Lower extremity amputations (LEAs) in a tertiary hospital in Togo: a retrospective analysis of clinical, biological, radiological, and therapeutic aspects.

BACKGROUND: We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. METHODS: Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. RESULTS: We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15-90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050-4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. CONCLUSIONS: Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and  relative complications.

Neurosural fasciocutaneous cross-leg flaps for leg salvage surgery

Introduction: Complex traumatic injuries in legs frequently lead to dramatic soft tissue and bone defects in which use of local and regional flaps may be compromised. This situation constitutes a major challenge in leg reconstruction. Apart from free-tissue transfers, cross-leg flap fascio-cutaneous flaps have a potential to become an ultimate limb salvage procedure. We report two cases of use of fascio-cutaneous cross-leg flaps for extensive defects in legs. Refinements to avoid flap failure are described. A review literature is performed. Cases: A child of 5-year-old and an adult of 26-year-old presenting extensive tissue loss of the leg were treated by cross-leg fascio cutaneous flaps. Apart from discomfort during the procedure, there was no undesirable event in the postoperative course. The flaps provided good tissue for further bone reconstruction. Conclusion: Although free-tissue transfer is the most used procedure nowadays, fasciocutaneous cross-leg flaps are found to be useful for limb salvage surgeries

Treatment of an acute deep hand burn in a lowincome country with no available microsurgery: a case report.

Deep hand burns usually lead to joint and tendon exposure. A simple skin graft is insufficient to achieve healing. Soft tissue reconstruction represents a surgical challenge that ranges from the simplest to the most complex flaps. In some areas, microsurgery is not technically possible. Choice is then limited to pedicled distant flaps such as the abdominal wall flap-graft. We report a case of an acute burned hand with exposure of metacarpophalangeal joints from the second to the fourth radius as well as proximal inter phalangeal joints from the second to the fifth radius and extensor tendons, treated in the burns and wound care unit of the Sylvanus Olympio Teaching Hospital in Lomé. The dorsum hand and fingers were covered with a pedicled abdominal flap-graft that was severed in two stages at 22 and 29 days. We achieved good results (sensitivity S3+, useful aesthetic hand) at two-year follow up.

Les brûlures profondes de la main conduisent habituellement à une exposition articulaire et tendineuse. La reconstruction des parties molles représente un challenge chirurgical qui va de la technique la plus simple au lambeau le plus complexe. Dans certaines contrées, la microchirurgie n'est pas techniquement possible et le choix se limite à l'utilisation de lambeau pédiculé à distance, comme le lambeau-greffe abdominal; nous rapportons un cas de brûlure récente de la main avec exposition des articulations métacarpo phalangiennes du second au quatrième rayon avec de plus une atteinte des articulations inter phalangiennes proximales du second jusqu'au cinquième rayon et exposition des tendons extenseurs. Ce patient a été pris en charge dans l'Unité des brûlés et des Plaies et Cicatrisation du Centre Hospitalier Universitaire Sylvanus Olympio de Lomé. La face dorsale de la main et des doigts a été couverte par un lambeau-greffe pédiculé abdominal, qui fut sevré en 2 étapes (22ème et 29ème jour). Nous avons obtenu de bons résultats sur le plan de la sensibilité ainsi que sur l'aspect esthétique chez ce patient après deux ans de suivi.

Hand trauma epidemiology in a hospital setting in Togo

Purpose: Hand trauma epidemiological characteristics are lacking in low and middle-income countries. The aim of the study was to determine hand trauma characteristics to be use as a framework for planning hand surgical care in our country. Material et methods: Registers in Surgical Emergency Department from 1st June 2009 to 31st May 2014 were reviewed retrospectively to determine frequency, socio-demographic of patients and clinical characteristics of hands injuries. Results: Frequency of hand trauma was 0.7% of all admissions in the Surgical emergency department. The male to female ratio was 3.4:1. Mean age was 28 years. Manual work was the most representative occupation (33.2%). Road traffic accidents were the main circumstances of hand injuries (38%). Open injuries represented 68%. Fractures, dislocation and sprains were seen respectively in 41%, 31%, and 8% of cases. Simple wounds were seen in 38 % of all patients. Conclusion: Hand trauma seemed to be of low frequency in hospital in our setting. Main injuries encountered are fractures, dislocation, and sprains