Surgical outcomes of diabetic hand infections in Lagos, Nigeria.

Background: Hand infections in diabetics can be a major cause of functional impairment. In patients with Tropical Diabetic hand syndrome prompt surgical intervention may salvage the hand, but return to premorbid function remain a challenge. Objectives: A retrospective study of consecutive diabetic patients with hand infections was done in 2 tertiary institutions in Lagos, Nigeria to identify the epidemiology, modes of presentation, types of surgical intervention and outcomes of treatment. Results: Twenty one patients were studied over a 5 year period. ten males, eleven females. All were type 2 Diabetes. 52.4%(11) were diagnosed less than a year prior to presentation. 61.9%(13) had digit/hand gangrene on presentation. All operated patients (20) had wound debridements. 52.5% (11) digit/hand amputations and this was the commonest surgical procedures done. Other surgeries done include skin grafts and `flap reconstructions. There was a 19% mortality rate. Less than a fifth were able return to their premorbid occupation after 3 months. But all had reduced range of motion in the interphalangeal joints in the adjacent digits. Conclusions: There is a high morbidity rate for hand infections in the diabetic, even though majority of the hands were salvaged, most patients were unable to return to their premorbid occupation at 3 months.

Reconstruction of complex craniofacial defects by free flaps: Two case reports.

Complex craniofacial defects often create a reconstructive challenge in our region. We highlight two cases that demonstrate this problem and highlight the role of microvascular free flaps in covering these defects. The evolution of head and neck reconstruction as well as the peculiarities of these types of reconstruction in our environment are discussed.