Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects.

BACKGROUND: We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. METHODS: Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. RESULTS: We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15-90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050-4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. CONCLUSIONS: Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and  relative complications.

Aesthetic Reconstruction Of Post-Burn Eyebrow Alopecia With A Superficial Temporal Island Scalp Flap: A Case Report And Review Of The Literature.

Eyebrows have a critical functional and aesthetic role on the face. Alopecia on the eyebrows has multiple origins, including scars formed after deep burns on the head and neck region. Reconstruction of the eyebrows represents a challenge for plastic surgeons due to their particular anatomical structure and variations inside of genders. Follicular Unit Transplantation (FUT) is believed to be the gold standard for the treatment of all sorts of alopecia, including that located on the eyebrows. However, FUT is technically demanding and requires skills, extensive anatomical knowledge, and equipment. In settings where FUT is still not feasible, flaps such as the superficial temporal artery island scalp flap remain reliable options. A 32-year-old male patient presented at the National Burn and Plastic Surgery Center, Casablanca (Morocco), with right eyebrow alopecia caused by fire burn on the face. We reconstructed the alopecia using a superficial temporal artery island scalp flap. The result was excellent. The patient and the physician were both very satisfied, and the patient stated that he was more comfortable with his social relationships. Among the current procedures used for the reconstruction of eyebrow alopecia, the superficial temporal artery island flap remains a versatile solution, especially after burn injuries in male patients.

Les sourcils ont des rôles fonctionnel et esthétique majeur au niveau du visage. Les alopécies sourcilières ont de multiples causes parmi lesquelles les brûlures. La reconstruction sourcilière doit tenir compte de leur structure anatomique particulière, qui plus est différente d'un sexe à l'autre. La transplantation d'unités folliculaires (TUF) est décrite comme le traitement de référence des alopécies, parmi lesquelles celles touchant les sourcils. Cette technique demande toutefois de l'entraînement, des connaissances anatomiques approfondies et du matériel spécifique. Quand la TUF n'est pas utilisable, le lambeau temporal superficiel en îlot (LTSI) est une alternative fiable. Un homme de 32 ans a été pris en charge dans le CTB national de Casablanca (Maroc) en raison d'une alopécie sourcilière droite consécutive à une brûlure, que nous avons traitée par LTSI avec un excellent résultat. Le patient comme le chirurgien étaient très satisfaits, le premier se déclarant beaucoup plus à l'aise dans sa vie sociale. Le LTSI est une solution polyvalente, ayant sa place dans la reconstruction sourcilière après brûlure, en particulier chez les hommes.

Auto-transplantation of amnion-chorion membrane in a burned pregnant patient at term.

Burn in pregnancy represents a threat to the mother and the fetus. Burn care in pregnant women is not well codified. An aggressive treatment including oxygen supplementation, smart fluid resuscitation and early excision has been reported. Nevertheless, auto-transplantation of amnion-chorion membrane in a pregnant woman with burns has not been reported to date. We present our first case of auto-transplantation of fresh amnion-chorion membrane in a pregnant woman admitted to our department with 14% TBSA deep and superficial burns associated with inhalation injury. The chorion-amnion membrane harvested after caesarean section was used to cover the excised and autograft sites. Outcome was good and all wounds healed. The child was healthy also.

La brûlure au cours de la grossesse représente une menace pour la mère et le foetus. La prise en charge de la brûlure chez la femme enceinte n'est pas encore bien codifiée. Un traitement agressif comprenant une oxygénation, une réanimation hydro électrolytique adéquate et une excision précoce a été rapporté. Cependant, l'autotransplantation de membrane chorio-amniotique prélevée chez la femme après accouchement n'a pas encore été rapportée. Nous présentons ici notre premier cas d'auto-transplantation de membrane chorio-amniotique fraîche chez une patient enceinte admise pour une brûlure de 14% de surface cutanée, profonde et superficielle associée à des lésions d'inhalation. La membrane chorio-amniotique prélevée après accouchement par césarienne a été utilisée pour couvrir les lésions superficielles et les lésions plus profondes excisées et greffées. Les suites ont été favorables. Les lésions ont cicatrisé et le nouveau-né se portait bien.

The pedicled groin flap in resurfacing hand burn scar release and other injuries: a five-case series report and review of the literature.

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Neurosural fasciocutaneous cross-leg flaps for leg salvage surgery

Introduction: Complex traumatic injuries in legs frequently lead to dramatic soft tissue and bone defects in which use of local and regional flaps may be compromised. This situation constitutes a major challenge in leg reconstruction. Apart from free-tissue transfers, cross-leg flap fascio-cutaneous flaps have a potential to become an ultimate limb salvage procedure. We report two cases of use of fascio-cutaneous cross-leg flaps for extensive defects in legs. Refinements to avoid flap failure are described. A review literature is performed. Cases: A child of 5-year-old and an adult of 26-year-old presenting extensive tissue loss of the leg were treated by cross-leg fascio cutaneous flaps. Apart from discomfort during the procedure, there was no undesirable event in the postoperative course. The flaps provided good tissue for further bone reconstruction. Conclusion: Although free-tissue transfer is the most used procedure nowadays, fasciocutaneous cross-leg flaps are found to be useful for limb salvage surgeries

Treatment of an acute deep hand burn in a lowincome country with no available microsurgery: a case report.

Deep hand burns usually lead to joint and tendon exposure. A simple skin graft is insufficient to achieve healing. Soft tissue reconstruction represents a surgical challenge that ranges from the simplest to the most complex flaps. In some areas, microsurgery is not technically possible. Choice is then limited to pedicled distant flaps such as the abdominal wall flap-graft. We report a case of an acute burned hand with exposure of metacarpophalangeal joints from the second to the fourth radius as well as proximal inter phalangeal joints from the second to the fifth radius and extensor tendons, treated in the burns and wound care unit of the Sylvanus Olympio Teaching Hospital in Lomé. The dorsum hand and fingers were covered with a pedicled abdominal flap-graft that was severed in two stages at 22 and 29 days. We achieved good results (sensitivity S3+, useful aesthetic hand) at two-year follow up.

Les brûlures profondes de la main conduisent habituellement à une exposition articulaire et tendineuse. La reconstruction des parties molles représente un challenge chirurgical qui va de la technique la plus simple au lambeau le plus complexe. Dans certaines contrées, la microchirurgie n'est pas techniquement possible et le choix se limite à l'utilisation de lambeau pédiculé à distance, comme le lambeau-greffe abdominal; nous rapportons un cas de brûlure récente de la main avec exposition des articulations métacarpo phalangiennes du second au quatrième rayon avec de plus une atteinte des articulations inter phalangiennes proximales du second jusqu'au cinquième rayon et exposition des tendons extenseurs. Ce patient a été pris en charge dans l'Unité des brûlés et des Plaies et Cicatrisation du Centre Hospitalier Universitaire Sylvanus Olympio de Lomé. La face dorsale de la main et des doigts a été couverte par un lambeau-greffe pédiculé abdominal, qui fut sevré en 2 étapes (22ème et 29ème jour). Nous avons obtenu de bons résultats sur le plan de la sensibilité ainsi que sur l'aspect esthétique chez ce patient après deux ans de suivi.

Hand trauma epidemiology in a hospital setting in Togo

Purpose: Hand trauma epidemiological characteristics are lacking in low and middle-income countries. The aim of the study was to determine hand trauma characteristics to be use as a framework for planning hand surgical care in our country. Material et methods: Registers in Surgical Emergency Department from 1st June 2009 to 31st May 2014 were reviewed retrospectively to determine frequency, socio-demographic of patients and clinical characteristics of hands injuries. Results: Frequency of hand trauma was 0.7% of all admissions in the Surgical emergency department. The male to female ratio was 3.4:1. Mean age was 28 years. Manual work was the most representative occupation (33.2%). Road traffic accidents were the main circumstances of hand injuries (38%). Open injuries represented 68%. Fractures, dislocation and sprains were seen respectively in 41%, 31%, and 8% of cases. Simple wounds were seen in 38 % of all patients. Conclusion: Hand trauma seemed to be of low frequency in hospital in our setting. Main injuries encountered are fractures, dislocation, and sprains