Microsurgical Digits Replantation in Resource-Limited Setting: A Retrospective Study.

Background: This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting. Methods: This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure. Results: Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and effective holding and grasping abilities without pain or instability (76.2%). Replantation failure was associated with a higher number of affected digits (p < 0.001), longer operative time (p = 0.004), complete avulsion (p = 0.003), current smoking (p = 0.025), diabetes (p = 0.006), hypertension (p = 0.047), procedure difficulty score (p= 0.004), and occurrence of complications (p < 0.001). Conclusion: Microsurgical finger replantation can yield favorable outcomes and acceptable survival rates, even within resource-limited settings. However, this procedure requires specialized equipment and personnel that may not be available at all institutions. Influential factors in digit replantation failure, include an increased number of damaged digits, extended operative duration, complete avulsion, current smoking, diabetes, hypertension, procedure difficulty score, and postoperative complications occurrence.

Surgical management of penoscrotal hypospadias in a child with Opitz G/BBB syndrome: a case report.

Opitz G/BBB syndrome is a rare condition characterized by three significant anomalies; hypertelorism, cleft lip and palate, and hypospadias. However, other anomalies may be associated. Herein, we report a 4-year-old child presented with penoscrotal hypospadias. On examination, hypertelorism and cleft lip and palate were noticed, suggesting a diagnosis of Opitz G/BBB syndrome. The cleft lip was corrected in the first year, and a two-staged surgical approach was implemented for penoscrotal hypospadias. In the first stage, the chordee was corrected and urethral plate was reconstructed using a tabularized incised plate urethroplasty and testicular tunica vaginalis flap. In the second stage, the remanent hypospadias was corrected, and the meatal opening reached its normal location. In conclusion, a two-staged surgical approach for the treatment of penoscrotal hypospadias associated with Opitz G/BBB syndrome may provide excellent outcomes in early-recognized cases. The urologist should pay attention to abnormal facial characteristics in patients with hypospadias.

Transient urocolpos due to vesicovaginal reflux in a 37-year-old woman: a case report.

Urocolpos is a urine collection in the vagina, possibly due to vesicovaginal reflux (VVR) or a fistula. Urocolpos is a rare phenomenon in adults, and it is commonly underrecognized by radiologists. The occurrence of urocolpos due to VVR after a Caesarean section in adult females is a rare phenomenon; failure to recognize it may lead to misdiagnosis as vesicovaginal fistula and often leads to unnecessary medical interventions. We report a 37-year-old female who complained of abdominal pain and intermittent daytime urinary incontinence for six months, starting after a Caesarean section for her third baby. An abdominal computed tomography scan revealed a large fluid-filled vagina on a full bladder without anatomical abnormality. A post-voiding scan showed a complete resolution. In conclusion, urocolpos is an underrecognized entity that rarely coexists with VVR. Post-voiding resolution and vaginal contrast reflux are important findings that can aid radiologists in identifying such cases.

Assessment of demographic characteristics and histopathological pattern of thyroidectomies patients in a resource-limited setting: a retrospective cross-sectional study.

Thyroid disorders are prevalent among Yemenis. However, there is limited data regarding thyroid disease burden, surgical intervention outcomes, and predictive factors in our country. This study aims to review the indications, histopathology, and complications of thyroid surgery in a resource-limited setting where the management is provided primarily by general surgeons. A retrospective study between Jun 2010 and March 2019 included 246 cases who underwent thyroid operations for a thyroid disorder in Al-Nasr Hospital, Ibb, Yemen. The patient's demographic characteristics, operative findings, complications, fine needle aspiration biopsy (FNAB) results, final pathology, and outcomes were gathered and analyzed. The mean age was 41.60± 8.31 years. The prevalence was high (30.1%) in the age group of 31-40 years and females (87.8%) with a female-to-male ratio of 7.2: 1. The main indication for thyroidectomy was compressional symptoms (35%), and the main preoperative cytology findings were multimodular goiter (89%). There was thyroid cancer in 18(7.3%) patients, and the most type was follicular thyroid carcinoma (FTC) in 9 patients. The most typical type of surgery was near-total thyroidectomy in 186 (75.6%) patients. Complications were presented in 47 patients (19.1%), and total mortality was observed in 5(2.03%) patients. Intraoperative bleeding was the most typical complication in 36 (14.6%) patients. The sensitivity, specificity, and accuracy of FNAB were 96.34%, 44.44%, and 96.34%, respectively. Fine needle aspiration biopsy (FNAB) was not precise enough in diagnosing FTC with a sensitivity of 55%. Our result showed a considerable rate of postoperative complications of thyroid surgery, and thyroidectomy may be a viable option even in a resource-limited setting or performed by general surgeons.

Role of microsurgical free flap reconstruction in managing complex wound: a retrospective cross-sectional study.

Introduction: while reconstruction of complex wounds with severe tissue defects has been a significant problem in plastic surgery, free flap microsurgical procedures could solve many of these problems. In Yemen, data regarding free flap microsurgery for complex wounds are scarce. This study aimed to share our microsurgery experiences in repairing complex wounds using different free flaps in a resource-limited setting. Methods: a retrospective cross-sectional study between April 2019 and June 2022 conducted at 21 University-affiliated hospitals included 30 patients with complex wound defects that were not amenable for regional, pedicle procedures, or skin grafts and underwent microsurgical reconstructions with deferent free flap tissue transfer. The primary outcome was flap survival or failure, while the secondary outcome was postoperative complications. Results: the main age was 34.76 ± 16.88 years, with 24 (80%) males and 6 (20%) females. Replacing extensive tissue loss caused by road traffic accidents was the most common indication (36.6%). The mean defects required to be reconstructed were 84.9 ± 44.70 cm2. The lower extremities accounted for the majority of reconstructed defects (50%), and mostly (23.3%) involved the leg. Only 10 (33.3%) flaps were performed immediately within 48 hours of trauma. The fibulae osteo-cutaneous free flap (30.0%), radial forearms free flap (23.3%), and anterolateral thigh flap (23.3%) were used most commonly. All flaps were harvested and repaired under loupe magnification or operative microscope by a single surgeon. The overall flap success rate was 83.3%. The total complication rate was 23.3%, and postoperative infection and partial flap necrosis occurred in 3 (10.0%) and 2 (6.6%) patients, respectively. A total flap loss occurred in 5 (16.7%) patients. Conclusion: reconstruction of complex wounds with microsurgical free flaps is a viable option even in a resource-limited setting. In our study, microsurgery with fibulae osteo-cutaneous free flap was the most commonly used. Despite many limitations, microsurgical free flaps were effective in treating individuals operated on in our setup with a limb salvage rate of 83.3%.