Acquired Lip Defects - Presentation and Management at Orlu; Nigeria

Background: Acquired defects of the lips are quite a heterogeneous group of defects; posing diverse challenges to the reconstructive surgeon. Recent reports have advocated primary closure in this environment. Aim: To highlight the pattern of presentation and management of acquired lip defects in Imo State University Teaching Hospital.Method: The case records of patients with acquired defects of the lip in a 12 - month period (March 2007 to February 2008) were reviewed. Information on biodata; clinical presentation; treatment; complications and outcome were extracted from the case notes. The extent of lip loss was given as a percentage of the inter-commissural length of the involved lip. The data were analyzed using descriptive statistics. Results: Ten patients with acquired lip defects were treated in the period under review. There were 5 males and 5 females ( M:F= 1:1). They were all adults. Four (4) had upper lip defects while 6 had lower lip defects. The commonest cause was human bite; followed by tumour resection. The commonest procedure for the upper lip defects was bilateral cheek advancement with a central Abbe flap; while for the lower lip; it was wedge excision and lateral lip advancement. All defects were repaired primarily. Results were satisfactory. Conclusion: Human bite and tumour excision are major causes of acquired lip defects in our centre. Primary reconstruction gives good results

Analysis of burn mortality in a burns centre.

We present an analysis of burn mortality in our burns centre in Nigeria. A total number of 285 patients sustained burns during the study period (1996-2000). Fifty-seven of the patients (20%) died, of whom 38 were male (66.7%) and 19 female (33.3%). Flame burn was responsible for 92.9% of the deaths, followed by 5.3% of deaths due to chemical burns and 1.8% to scalding. The highest mortality was found in the 71-80 yr age group, and survival decreased with increasing percentage burn surface areas. Mortality in males (20.8%) was higher than in females (18.6%), with flame burns causing produced more deaths than other aetiologies. The causes of deaths were acute renal failure (24 cases, 42.1%), septicaemia (18 cases, 31.6%), acute respiratory syndrome (5 cases, 8.7%), shock (4 cases, 7.0%), and upper gastrointestinal bleeding due to peptic ulcer and severe anaemia (1 case each, 1.8%). We conclude that improved facilities and better trained personnel will lead to a reduction in the current high mortality rate among burn patients in our environment.

Burns in epileptics: experience from enugu, Nigeria.

We present burn injuries sustained by epileptics and managed in our burns centre over a period of 10 years. There were a total of 18 patients who sustained burns as a result of epileptic attacks during the study period. This constituted 3.7% of the 485 burn patients seen during the period. There were 10 males and 8 females. Sixteen of them (88.9%) were known epileptics, while two had their first seizures when they sustained the burn injuries. Only seven of the patients (38.9%) had attempted any form of treatment for epilepsy prior to the burn injuries - four of these were on native herbal medications while three had seen orthodox medical practitioners but did not comply with their medications. Sixteen of the patients (88.9%) had flame burns and two (11.1%) had scald injuries. The burn surface areas ranged between 5 and 80%, with a mean of 21.0%. Most of the injuries were full thickness, necessitating wound cover. One patient had amputation of the right hand digits, while another had an above-elbow amputation. We submit that sociocultural beliefs about epileptics and epilepsy constitute a significant problem in this group of patients in our environment. Education of the people will reduce burn injuries in such patients.

Bacteriology of burn wounds in Enugu, Nigeria.

A retrospective study of bacterial infection in 71 burned patients over a 5-year period (1993-1997) was carried out. The commonest colonizing organism was Klebsiella species (26.7%) followed by Staph aureus (25.6%). There was a very high degree of resistance by these organisms to commonly available antibiotics in Nigeria, with the result that more expensive antibiotics such as the cephalosporins were required. The poor socioeconomic condition of most of the patients was a very important pre-disposing factor to burn wound infection, as only 25% of patients were able to afford the cost of wound microscopy and culture, thus leading to limited numbers of cultures being performed, the result being their prescription of antibiotics was made generally on an empirical basis. Restriction in the misuse of antibiotics and establishment of an infection control until will help to lower the incidence of infection.

Reduction mammaplasty by the inferior pedicle technique: experience with moderate to severe breast enlargement.

A ten year experience in breast reduction using the inferior pedicle technique of Robbins is presented. In 60 patients using this technique, there was no nipple or breast necrosis. Nipple sensation and lactation were preserved. Additionally, the breast shape and symmetry were satisfactory, in the majority of cases. This technique is recommended as safe and satisfactory especially for the large breast reductions usually performed in this environment.

Scope and problems of day-care surgery in a plastic surgical unit.

Interest in day-care surgery is on the increase world-wide, with various surgical specialties embracing this mode of health service. In a period of 5 years (January 1989-December 1993), 286 patients attending a Plastic Surgical Unit were operated on a day care basis. This represented 22.7% of all cases done within the period. The most frequently performed procedure was keloid excision and suture/flap cover (29.7%) followed by inguinal hemiorrhaphy (10.8%) ganglionectomy (8%), excision of lipoma (8%), scar revision (5.2%), suture of skin lacerations (4.5%), breast lumps biopsy (5.9), release, grafting or plasty of flexion deformity of fingers (3.4%). Other problems dealt with on day care basis included repair of human bite losses of face (3.2%); Excision of gynaccomastia (3.1%) umbilical hernia repair (2.4%); breast augmentation with implant 0.3%. Excision of planter wart, hairy naevus, chronic neck folliculitis, sebaceous cyst, dermoid cyst and polydactylism constituted the rest of problems dealt with as day cases. Readmission represents failure of day care surgery and constituted 2.4% of all cases. This was due mainly to social factors and bleeding at home. Significant wound breakdown occurred in 0.69% of cases. We conclude that day care plastic surgery in our subregion is safe and effective.

Early results of operative closure of pressure sores in traumatic paraplegics.

The development of pressure sores in the course of management of a paraplegic represents a major setback which will not only delay rehabilitation but prolong hospital stay. Pressure sores may heal under conservative management provided the site is relieved of pressure. This mode of treatment is associated with prolonged immobilisation and is accompanied by a higher incidence of recurrence. Since in our unit pressure sores are mostly closed with flaps, we decided to review our early results. Between 1981 and 1986, 28 patients with 61 pressure sores were surgically closed at the National Orthopaedic Hospital, Enugu, Nigeria. The 29 trochanteric sores were closed with tensor fascia lata (TFL) myocutaneous flap. Sacral sores were closed with bilateral gluteal flaps or a rhomboid flap. Most ischial sores were closed with gracilis myocutaneous flap. Overall 72.1% of our cases healed primarily with no complications. There were 3 major complications requiring reoperation and 14 minor complications which healed on conservative management with daily dressing. We conclude that operative closure of pressure sores in traumatic paraplegics is advocated as this affords the greatest benefit to the patients.