SCROTAL RECONSTRUCTION WITH A PEDICLED GRACILIS MUSCLE FLAP AFTER DEBRIDEMENT OF FOURNIER'S GANGRENE: A CASE REPORT.

As part of surgical management of Fournier's gangrene, multiple and extensive debridement of necrotic tissue is done which results in significant loss of scrotal skin and exposure of testes. This necessitates reconstruction of a neoscrotum to cover of the testes. Several scrotal reconstructive options are available including split thickness skin grafts, scrotal advancement flaps, local fasciocutaneous, muscle or myocutaneous flaps, and free tissue transfer. We report a case of a 34 year old African male who presented as a referral from a district hospital with a scrotal defect and exposed testes following extensive debridement of Fournier's gangrene. Scrotal reconstruction with a pedicled gracilis muscle flap was done. The pedicled gracilis muscle flap is close to the scrotal area and is ideal for coverage of large scrotal defects with deep pockets. It is well vascularised thereby providing greater resistance to infection, a good bed for skin grafting yet eliminating the risks associated with potentially non reliable skin paddle in the myocutaneous flap.

Short-term surgical missions: joining hands with local providers to ensure sustainability.

Short-term surgical missions may appear to fill a void in surgical capacity in the developing world, but may inadvertently also disrupt well-established local healthcare systems. The surgical providers of an East African hospital developed suggestions for improving these missions so that they can benefit visitors, local providers and patients alike.

Motorcycle injuries as an emerging public health problem in Mwanza City, north-western Tanzania.

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and are a common cause of road traffic injuries. The aim of this study was to establish the prevalence, injury pattern and treatment outcome of motorcycle injuries among patients presenting to Bugando Medical Centre in Mwanza, Tanzania, between March 2009 and February 2010. Data was collected using a pre-tested, coded questionnaire. A total of 384 motorcycle injury patients were studied constituting 37.2% of all road traffic injuries. Over two-thirds (69.5%) of the patients were males (Male: Female ratio = 2.3:1). The mean age of the patients was 25.7 years (range: 4-87 years). The majority of patients were businessmen and students accounting for 68.8% and 42.2%, respectively. Motorcyclists accounted for the majority of motorcycle injury patients (212, 55.2%), followed by passengers (130. 33.9%) and pedestrians (42, 10.9%). Helmet use was recorded in 87 patients (22.7%). Most patients (352; 91.7%) sustained blunt injuries. Musculoskeletal (extremities) and head injuries were the most common body region injured affecting 234 (60.9%) and 212 (55.2%) patients, respectively. The majority of patients (244; 63.5%) were treated surgically. Wound debridement was the most common (86.9%) procedure performed. The overall mean length of hospital stay (LOS) was 19.23 days (range= 1-120 days). The LOS for non-survivors was 5.6 days (range= 1- 25 days). Patients with major trauma (ISS > 16), severe head injury (GCS 3-8) and those with long bone fractures stayed longer in the hospital and this was significant (P-value <0.001). Mortality rate was 16.7% (64 deaths). Age of the patient, non-helmeted patients, major trauma (ISS > 16), admission systolic blood pressure <90mmHg, severe head injury (GCS <9), need for intensive care unit admission and need for ventilatory support significantly influenced mortality (P-value < 0.001). Motorcycle injuries constitute a major but neglected emerging public health problem in Mwanza City and continue to be one of the most common cause or agent of road traffic injuries. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws.