Latex glove conduit as improvised blood vessel model for microvascular anastomosis training.

BACKGROUND: In the growing need of microvascular surgery in modern-day plastic surgery, financial burden on surgeon or institution can discourage acquisition of skill particularly in the initial phase of laboratory simulation. This article describes the construction of a cheap, easy-to-make blood vessel model. MATERIALS AND METHOD: The model was made using infusion giving set, latex glove, scissors, tape measure and Swan glue CD 308. A cut sheet from the latex glove was rolled twice over two glue-painted segment of the infusion giving set stent. The stents were gently pulled out, turning the sheet into a conduit. The blood vessel model was then allowed to dry. DISCUSSION: The use of latex glove for initial training in microvascular anastomosis has been for long. Previously described productions into a conduit are cumbersome. This model is easy to construct and is useful in an office or dry laboratory setting. CONCLUSION: The latex glove blood vessel model described in this article is a useful material in the training of budding microsurgeons. Residents in our institution have reported a very good learning experience with its use.

STATE DISTRIBUTION OF NEW PATIENTS PRESENTING WITH CLEFT LIP AND PALATE TO THE UNIVERSITY COLLEGE HOSPITAL: A PILOT STUDY.

BACKGROUND: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. OBJECTIVE: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. METHODS: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. RESULTS: Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA's) in Oyo state. Patients were seen from LGA's in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA's. CONCLUSION: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.

Management of split skin graft donor site in the West African sub region: survey of plastic surgeons' practice.

Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.

Les greffes de peau mince font partie des opérations les plus fréquemment réalisées dans tout service de chirurgie plastique. La qualité de cicatrisation du site donneur dépend de plusieurs facteurs, dont le type de pansement utilisé. Le but de cette étude est d'enquêter sur la pratique des chirurgiens plasticiens en Afrique de l'Ouest, vis-à-vis de la gestion du site donneur de peau mince et de vérifier si elle est en accord avec les standards internationaux. Des questionnaires structurés sur les différents aspects du prélèvement cutané de peau mince ont été remis aux chirurgiens plasticiens pendant la 53e Conférence annuelle des chirurgiens du Collège des Chirurgiens de l'Afrique de l'Ouest(WACS) à Lomé, Togo en Mars 2013. Les données ont été analysées à l'aide de statistiques descriptives. Ont été recueillies 47 réponses sur 55 chirurgiens plastiques de 4 régions de l'Afrique de l'Ouest, soit 85 8,4 % des participants inscrits à la section chirurgie plastique de la Conférence. Toutes les réponses émanaient de chirurgiens pratiquant des greffes de peau mince de façon régulière et la cuisse était la zone la plus communément utilisée. Différents types de pansements à la paraffine étaient le plus souvent utilisés en première intention. Seulement 17 % des réponses signalaient l'utilisation d'un topique anesthésiant local sur le site donneur. Le choix de pansement du site donneur dépendait principalement de sa disponibilité. Des efforts concertés doivent être faits pour avoir accès aux nouveaux produits cicatrisants, afin d'obtenir une meilleure prise en charge de ce type d'intervention couramment pratiquée.

NORMAL VALUES OF KEY PINCH STRENGTH IN A HEALTHY NIGERIAN POPULATION.

BACKGROUND: With the severity of machine hand injuries in our environment, the need to determine the normal values for key pinch strength with which to compare restorative surgeries was justified. METHOD: A cross sectional survey of participants who had no previous hand injuries limiting hand function. Data obtained included age, gender, body mass index, hand dominance and hand span. The Baseline Hydraulic Pinch Gauge was used to obtain key pinch strength. The influence of the above variables on measured pinch strength was analyzed using independent sample t-tests and Pearson's correlation. RESULTS: Of the 242 recruited participants, age range between 20 and 80 years, 163(67.4%) were male and 79 (32.6%) were female. Males had higher pinch strength (right-8.3±2.7kg, left-7.6±2.5kg) than females (right-6.3±1.5kg, left- 5.8±1.5kg). Pinch strength varied with age peaking in the fifth decade in males and females. Interestingly, the left handed dominant female had higher right pinch strength than her right handed counterpart (p<0.009). Height, and hand span correlated with pinch strength in females. CONCLUSION: Normal values for key pinch strength in this Nigerian population are lower than that of Caucasians.

Demographic characteristics and prognostic indicators of childhood burn in a developing country.

Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.

Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking.

INTRODUCTION: This study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes. METHODS: A cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined. RESULTS: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p<0.001, p=0.004, p=0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. CONCLUSION: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.

Genetic studies in the Nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders.

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck, with a worldwide prevalence of 1 in 700 births. They are commonly divided into CL(P) and CP based on anatomic, genetic, and embryologic findings. A Nigerian craniofacial anomalies study (NigeriaCRAN) was set up in 2006 to investigate the role of gene-environment interaction in the origin of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from Nigerian probands was used for genotype association studies and direct sequencing of cleft candidate genes: MSX1 , IRF6 , FOXE1, FGFR1 , FGFR2 , BMP4 , MAFB, ABCA4 , PAX7, and VAX1 , and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four HapMap controls. No other apparent causative variations were identified. Deviation from Hardy Weinberg equilibrium (HWE) was observed in these cases (p = .00002). A significant difference was noted between the affected side for unilateral CL (p = .03) and bilateral clefts and between clefts on either side (p = .02). A significant gender difference was also observed for CP (p = .008). CONCLUSIONS: Replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the development of CL(P).

Predictors of mortality in paediatric burns at Ibadan, Nigeria

Burn injury constitutes a major cause of trauma related morbidity and mortality. Improvements in care have resulted in reduced mortality in the burn patient significantly. The aim of this study was to determine the outcome and management of burns in children. This was a prospective study of children aged 0-13 years, managed in the burns unit of University College Hospital, Ibadan, Nigeria, between January 2001 and September 2003. There were 62 patients, 42 (67.7%) were females and 20 (32.3%) were males (Male: Female= 1:2. Their ages ranged between 1month and 13 years (mean = 4.8 ± 3.8 years). Majority of the patients (56.5%) were below 4 years of age. Burn was caused predominantly by flame (57%), followed by inhalation injury in 43.5% of the patients. The percentage total burn surface area (%TBSA) ranged between 1%and 95%(mean 29.7%± 22.8%), and 41.4% of the patients sustained amajor burn (TBSA= 30%). Infective complications were present in 37% of patients. The overall mortality was 33.9%, and occurred in those patients with %TBSA of 14 95% (mean = 48.8%). Mortality rate was 62.9% among those that had inhalation injury compared with 11.4% in those without inhalation injury. There was no mortality in those patients whose %TBSAranged between 1 and 32%(mean = 17.5%). Percentage of the total body surface area burnt and the presence of inhalation injury were important predictors ofmortality in childhood burns injury

Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Surgical management of advanced hypopharyngeal carcinoma: a case report and literature review.

BACKGROUND: Surgical resection of advanced primary head and neck cancers especially of the upper aerodigestive tract like hypopharyngeal cancer, usually leave a very big defect, which has to be reconstructed in order to maintain the gastropharyngeal continuity. This oncological surgery is best performed at the same sitting as a one staged procedure. STUDY DESIGN: A clinical case of a 56-year-old female with advanced hypopharyngeal cancer who had a single stage total pharyngolaryngectomy and partial oesophagectomy with reconstruction of the upper aerodigestive tract using pectoralis major pedicled flap and post operative adjunct chemo-radiation therapy. RESULT: Functionally, our patient had good swallowing reflex, fed on normal diet free of feeding tube and no gastric reflux. There was clinical evidence of weight gain. No evidence of flap complications post surgery. CONCLUSION: The rarity of this procedure and its advantages in the management of an advanced hypopharyngeal cancer in this environment are discussed.

Necrotizing fasciitis.

Necrotizing fasciitis (NF) is a rare but rapidly progressive and potentially fatal disease condition. It is characterized by progressive inflammation and extensive necrosis of the subcutaneous tissue and fascia, sparing the underlying tissue. It is a poly-bacterial infection and is associated with profound systemic toxicity, considerable morbidity and a high mortality rate. The outcome is influenced by early recognition and radical surgical debridement. We present a report of six cases of NF who presented to our surgical service within the past 5 years.

Blepharoptosis in Ibadan, Nigeria.

OBJECTIVE: To look into the cases of blepharoptosis in our environment as well as find out the causes and effects of the ptosis. DESIGN: Prospective clinic study and prospective cluster sampling method of school children. SETTING: University College Hospital, Ibadan and 3 schools in Ibadan, Nigeria. SUBJECT: Over a 5 year period, all patients who presented with blepharoptosis at the University College Hospital were recruited for the study. During the same period, a school survey was also done to find out the prevalence of blepharoptosis among school children. RESULTS: Twenty five cases of blepharoptosis were found during the 5 year period. Fifty two percent of the patients were found to be less than 16 years of age while only 8% were over 50 years of age. There was a 1:1 male to female ratio with majority of them (68%) having only one eye affected. The most common cause of blepharoptosis was found to be congenital, accounting for 56% of the patients. The prevalence in the school survey was found to be 1.2% higher than the incidence of 0.5% found in the eye clinic. CONCLUSION: Blepharoptosis is not an uncommon ocular problem. A detailed assessment of the cause, amount of ptosis and levator functions helps to determine the most appropriate surgical technique which would give the best functional and cosmetic result.

Knowledge of the scope of plastic and reconstructive surgery by surgical specialists at Ibadan and Ilorin, Nigeria.

BACKGROUND: Defects created by all surgical specialties require closure. Plastic and reconstructive surgery is a subspecialty that reconstructs large defects. Many people including the medical and dental practitioners are still unaware of its scope. This study was conducted to assess the level of awareness of surgical specialists in the practice of plastic and reconstructive surgery. METHODS: Questionnaires were sent to all surgical specialists working at the University College Hospital, Ibadan located in the South-West zone of Nigeria and to surgical specialists at the University of Ilorin Teaching Hospital, located in the North Central zone of Nigeria. Scores of respondents were compared and analysed using student t-test. RESULTS: The mean knowledge of specialists at the University College Hospital, Ibadan was 62.61% (SD 14.63) while that of University of Ilorin Teaching Hospital was 47.86% (SD 20.26). The difference was statistically significant (p < 0.05). CONCLUSION: The study demonstrated the general limitation of knowledge among surgical specialists on the scope of plastic surgery. It also showed a variation in the knowledge of the practitioners at Ibadan and Ilorin on the scope of plastic surgery. Greater progress must be made in the education of our colleagues as well as the general public, if the specialty of plastic and reconstructive surgery is to be practiced in its full scope.

Encephalocele and associated skull defects.

Encephalocele is a common congenital problem in the practice of Neurosurgery worldwide, with varying sizes of the underlying skull defects. This study was carried out to determine the size of the problem; to assess whether the skull defects are being under-managed or not; and also to determine those patients that will benefit from cranioplasty. The case notes of the patients with encephalocele managed over a 5 year period were reviewed and the relevant data obtained. Seventy-six percent of the patients had occipital encephalocele. The average diameter of the skull defect was 1.8 cm. Only 2 (9.5%) of the patients had cranioplasty. Cosmesis was acceptable to all the patients. No recurrence was noted in the series studied. We therefore concluded that the skull defects are not being under-managed, however large anteriorly based lesions with wide skull defects (i.e >2.5 cm) will require cranioplasty.

The temporalis muscle plus glabellar flap: handy local flaps for orbital repair after exenteration.

Primary tissue coverage of the orbit is desirable after orbital exenteration. This apart from reducing morbidity, is cost effective. Two patients who had immediate local flap reconstruction with temporalis muscle and glabellar skin, after major orbital resection are presented. The advantages of flap reconstruction over skin grafting are discussed.

A comparison of topical honey and phenytoin in the treatment of chronic leg ulcers.

In view of the reports that phenytoin and honey are useful in the healing of wounds, a comparison of their topical use in the treatment of chronic leg ulcers was carried out. Fifty cases of chronic leg ulceration were studied, each for a period of four weeks. They were assigned into three groups for honey, phenytoin/honey mixture, and phenytoin topical treatment. Overall mean duration of the ulcers was 56.5 months while the mean(s.d.) size was 3339 (5193) mm2. Mean percent reduction in size in the group treated with honey, 27.0 (36.9), was not significantly different (H = 0.26; 2 df; p = 0.88) from that of the mixture group, which was 25.9 (46.4), and from that of the phenytoin group which was 35.5 (53.2). This percent reduction in size was significantly greater, (H = 7.69; 2 df; P = 0.02), during the first week in the phenytoin group than in the other groups. Four of the cases progressed to complete healing at the end of four weeks with phenytoin. Pain score difference (using a graduation scale from 0 to 10) at the end of the four week treatment, was, 1.8 (1.7) in honey group, 2.0 (1.3) in mixture group and 3.6 (2.4) in phenytoin group. This difference was not significant, (H = 3.09; 2 df; P = 0.21). Our study suggests that phenytoin may be superior to honey as a topical agent in the treatment of chronic ulcers.

ABDEFS' scoring system: a new method of evaluating chronic ulcers.

Six clinical features of chronic skin ulceration are employed to described a new scoring system. When utilised in 50 evaluations of chronic leg ulcers, a significant correlation with independent observations of the same ulcers, based on the clinical judgement of an expert, was obtained. The new method of scoring can be applied with ease, requires no special training, and can be used consistently by health workers.

Orofacial indices: a study in 240 Nigerian children.

This paper seeks to establish normal orofacial indices in Nigerian children under the age of 12. The children were grouped according to age and sex. The indices studied were: mouth width/upper vermilion are with lip relaxed; coefficient of upper lip curvature; upper lip height/mouth width; height of cutaneous upper lip/upper lip height; height of upper vermilion/upper lip height; upper lip elasticity; and size of oral aperture. The indices varied with age. Except for upper lip elasticity in 10-11-year-old children, there were no significant differences in orofacial indices in males and females. The coefficient of upper lip curvature which is an index that measure the curve or protrusion of the upper lip, was maximum in two or three-year-olds in both sexes. The orofacial indices calculated from lip dimensions could provide important baseline information for surgical repair or reconstruction of the orofacial region in black children.