Results of Open Wound Technique in the Treatment of Post-Sequestrectomy Dead Space

BACKGROUND AND METHOD. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic; Ekpoma; Edo State; Nigeria; between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation; sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-squaretest was used for statistical analysis. RESULT. The median age was 13 years; with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p0.05); eventhough it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years; with a median of 2 years.CONCLUSION. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good; and we advocate its use in resource-poor settings

Pattern of civilian gunshot injuries in Irrua; Nigeria : trauma

This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life; and armed robbery was the cause of gunshot trauma in 69.7of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9of complications. The mortality rate was 5.3. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition; high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness; armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness; armed robbery and firearm-related violence

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