Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution

Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation.Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population.Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below­knee amputation (46.8%), followed by above­knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis.Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees

Les gangrènes des organes génitaux externes masculins. Aspects épidémiologiques et thérapeutiques

Objectif : Décrire les aspects épidémiologiques et thérapeutiques des gangrènes des organes génitaux externes masculins. Matériel et méthodes : Il s'est agi d'une étude descriptive et descriptive sur une période de 5 ans allant du 1er janvier 2007 au 31 décembre 2011 au cours de laquelle nous avons enregistré 47 cas de gangrènes des organes génitaux externes. Nous avons analysé rétrospectivement les 39 dossiers qui étaient complets et exploitables. Résultats : Les gangrènes des organes génitaux externes étaient relativement peu fréquentes, constituaient 3,25% des urgences urologiques. Elles étaient l'apanage du sujet d'âge mur avec un âge moyen de 50,17 ans, tous de sexe masculin. Les patients provenaient majoritairement du milieu rural avec 56,4%. Le délai de consultation était assez long avec une moyenne de 9,69 jours avec des extrêmes de 2 jours et 30 jours. Les facteurs de comorbidité ont été retrouvés chez 46,11% des patients. L'origine cutanée a été retrouvée dans 48,7% des patients. Les prélèvements bactériologiques effectués chez 23 patients ont retrouvé un germe chez 13 patients et avec E. coli comme principal germe (10 cas) et accessoirement Staphylococcus aureus (1 cas), Klebsiella pneumoniae (1 cas) et Proteus mirabilis (1 cas). Au plan de la prise en charge tous les patients ont bénéficié d'un traitement médicochirurgical précédé d'une réanimation médicale. Un débridement large avec nécrosectomie a été réalisé chez tous les patients associé à une triple antibiothérapie d'abord probabiliste puis ajustée en fonction du résultat de l'antibiogramme lorsqu'un germe a été identifié. Tous les patients ont subi une cicatrisation dirigée et une plastie de recouvrement a été réalisée. La gangrène des organes génitaux externes reste une affection grave souvent invalidante avec un long séjour hospitalier. Le taux de mortalité était de 17,95%. Conclusion : Les gangrènes des organes génitaux externes masculins sont assez graves avec un fort taux de mortalité. Elles sont relativement peu fréquentes dans notre contexte et la prise en charge est médico-chirurgicale et doit être multidisciplinaire pour espérer obtenir des résultats satisfaisants

Lower limb amputation in diabetic foot disease: experience in a tertiary hospital in southern Nigeria

The diabetic foot is characterised by the triad of neuropathy, infection, and ischaemia, which may ultimately lead to limb amputation. It is important to understand the factors that place diabetic patients at increased risk of amputation in our society, hence the need for this study. The medical records of all patients admitted and treated for diabetic foot complications over a 3-year period (January 2007 to December 2009) were retrieved. Relevant information was obtained from the case notes. Thirty-six (36) patients entered the study, 25 males and 11 females (M:F ratio 2.3:1.0). Mean age was 54 years (range 24­74). Patients presented with foot gangrene (58%), ulceration (31%) and infection (11%) with trauma being the most common precipitating factor (53%). Nineteen patients (53%) had lower limb amputation, the commonest of which was below knee. Of the patients that had amputation, 18 (95%) had type 2 diabetics. Adequate diabetic foot disease preventive strategies need to be designed and implemented to reduce the incidence of lower limb amputations

Footcare practices among Nigerian diabetic patients presenting with foot gangrene

Diabetic foot ulceration and gangrene is a major cause of morbidity andmortality. This study has examined potential preventive footcare practices in a cohort of diabetic patients presenting with foot gangrene. One hundred and two (102) diabetic emergencies presented during the study period. Diabetic foot gangrene accounted for 27 (26%) of these cases. There were 18 males and 9 females (M:F = 2:1), with a mean age of 52+13 years. The mean duration of ulceration was 4±3 weeks and mean ulcer­gangrene interval was 1.2±0.5 weeks. Only 9 patients (33%) had been exposed to any form of footcare education, 15 patients (55%) treated their ulcers by unorthodox means, and 63% of the patients practiced no significant footcare. More widespread education and awareness is needed to prevent the continuing and serious problem of diabetic foot gangrene and consequent lower limb amputation

Bone Setter's Gangrene

Gangrene usually supervenes following prolonged pressure of tight splintage by traditional bone setters (TBS) in the process of treating fractures. However; various complications such as blisters; pressure sores; Volkmann's ischaemia/ contracture; Crush syndrome and pregangrene occur by the same mechanism depending on degree of pressure and duration of splintage of the limb. Method: This is a guest lecture delivered to resident doctors. Literature search was done through the internet and some unlisted journals and texts. Experiences of various institutions in Nigeria and abroad concerning bone setters' gangrene were elucidated. Attempt was made to broaden the concept of bone setters' gangrene to include all complications that arise through the same mechanism. The aetiology; pathophysiology and treatment of the various conditions were highlighted and the solution and way-forward suggested. Result: The various health institutions recorded unacceptably high percentage of amputations secondary to bone setters' gangrene e.g. Zaria - 57to 63; Jos - 60-77.8. Enugu recorded mortality of 26.7while Banjul had 11.1mortality in their series. Nearly all the series suggested education of bone setters as a solution. Conclusion: A different approach to limiting bone setters' gangrene is suggested such as condemning bone setters' practice and expanding orthopaedic care

Bone Setter's Gangrene

Gangrene usually supervenes following prolonged pressure of tight splintage by traditional bone setters (TBS) in the process of treating fractures. However; various complications such as blisters; pressure sores; Volkmann's ischaemia/ contracture; Crush syndrome and pregangrene occur by the same mechanism depending on degree of pressure and duration of splintage of the limb. Method: This is a guest lecture delivered to resident doctors. Literature search was done through the internet and some unlisted journals and texts. Experiences of various institutions in Nigeria and abroad concerning bone setters' gangrene were elucidated. Attempt was made to broaden the concept of bone setters' gangrene to include all complications that arise through the same mechanism. The aetiology; pathophysiology and treatment of the various conditions were highlighted and the solution and way-forward suggested. Result: The various health institutions recorded unacceptably high percentage of amputations secondary to bone setters' gangrene e.g. Zaria - 57to 63; Jos - 60-77.8. Enugu recorded mortality of 26.7while Banjul had 11.1mortality in their series. Nearly all the series suggested education of bone setters as a solution. Conclusion: A different approach to limiting bone setters' gangrene is suggested such as condemning bone setters' practice and expanding orthopaedic care

Ileosigmoid Knotting : A Report of Two Cases

Background: Ileosigmoid knotting (ISK) is a rare cause of acute intestinal obstruction with high morbidity and mortality. The diagnosis is rarely made preoperatively because of its infrequency and the variations in presentation.Aim: To report two cases managed by the author; which will hopefully increase awareness of this condition.Case Reports: The first was a 51-year-old man who presented with a sudden onset of colicky lower abdominal pain; which later became generalized. His pulse rate was 100 beats/minute while his blood pressure was 80/60 mmHg.There was mild abdominal distension with absent bowel sounds. The second was a 50-year-old man with a sudden onset of generalized colicky abdominal pain; abdominal distension and vomiting. His pulse rate was 120 beats/minute and the blood pressure 80/50 mmHg. His bowel sounds were markedly reduced. They were resuscitated accordingly. In both patients; exploratory laparotomy revealed a copious amount of sero-sanguinous fluid in the peritoneal cavity with ileosigmoid knotting; and extensive gangrene involving the distal ileum and the sigmoid colon. In the first patient; the caecum was involved in the knot and therefore also gangrenous. Each of them had a sigmoid colectomy with a right hemicocetomy. The first patient died of adult respiratory distress syndrome while the other had an uneventful recovery. In the patient who died; surgery was done on the third day of onset of symptoms.Conclusion: A high index of suspicion; aggressive resuscitation; and prompt surgical intervention are indispensable for a successful outcome

Maladie de Fournier : a propos de 36 cas traites dans le service d'Urologie du CHU de Treichville

Notre travail porte sur une etude retrospective (21 malades) et prospective (15 malades) soit un total de 36 cas de gangrene des organes genitaux externes hospitalises de Janvier1999 a Septembre 2004 dans le service d'urologie du Centre Hospitalier Universitaire de Treichville. Elle permet de retenir les resultats suivants : AU PLAN EPIDEMIOLOGIQUE: La frequence annuelle moyenne est de 6 patients par an. L'age moyen est de 47 ans. Cette affection sevit beaucoup plus chez les personnes economiquement faibles: 88;9pour cent des cas. Le diabete est la tare la plus frequemment associee 11;10pour cent. Malgre la rarete de cette affection; le taux de mortalite reste eleve dans notre serie; soit25pour cent des cas. AU PLAN DIAGNOSTIQUE:Le diagnostic est essentiellement clinique. La symptomatologie est dominee par le debut brutal; la fievre; la douleur; la tumefaction; la necrose cutanee et l'ecoulement fetide. La lesion siege le plus souvent au niveau scrotal uniquement: 47;22pour cent. AU PLAN THERAPEUTIQUE : C'est une urgence chirurgicale et le traitement a consiste a realiser un debridement des tissus necrotiques et devitalises. AU PLAN PRONOSTIQUE : Le retard diagnostic et de prise en charge therapeutique constituent les facteurs de mauvais pronostique qui expliquent le taux eleve de mortalite (25pour cent)

La gangrene perineo-scrotale : etiologies et therapeutiques : a propos de 60 cas

Objective To assess the epidemiological and diagnostic aspects; treatment and early and late outcomes of perineo-scrotal gangrene. Patients et Methods We report on 60 cases collected over a period of 14 years. The patients' mean age was 40 years. All patients were males. Twenty of them had diabetes. An aetiology was found in 47 cases. It was a urologic aetiology in 27 cases and a proctologic aetiology in 20 cases. 13 cases were considered as primitive and classified as Fournier's Gangrene. All patients were admitted to the emergency unit and underwent a large debridement with urinary diversion. A colostomy was done in 25 cases. A hyperbaric oxygenotherapy was administered in 30 cases. Results Ten patients died after a week due to a delayed diagnosis. 39 patients were cured primarily without sequelae and 11 others after reconstructive surgery using a cutaneous graft in 10 cases and a musculo-cutaneous graft in one case. Conclusion 20of cases of perineo-scrotal gangrene are idiopathic. Given the high mortality and morbidity; an early treatment associating intensive care; triple antibiotherapie; large debridement and; if possible; hyperbaric oxygenotherapy is necessary

Le traitement des gangrènes périnéales et de la sphère genitale par le miel

Les gangrenes du perinee et des parties molles se rencontrent sous les tropiques avec une frequence non negligeable. Leur prise en charge therapeutique se heurte souvent au cout des produits pharmaceutiques utilises. Depuis deux ans ces lesions sont traitees avec du miel en raison de ses proprietes antibiotiques et cicatrisantes(3;7)

Diabetic Foot Gangrene

Over a 5-year period; 1987 to 1991; 108 patients with foot gangrene were treated at the National Orthopaedic; Enugu. Out of these; 30 were diabetics; 12 of them being diagnosed on admission. Diabetic control; wound care and amputation constituted the treatment regimen. Amputations were peformed in 66.7of the cases. Patients ignorant of their diabetic status before admission had the worst prognosis. There was 33 percent mortality. This can be bettered with health education; including better awareness among doctors in peripheral hospitals

Diabetic Ketoacidosis Presenting with Fournier's Gangrene

A case of survival of a patient with Fournier's gangrene and diabetic ketoacidosis is described. Careless handling of itchy scrotal disease in this diabetic patient was responsible for the onset of scrotal gangrene. Early recognition of diabetic ketoacidosis and Fournier's gangrene and prompt treatment led to survival. Consequently; early consultation of a physician/dermatologist is advised when diabetics have itchy groin lesions; while doctors are urged to routinely examine the scrotum of patients with diabetic ketoacidosis

A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene

Background:Tropical idiopathic lower limb gangrene (TILLG) is also known as Symmetrical gangrene in the African; Idiopathic gangrene in the African and Idiopathic peripheral gangrene of the tropics.The aetiopathogenesis of this clinical entity is a mystery. Objective: To review methods of diagnosing tropical idiopathic lower limb gangrene (TILLG) and highlight its clinical variants. Method: All Literature on idiopathic gangrene of the extremities was searched from libraries; colleagues and internet but only literature on TILLG (in Africans) from 1947 to date was scrutinised. Each case was studied to find out the basis of diagnosis. Result:TILLG is not fully understood and not easy to recognise.Two sets of criteria are known to be helpful in establishing diagnosis. These criteria can be classified as major and minor criteria. Major criteria are those clinical data that can establish the diagnosis of TILLG. No devices are required to identify them. Minor criteria are pathological changes that are consistent with TILLG. Devices are required to identify them.Three pathomorphological types of TILLG were described in literature and are classified as types A; B and C. Conclusions:This review is supposed to sensitise the clinician and make diagnosis easier.This will also encourage more researches.As more information becomes available; aetiopathogenesis of TILLG will be clearer and more clinical variants of the disease may be reported.This additional information will help in the prevention of gangrene; reducing the socioeconomic problems arising from amputation