Abdominal Wall Reconstruction Using De-Epithelialized Dermal Flap: A New Technique

Background: Although autogenous materials have been used in abdominal wall hernioplasty for a long time; the introduction of prosthetic materials diminished their popularity. However; these materials may be expensive; inappropriate or unavailable. The aim of this study is to determine the place of de-epithelialized dermal flap in the reconstruction of abdominal wall hernias. Materials and Methods: A five-year prospective; descriptive analysis of eligible patients with difficult abdominal wall hernias closed with de-epithelialized dermal flap in a Nigerian Tertiary Health Institution; from January 2001 to December 2005. Results: Over the five-year period; 37 patients were recruited into the study. There were 11 males and 26 females; giving a male: female ratio of 1: 2.4. The ages ranged from 8 months to 47 years (mean = 12.6 years). The defects consisted of 15 incisional hernias; 12 intermuscular/inferior lumbar hernias; nine healed exomphalos major and two giant umbilical hernias. The size of the hernia defects ranged from 4.5 cm to13cm (mean = 6.4 cm). Three patients had bowel resection and end-to-end anastomosis; in addition to the flap reconstruction. Morbidity was minimal and included skin dimpling in 11 patients; seroma in three; and wound infection in two patients. Neither recurrence of herniation nor mortality was recorded during the period of follow-up; which ranged from three months to 4.5 years (mean = nine months). Conclusion: The results suggest that this is a useful technique that can easily be applied in many centers with minimal resources. It is cheap; effective and associated with minimal morbidity

Cutaneous manifestations of malignant disease: A review

Background: The skin is the largest and most accessible organ in the body. Internal malignancies can produce a wide range of cutaneous manifestations that are often neglected by clinicians. This review aims to increase the awareness of clinicians by highlighting the various cutaneous manifestations of common internal malignancies. Method: A review composed via Medline Internet search; literature search and contributions from our experiences as well as shared experiences from colleagues over the years.Results: The skin can be involved in systemic malignancy in a variety of ways: secondary spread; as part of a genetic or acquired syndrome; as a consequence of immunosupression or as paraneoplastic phenomena. The cutaneous markers of malignancy may occur before; at the same time as; or after the diagnosis of the tumour. While in some instances the skin lesion abates with the treatment of the primary tumour; relapse of a previously treated cutaneous disease can herald recurrence of the tumour. Conclusion: Systemic malignancies could; and do; produce a wide range of skin manifestations that are easily seen but often neglected by clinicians. A good understanding of these features will aid prompt and appropriate diagnosis; upon which the necessary treatment could be anchored

Cutaneous Manifestations of Malignant Disease: a Review

Background: The skin is the largest and most accessible organ in the body. Internal malignancies can produce a wide range of cutaneous manifestations that are often neglected by clinicians. This review aims to increase the awareness of clinicians by highlighting the various cutaneous manifestations of common internal malignancies. Method: A review composed via Medline Internet search; literature search and contributions from our experiences as well as shared experiences from colleagues over the years.Results: The skin can be involved in systemic malignancy in a variety of ways: secondary spread; as part of a genetic or acquired syndrome; as a consequence of immunosupression or as paraneoplastic phenomena. The cutaneous markers of malignancy may occur before; at the same time as; or after the diagnosis of the tumour. While in some instances the skin lesion abates with the treatment of the primary tumour; relapse of a previously treated cutaneous disease can herald recurrence of the tumour. Conclusion: Systemic malignancies could; and do; produce a wide range of skin manifestations that are easily seen but often neglected by clinicians. A good understanding of these features will aid prompt and appropriate diagnosis; upon which the necessary treatment could be anchored

Cutaneous Manifestations of Malignant Disease: A Review

Background:The skin is the largest and most accessible organ in the body. Internal malignancies can produce a wide range of cutaneous manifestations that are often neglected by clinicians. This review aims to increase the awareness of clinicians by highlighting the various cutaneous manifestations of common internal malignancies. Method: A review composed via Medline Internet search; literature search and contributions from our experiences as well as shared experiences from colleagues over the years.Results: The skin can be involved in systemic malignancy in a variety of ways: secondary spread; as part of a genetic or acquired syndrome; as a consequence of immunosupression or as paraneoplastic phenomena. The cutaneous markers of malignancy may occur before; at the same time as; or after the diagnosis of the tumour. While in some instances the skin lesion abates with the treatment of the primary tumour; relapse of a previously treated cutaneous disease can herald recurrence of the tumour. Conclusion: Systemic malignancies could; and do; produce a wide range of skin manifestations that are easily seen but often neglected by clinicians. A good understanding of these features will aid prompt and appropriate diagnosis; upon which the necessary treatment could be anchored

Bacterial Isolates from Necrotizing Fasciitis : a Clinico-Pathological Perspective

Background : Necrotizing fasciitis (NF) is a progressive; polymicrobial; potentially fatal soft tissue infection that can affect both sexes; all age groups and any anatomical region of the body. Identification of the offending microorganisms is important; since the eventual outcomeof treatment is dependent on aggressive; chemotherapeutic and supportive therapy. Aim : To determine the spectrum of aerobic bacterialorganisms responsible for NF in Sokoto; Northwestern Nigeria; and to establish a baseline for which further studies can be conduct Patients and Methods : A 5-year prospective study of aerobic bacteria isolated from all consecutive patients with NF seen at the Usmanu Danfodiyo University Teaching Hospital; Sokoto; Nigeria from January 2001 to December 2005. All necessary information from each patient was fed into the computer for analysis. Results: There were 62 patients; of which 33 (53.2) were males while the remaining 29 (46.8) were females. The ages ranged from six days to 70 years (mean = 21.4 years). One or more precipitating factors were identified in) patients; while 40 (64.5) patients had identifiable pre-morbid pathology. The body surface area (BSA) involved ranged from 1 3 32 (51.6). The commonest anatomical region involved was the trunk in 23 (37.1) patients; this was followed by the lower limbs; upper limbs; head and neck; perineum and buttocks in that order. From the 62 patients; 176 aerobic cultures were carried out. Of this; 147 cultures (83.5) were positive; while the remaining 29 (16.5) grew no organisms after 48 hours of incubation. The commonest offending organisms were Staphylococcus aureus and Pseudomonas aeruginosa. Infection was polymicrobial in; 64 of patients. Cephalosporins; quinolones and aminoglycosides were the most sensitive antibiotics. Multiple wound debridements were required in nearly half of the patients. The duration of hospital stay ranged from 3 132 days (mean = 39 days). The overall mortality was 14.5. Conclusion : NF is essentially polymicrobial; deriving significant contributions from both gram-negative and gram-positive bacteria. The cultural characteristics of the disease; and sensitivity to antibiotics; require periodic assessments