African primary research publications in plastic surgery: A PRISMA-S-compliant systematic review.

BACKGROUND: Plastic surgery (PS) in Africa is a relatively young surgery specialty, and the number of available plastic surgeons on average is one or two surgeons per country in many African low-income countries. This systematic review aims to geographically map the research activities through scientific publications of African PS centres, between February 2012-February 2023. METHODS: We searched four literature databases (Medline, Embase, Google Scholar and African Journal Online) and did a manual search. We included case reports, randomised controlled trials, and clinical, comparative, observational and multicentre studies conducted in Africa and published in English and French. In the Google Scholar database, we analysed the first 200 references (scientific articles) selected per relevance according to the Boolean terms. In the African Journals Online database, we analysed the references from the first five pages. The selected keywords were: burns, trauma reconstruction, pressure injuries, wound, cleft lip and palate, breast reconstruction, microsurgery, aesthetic surgery, face surgery, head and neck surgery, hand surgery, open fracture surgery, oculoplastic surgery, skin surgery, and soft tissue surgery. RESULTS: We retrieved a total of 228 articles. Out of the 73 African centres we identified, 27 were in the North, 22 in the West, 8 in the East, 3 in the Centre, and 14 in the South. Most of the retrieved 228 articles involved burns (60, 26.31%), congenital abnormalities (52, 22.80%) and reconstruction (28,12.80%); however, other conditions, such as breast or skin cancer, hand surgery, microsurgery or aesthetics are emerging. The studies were case reports/case series (93, 40.78%), retrospective (78, 34.21%), prospective (36, 15.78%), randomised controlled studies (10, 4.38%), cross-sectional (5, 2,19%) and cohort (2, 0.87%). CONCLUSIONS: Beyond burns, congenital abnormalities, or reconstructions, other PS indications are emerging, such as skin cancer, breast reconstruction, hand surgery, microsurgery, and aesthetics.

Female breast cancer in sub-Saharan Africa: A PRISMA-S-compliant systematic review of surgery.

BACKGROUND: In sub-Saharan countries (SSAs), the advanced stage at diagnosis and the limited surgical interventions of female breast cancer (FBC) lead to poor outcomes. This study assessed current modalities of FBC surgeries. METHODS: Six literature databases (Medline, Embase, African Journal Online, Google Scholar, Web of Science, Cochrane Library) were searched, plus a manual search, in 2011-2021. We included primary data studies with any setting and presurgeries or postsurgeries treatments, we excluded non-English language studies, editorials, and grey literature. RESULTS: The search yielded 21 observational studies (16 retrospective, 3 prospective, and 2 case reports). Of the total 6900 patients, 4121 (60%) patients underwent FBC surgical excision only, and 751/2779 (27%) conservative surgery (BCS) or therapy (BCT). All studies reported similar use of mastectomy (>60%), the FBC surgical excision/reconstruction studies displayed more neoadjuvant chemotherapy (536/2779, 19% vs. 215/4121, 5%), and radiotherapy or adjuvant radiotherapy (1461/2779, 52% vs. 411/3921, 4%). Patients' age, histological classification, staging, and follow-up data were often missing. CONCLUSIONS: The FBC complexity requires structured management by general and plastic surgeons, radiotherapy specialists, and obstetrician-gynecologists through shared guidelines, protocols, and specific programs of public health. In SSAs, FBC surgical strategies should point at decreasing radical mastectomy and increasing BCS/BCT.

A thin superficial temporalis artery revealed by total necrosis of an island scalp flap, a case report.

INTRODUCTION AND IMPORTANCE: The superficial temporalis artery (STA) counts as one of the most reliable blood supplies capable of supporting the vascularization of the entire scalp. Therefore, total necrosis of a scalp flap based on the superficial temporalis artery is a rare complication. CASE PRESENTATION: A 43-year-old woman with a history of hypertension and cerebral stroke presented to our consultation for fronto-parietal scalp alopecia. The scar was the result of spontaneous healing of a chemical burn that occurred eight months earlier. We performed the first step of scalp expansion and raised a parietal expanded goblet island flap based on the right STA. In the postoperative period, the flap developed progressive necrosis. Despite the release of tension and stab incisions, the flap failed in a week. An angio-MRI revealed a thin STA on the right compared to the left side. After debridement, the necrosis was superficial, deep galea, and some subcutaneous tissues were viable. We performed a split-thickness skin graft that achieved a total wound closure. CLINICAL DISCUSSION: An extensive exploration of the vascular supply of the scalp before raising a scalp flap is not a common rule. The anatomical variation that we discovered as a thin superficial temporal artery may have explained the total failure of this flap surgery. CONCLUSION: Surgeons should keep in mind the possible existence of a detrimental anatomical variation when planning a single pedicled scalp flap.

Use of domestic tools to downstage the reconstructive ladder in a patient with severe crush and degloving injury: a case report.

In the COVID-19's crisis, elective surgery and non-emergent cases were postponed; all other procedures have to be minimized. A 17-year male patient with severe crush and degloving injury over the thigh, gluteal, sacral, and perineum areas was admitted to our Department on the 16th of March 2020. The patient presented soft tissue skin and muscle loss. A double Latissimus Dorsi and Anterolateral Thigh free flaps were indicated. However, due to the particular circumstance of the COVID-19 crisis, we applied domestic negative wound therapy (NPWT) using gauzes and wall suction. We obtained suitable granulation tissue after 17 consecutive days with this treatment. The raw area was then covered with an expanded split-thickness skin graft. The wound healed at 95%, and the patient was discharged on 25th of April 2020. He was followed up in an outpatient setting with wound care and physiotherapy. This case showed that in a limited-resource setting, with available wall suction, the domestic NPWT is a versatile tool to promote granulation tissue.

Embrochage de Kapandji sans amplificateur de brillance des fractures du radius distal

Introduction : Les méthodes thérapeutiques des fractures du radius distal sont variées. Les buts de cette étude étaient de décrire la technique de l'embrochage selon Kapandji sans amplificateur de brillance et d'évaluer les résultats obtenus. Patients et Méthodes : Les patients ont été opérés entre mars 2009 et décembre 2012 pour une fracture du radius distal extra- articulaire à bascule postérieure. L'âge moyen était de 38 (18-75) ans. Il s'agissait de fractures fermées ou ouvertes de type I de Gustilo-Anderson. L'embrochage de Kapandji a été réalisé en ambulatoire sans garrot au bras. L'anesthésie était locale (n=52 ; 76%) et générale (n=16 ; 24%). La fracture était réduite par la technique de Judet et ou de « démonte pneu ». La qualité de la réduction était appréciée par la correction de la bascule postérieure et la restitution de la ligne bi- styloïdienne. Soixante-huit patients ont été retenus au contrôle final. Les évaluations fonctionnelle et radiologique ont été faites selon les critères de Castaing. Le recul moyen était de 15,6 mois. Résultats : Les fractures ont consolidé en 44 jours (42-49). Le résultat radiologique en post opératoire était très bons (n=22; 32%), bons (n=28 ;41%), moyens (n=14 ;21%) et mauvais (n=4 ;6%). Au dernier recul, les résultats fonctionnels étaient très bons (n=40 ;59%), bons (n=22 ;32%), moyens (n=6 ;9%), et mauvais (n=0). Les résultats radiologiques étaient très bons (n=20 ;29%), bons (n=30 ;44%), moyens (n=12 ;18%) et mauvais (n=6 ;9%). Les complications étaient une infection superficielle (n=14), le déplacement secondaire (n=22), la migration des broches (n=18), une lésion de la branche sensitive du nerf radial (n=6). Les facteurs de bon pronostic étaient l'âge< 60ans, la lésion métaphysaire M1M2, l'articulation radio-ulnaire intacte, la physiothérapie, et l'absence de syndrome complexe douloureux régional. Conclusion : L'embrochage de Kapandji des fractures extra-articulaires à déplacement postérieure sans l'utilisationde l'amplificateur de brillance donne de bons résultats. Cette méthode peut être appliquée dans les centres dont le plateau technique est limité

Foot hexadactyly, social implications and management in the African setting: Case report.

Amouzou KS, Malonga-Loukoula ELJ, Kouevi-Koko TE, Bakriga B, Abalo A. Foot hexadactyly, social implications and management in the African setting: Case report. Turk J Pediatr 2018; 60: 453-455. Hexadactyly of the foot, an abnormal congenital condition presenting as eight toes, is a rare malformation. We report the case of a ten-year-old girl, admitted to our orthopedic and reconstructive surgery department for a preaxial hexadactyly. The girl was abandoned by her parents at birth and stopped school early due to stigmatization. The goals of the surgical procedure were: social reintegration, gait improvement, ability to wear shoes comfortably, and improved appearance of the foot. The surgery was a medial resection of the supernumerary toes.

Hand replantation: First experience in a sub-Saharan African country (Togo).

Fifty years after Chen has performed the first forearm replantation, we report our first case of hand replantation in a sub-Saharan African country. The etiology of the amputation was machete due to interpersonal violence. The amputation was trans-carpal, guillotine-type, subtotal non-viable maintained with a small skin bridge. The replantation procedure was successful. At one year follow-up, the functional result according to Chen's criteria was excellent. Through this first experience, we can state that hand replantation can be performed successfully both in survival and function in a non-specialized hospital of a sub-Saharan African country.