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   2020| January-June  | Volume 16 | Issue 1  
    Online since September 17, 2020

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Plastic surgery in Nigeria: our yesterday, today and tomorrow
Simon Jekat Yiltok
January-June 2020, 16(1):1-8
The Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) instituted a lecture in honor of the doyen of Plastic Surgery in Nigeria, Professor Joseph Olatunde Oluwasanmi. A man who took up the challenge to specialize in plastic surgery thus becoming the first indigenous consultant plastic surgeon in 1967. He rose through the ranks to become a professor in 1973. The 2017 annual conference of the association took place in Sokoto and the lecture focused on the history and practice of plastic surgery in Nigeria. The lecture chronicled those who practice plastic surgery in Nigeria beginning from Mr Michael Norbert Tempest, a British Surgeon who worked in University College Hospital (UCH), Ibadan as a consultant, while Mr J.O. Oluwasanmi (now Prof J.O. Oluwasanmi) worked under him as a Senior Registrar. Oluwasanmi was later appointed as the first indigenous Consultant Plastic Surgeon in1967 after returning from the UK where we went for his specialty training in plastic surgery. Many other centers sprang up providing plastic surgery services. These centers include Lagos University Teaching Hospital, Lagos; National Orthopedic Hospital, Igbobi Lagos; National Orthopedic Hospital, Enugu; Ahmadu Bello University Teaching Hospital, Kaduna; Mangu Rehabilitation Centre, Mangu Plateau State and ECWA Evangel Hospital Jos (now Bingham University Teaching Hospital). Most of these centers have continued to provide plastic surgery services and training while several others have joined the train. Plastic surgery is now well established in Nigeria, however there are still challenges that affect the provision of excellent service. These challenges include; inadequate personnel, lack of awareness of the practice of plastic surgery, limited infrastructure, poverty and lack of universal health coverage, cultural practices and believes, patients’ expectations, complications, complexity of cases and workload.
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The utility of the lateral forehead flap in demanding reconstructive situations: our experience in a tertiary care center
Manojit Midya, Rajneesh Galwa, Pradeep Goil
January-June 2020, 16(1):9-17
The current century is an era of microsurgical reconstruction. However, there are situations when free tissue reconstruction is not possible due to extremes of age, their associated co morbidities and dearth of microsurgical expertise and equipment. The significance of local and regional flaps in such reconstructive scenario is paramount. These flaps are well vascularised, easy to master, quick to perform and can be used in both primary as well as salvage reconstruction. The Lateral forehead flap (LFF) is one such useful option. The LFF is an axial myocutaneous flap spanning the entire forehead aesthetic subunit. Herein we describe the operative technique of LFF elevation, advantages and disadvantages of the use of this flap in the reconstruction of facial and intra oral defects reconstruction, both in primary and salvage settings. We describe our experience in the use of this handy flap for various facial reconstructions in our institute. This versatile “forgotten” flap which is easy to master can be handy to all general plastic surgeons who indulge in such reconstructions.
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Morphometric analysis and key dimensions of the female breast: a baseline study of 500 nulliparous Nigerian females
Egiehiokhin Isiwele, Richard E. E. Nnabuko, Iheuko S Ogbonnaya
January-June 2020, 16(1):27-31
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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Post burn perineal contractures: case series and a classification system
Rex Ochuko Dafiewhare, Ifeanyi Igwilo Onah
January-June 2020, 16(1):18-23
Introduction: Perineal burn contractures remain under reported in our region. We have set out to study the pattern of presentation, describe the formation of these contractures and identify any recurring patterns that will form a basis for a classification that will be useful in planning their management. Methods: A retrospective study of the patients seen over a three year period (2009–2011) at the National Orthopaedic hospital Dala is presented. Information was retrieved from case notes in the medical records department. The bio-data, type of care received post injury associated percentage burns, formation of contractures, were all noted. Results: All the seven patients seen were children of which five were females. Flame burn was the main type of burn. All burns occurred at home. Four major types of contractures were identified as transverse bands, hooding, fusion and obliteration. An equal number of patients presented following home versus hospital care. Conclusion: The relative rarity of post burn perineal contractures leaves little experience for the young surgeon to take advantage of when in training. A classification system will help to make it easier to identify what structures are involved and make planning easier. In the absence of specialized care it is doubtful that there is any statistical difference in the likelihood of perineal contracture development of patients managed at home by traditional healers versus those presenting in peripheral centers lacking formal burn management protocols. Most childhood burns still occur at home. There is a need to continually educate the public on the need to make the home a safe place for children.
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Parotidectomy with local anesthetics: a viable option in medical outreach in a resource poor setting
Charles Chidiebele Maduba, Ugochukwu Uzodimma Nnadozie, Victor Ifeanyichukwu Modekwe, Ifeanyichukwu Igwilo Onah
January-June 2020, 16(1):24-26
Background: Parotidectomy has been traditionally done with general endotracheal anaesthesia mostly in tertiary institutions where there is adequate anaesthetic manpower. A lot of patients with parotid masses presents to other cheaper healthcare providers including medical outreaches where there is paucity of both anaesthetic manpower and gadgets. Aim: To share our experience in parotidectomy using local anaesthetics in medical outreaches where there is inadequate support of anaesthetic personnel and gadgets. Method: Patients counseled for parotidectomy had local anesthetic infiltration and nerve block with 1% ligdocaine in 1:100,000 adrenaline. Lazy-S incision was used starting pre-tragally down to the angle of the mandible. Branches of the facial nerve were gently separated from the mass which is delivered to the wound and shelled out. Wounds were closed in layers without drain. Conclusion: Parotidectomy with local anaesthetic agents is a safe option especially in settings of medical outreaches in resource poor countries with limited anaesthetic manpower and gadgets. The safety of surgery on day case basis and avoidance of use of hardly available nerve stimulator all the more make it an appealing alternative.
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Assessment of local wound healing complications after groin surgery: a comparative study between two wound closure techniques
Ikechukwu Bartholomew Ulasi, Olakayode Olaolu Ogundoyin
January-June 2020, 16(1):32-38
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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Customized hollow surgical stent for congenital vaginal agenesis in early adolescent female with MRKH syndrome: a case report
Manu Rathee, Meenakshi Chauhan, Prachi Jain, Akanksha Shetye
January-June 2020, 16(1):39-43
Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is a congenital malformation resulting in the absent or small uterus and variable degrees of vaginal hypoplasia of its upper portion. One of the treatment goals for these patients is the creation of an artificial vagina either conservatively or surgically. Use of long-term prosthetic vaginal stents prevents the possible contraction of the reconstructed vagina, maintain vaginal width and depth and avoid vaginal stenosis. Prefabricated stents of standard sizes have widely been utilized to assist surgical creation of a neovagina. However, a customized stent has the evident advantage of the possibility of adjusting the size as per individual patient requirements. In the present clinical report, an early adolescent female patient with MRKH syndrome was surgically managed with insertion of a customized vaginal stent that offers the versatility of design configuration to suit the various clinical situations.
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