was such that it had avulsed the soft tissues from the forearm and the skin from the level of the arm as though a full sleeve of a shirt was being ripped off. Due to the extensive damage in multiple planes, the amputated part could not be saved. The below-elbow amputation stump though was covered with a new local flap based on the interosseous membrane and the periosteal flaps from the radius and ulna. The stump healed well and the patient recovered the full range of elbow movements.

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Extravasation of cytotoxics is a dreaded complication of the intravenous route medication, especially in chemotherapy. The use of saline washout is insufficiently documented in the literature. Here, we report the excellent results of using saline washout in the management of these injuries. Three patients presenting extravasation of anthracycline, calcium gluconate, and radiologic contrast were treated in our department by saline washout. The technique was a use of saline to flush the extravasation area after liposuction of the body site injured. All patients were treated in an outpatient setting. No case of skin necrosis nor other complications related to the extravasation or to the surgical technique have been reported during the follow-up. Patients with extravasation should be referred to the plastic department at early stage. Saline washout is reliable technique to prevent skin and soft tissue necrosis caused by extravasation of cytotoxics.

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In Togo, reconstructive management has been based on local and regional flaps. In some severe cases and in cases of failure, only a cross leg flap (if possible) or an amputation would save the patient. It has become vital to move forward in the reconstructive ladder in our setting. We report our first case of free gracilis muscle flap for the reconstruction of a foot defect in a 21-year-old male patient who was presented with a foot laceration due to a road traffic accident. The plastic surgeon had training in microsurgery. For other members of the operative team, this was the first microsurgery procedure. The gracilis muscle was harvested from the contralateral thigh and inset in the defect by microsurgical vascular anastomosis. The flap’s monitoring was done clinically. The post-operative course was uneventful. The muscle flap was resurfaced on day 5 using a split thickness skin graft. The patient was discharged on day 12. Total healing was seen on day 21. The patient was very satisfied with the procedure. The success of this first case represents an optimal motivation to build up a microsurgery team and the debut of microsurgery procedures for patients with difficult defects in Togo.

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A case of necrotizing infection of the vulva in a 15-month-old female child has been presented. The case presented multiple problems, from delayed presentation to involvement of critical area and associated issues. The patient sailed through a series of interventions before she could be rehabilitated to her routine but still awaits further reconstructive procedure. Early detection and appropriate intervention of this fulminant disease would help reducing the morbidity.

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Negative pressure wound therapy (NPWT) has become a popular tool for wound healing. The use of domestic material has been reported, but it is still not completely documented. We present the use of a domestic NPWT on traumatic wounds to achieve a final minimal reconstructive surgery. We treated three patients presenting with traumatic skin loss of the abdomen, lower leg, and foot with domestic NPWT. A wall suction was used as the source of negative pressure and gauzes as interface over the wounds. We documented the size of wounds, the anatomic structure exposed, the number and the length of cycles of NPWT, and the final reconstructive procedure. The cycles of NPWT ranged 3–5 days. A good granulating tissue appeared in range 17–21 days. Exposed urinary bladder, fractured metatarsal, and fractured lateral malleolus were covered by a good granulating tissue. There was no infectious complication. All the wounds healed with a split thickness skin graft. The cost of the procedure per patient ranged from 65 to 85 US Dollars. Domestic material for negative pressure has been a reliable technique in the management of traumatic wounds and helped pass down the reconstructive ladder.

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Context: The female breast is a symbol of femininity. With recent developments in the surgical management of breast pathology, women now demand better aesthetic outcomes. Data on breast morphometry which should guide Nigerian breast surgeons in decision making is scarce. Aims: This study was aimed at measuring morphometric breast values in nulliparous Nigerian females, thus establishing reference data for the region. Settings and Design: This was a prospective and community-based study in which volunteer female students from the study hospital and 3 secondary schools in the community underwent breast measurements in order to establish reference data. Methods and Material: Physical measurements were carried out using measuring tape and meter rule, in the standing position. Statistical Analysis Used: Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 16 and Student’s t-test analysis carried out.Results : Five hundred female volunteers with age range 15–30 years were studied. The average distance from the suprasternal notch to the right and left nipples were 19.76 cm and 20.09 cm respectively. The average distance from right and left nipples respectively to their inframammary folds were 8.13 cm and 8.28 cm. Breast dimensions were symmetrical in >50% of subjects. In the subjects with asymmetry, more were found to have greater left breast dimensions than right. Conclusions: Physical measurements of the Nigerian female breast are comparable with ranges in other parts of the world except for the Inframammary fold to nipple distance which is longer than values in studies on white subjects. This study establishes preliminary morphometric breast reference data for Nigerian females.

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Background: Scars are inevitable sequelae of any surgical procedure. Wound closure method has been shown to affect the post-operative scar outcome. This study compared the post-operative scar of two wound closure techniques in paediatric groin surgeries. Methods: This was a prospective comparative analytical study involving 60 paediatric surgical patients randomized into two groups. After a groin procedure in patients who met the inclusion criteria, patients in Group A had only the skin layer closed whereas both skin and subcutaneous tissue were closed in Group B. Scar assessment was done using the Patient and Observer Scar Assessment Scale (POSAS) at 1 week, 3 weeks and 6 weeks after surgery. Results: The mean POSAS score was 108.44 ± 20.32 and 113.91 ± 26.18 for groups A & B respectively (P = 0.379) while the overall opinion score for groups A & B were 19 (IQR = 4) and 21(IQR = 10) (P = 0.392) respectively. The average duration of surgery was 35 minutes in each group. There was equal distribution of seroma formation among the two wound closure groups. Among the patients that developed wound dehiscence, 25% were in group A, while 75% were in group B. Ninety-five percent of the wounds healed with fine linear scar. Conclusion: Majority of paediatric groin wounds heal with fine linear scars. Although no statistically significant association exists between wound closure technique and scar assessment scores, patients who had two-layer wound closure recorded worse scar assessment scores compared to those who had one-layer closure.

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Context: Width of cleft palate influences difficulty of surgical repair and indirectly the outcome. Palatoplasty complicated with oronasal fistula causes persistence of speech, feeding, and social problems. Subsequent closure of palatal fistula has high recurrence rate. Aim: To determine the relationship between palatal cleft width and oronasal fistula. Setting and Design: One-year prospective nonblinded study. Materials and Methods: All consecutive patients with cleft palate that presented to the study institutions within the period, and met inclusion criteria were studied. The width of the palatal cleft defect was measured intraoperatively. Statistical Analysis Used: Chi-square and Mann-Whitney U-tests were used. P < 0.05 were considered statistically significant. Results: Forty-six patients were studied out of 53 patients seen during the study period. These were 22 males and 24 females giving male to female ratio of 0.92:1. Patients' ages ranged from 10 months to 28 years; 52.17% of the study population were 2 years and below while 47.83% were aged over 2 years. Cleft width ranged from 4 to 25 mm. Nineteen patients developed fistula. Thus, the overall rate is 41.30%. Likelihood of fistula occurring increased as the width of cleft increased. Fistula rate was higher for patients with cleft width above 15 mm. Fistula rate for intravelar veloplasty was 30% and 50% for von Langenbeck repair; this was not statistically significant. Conclusion: Cleft width is a strong factor in the development of oronasal fistula. The fistula rate suggests a high burden of the problem. Efforts should be made to improve management outcome.

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Context: This article presents a preliminary experience on implant breast reconstruction undertaken by the general surgeons in a tertiary hospital in Nigeria. Aim: This article presents a preliminary experience on the implant breast reconstruction undertaken by the general surgeons in a tertiary hospital in Nigeria. It also discusses our challenges and limitations. Patients and Methods: Five patients who consented to implant surgery in 5 years were reviewed retrospectively. Results: Four of the five patients were satisfied with the outcome in the early postoperative period. There was one flap necrosis and one capsular contracture which developed a year after the procedure. Conclusion: The practice of breast reconstruction in Nigeria is evolving, and demands will be made on general surgeons, especially in centers without reconstructive surgeons.

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Objective: To document the clinico-pathological characteristics of skin malignancies seen at Benue State University Teaching Hospital, Makurdi. Materials and Methods: A 3-year retrospective study of patients with histologically-confirmed skin cancers presenting to our institution from April 1, 2012 to March 31, 2015 was done. Relevant data was extracted from the patients' records and subjected to statistical analysis. Results: Records were available for 43 patients with a mean age of 46 ± 18 years. There were 21 males and 22 females with a male:female ratio of approximately 1:1. Squamous cell carcinomas were the most common histologic type seen (44.2%) followed by melanoma and Kaposi's sarcoma (25.6% each) while basal cell carcinomas accounted for 4.7%. Farmers (37.2%) and artisans (23.3%) were the most common occupations seen. Human immunodeficiency virus (HIV)-positive patients accounted for 27.9% of the total and albinos 18.6%. Majority of the patients (60.4%) had history of prolonged exposure to sunlight with little regard for protective measures. The average duration of symptoms before presentation was 28 ± 33 months. Conclusion: The study suggested an association between skin cancer and prolonged, unprotected exposure to sunlight on one hand and HIV infection on the other. It highlights the need to promote basic preventive measures.

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Objective/Purpose: A pilot study to assess the efficacy of compression therapy on the healing rate of chronic leg ulcers (CLUs) in patients with sickle cell anemia (SCA) in Nigeria. Materials and Methods: A cohort study of patients with SCA and CLU complication was conducted using simple random sampling method to enroll patients from communities in Ibadan, Oyo State, Nigeria. A total of 18 patients with SCA having a total of 25 chronic leg ulcers and ankle brachial pressure index >1 were treated with a high compression bandage of four layers on a weekly basis after wound assessment for a period of 3 months. Wilcoxon signed-rank test was used to compare wound area at pre- and postintervention. Results: The enrolled patients with SCA were in the age range of 19–44 years, and mean ± SD was 28.8 ± 6.5 years. The initial median ulcer size was 38.4 cm² (range 0.5–416 cm²); 21 leg ulcers (84%) were >10 cm² in size at the beginning of the study. These leg ulcers had been present for a median age of 7 years (range 1–22 years). The compression therapy technique achieved >50% healing rate in 16 legs (64%) with an initial ulcer size of 0.5–312 cm². Four leg ulcers (16%) were completely healed during the study. The postintervention median ulcer size was 18.6 cm² in all the 25 leg ulcers studied (P < 0.001). Conclusion: Compression wound therapy promotes a positive healing rate of the CLUs in patients with SCA in Nigeria.

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Introduction: This work investigates the prevalence of psychiatric morbidity and its impact on the quality of life of mothers of children with orofacial cleft. Mothers bear stresses and care burdens of ill family members and it affects their mental health. Little is known about the psychiatric morbidity of such mothers in South-eastern Nigeria. Materials and Methods: Participants were assessed using the Brief Screen for Depression (BSD), the EUROHIS-QOL 8-item Index, and the Self-Reporting Questionnaire (SRQ). The data was analyzed using SPSS version 15. Results: Of the 48 participating mothers, 50% screened positive for psychiatric morbidity with the SRQ, whereas 62.5% screened positive for depression using the BSD. Psychiatric morbidity was found more among mothers with lower levels of education, having more children; older index children and with over-representation of affected female children. The mean quality of life score was 3.34 ± 0.86. Mothers that screened positive for psychiatric morbidity reported a significantly lower quality of life than those without morbidity (2.82 ± 0.90 versus 3.85 ± 0.40). Conclusion: Features of psychosocial distress and depression are common among mothers of cleft children and exert negative effects on their quality of life.

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Background: The development of hand surgery in our subregion is still very much in its infancy. At the national level, very little documentation exists on the patterns of hand injuries. This study was aimed at determining the patterns of hand injuries seen in an urban orthopedic hospital in Kano, Kano State, Nigeria. Patients and Methods: A retrospective study of 101 cases of hand injuries presenting between April 2009 and April 2010 in the accident and emergency unit was carried out. Results: There were 86 (85.1%) and 15 (14.9%) males and females, respectively. The mean age of the patients was 25.69 ± 14.04 years. Out of all the patients, 55.4% were presented within 6 h of injury. Traumatic amputations and fractures were the commonest types of injury. There was no significant difference between left and right hand involvement in injuries. The triad of occupational injuries, injuries from road accidents, and domestic accidents was the most common. Traditional bone setters played very little role in the prehospital management of injuries. Conclusion: Occupational hand injuries are most common among young working males. Early presentation of the patients and low involvement of traditional bone setters reflect the severity of hand injuries to victims.

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