Digit Replantation Practice: A Comparison of Three Rat Models.

Digit replantation is a complex surgery that nearly always needs to be done as an emergency. As such it is often difficult to teach. Several models have been developed to train surgeons in this procedure. We compare three rat models of replantation with the aim of ascertaining which most simulates the digit replantation. Inbred albino rats were selected and divided into three groups of 13 each, tail, penile, and hind replant groups. Three rats in each group were anesthetized, the specific amputation injury is created and is replanted for the anatomic component of the study. For the comparative section, 10 animals were anesthesized and the amputated parts were replanted under standard conditions. The parameters measured included weight, vessels and nerve diameters, method of fixation, total ischemia and replant times, the patency rates (after operation and at one week post surgery), as well as postoperative complications. All rats survived in the procedure. There was patency in all groups immediately. Rat tail group had 90%, penile group 100%, and hind limb group 90% survival 1 week after the replantation. There was one mortality in the hind limb group. The penile replant group was the shortest ( p < 0.001), and all vessel sizes were comparable except the central artery of the tail which was significantly smaller ( p < 0.001). The processes of the hind limb group most simulated the human digit replant procedure, though the ischemia and total replant times are significantly longer ( p < 0.005). Though the immediate and 1 week patency rates were similar in all three groups, the hind limb replantation model involved steps most similar to human digit replant surgery and is recommended as the preferred teaching model.

Does a wrist tourniquet improve the quality of Biers block for surgeries in the hand?

This study aims to determine the effect of a wrist tourniquet on Biers Block quality for short hand procedures. 40 patients were randomized into 2 groups. One had the intravenous lignocaine injected with a wrist rubber tourniquet in situ, While the control group had none during injection. The onset of block, sensation, motor activity, need for additional analgesia and duration of surgeries were recorded for each group and analysed statistically. 27 males and 13 females were recruited. Mean onset for the tourniquet group was 4.3minutes and 9.0 minutes for the control (p< ˂0.0000005), Visual analog Pain Scores were 0.2 for Tourniquet and 1.8 for control (p< 0.0003) at 15 minutes. Sensory and motor block scores were significantly higher at 15 minutes following anaesthetic agent administration in the tourniquet group compared to the control(p<0.05). At 30 minutes there was no statistically significant difference in the scores. There was also no difference in the need for additional analgesia in either group. It appears that the use of a wrist tourniquet shortens the onset of Biers block for hand surgeries. However, it does not improve overall block quality after 30 minutes of administration but allowed a smaller dosage to be used with fewer side effects

Reconstruction of complex craniofacial defects by free flaps: Two case reports.

Complex craniofacial defects often create a reconstructive challenge in our region. We highlight two cases that demonstrate this problem and highlight the role of microvascular free flaps in covering these defects. The evolution of head and neck reconstruction as well as the peculiarities of these types of reconstruction in our environment are discussed.

Predictors of surgical site infections of the abdomen in Lagos, Nigeria.

BACKGROUND: The issue of nosocomial infection constitute a significant burden on any health care facility particularly in resource constrained centers of many developing countries. OBJECTIVES: A prospective cross sectional study was designed to determine the baseline surgical site infection rate following abdominal surgeries, determine the influence of various factors on infection rates, evaluate the predictive value of the ASA, SENIC, NNIS indices on infection rates and identify the common aerobic and anaerobic organisms responsible for such infections. METHODS: One hundred and forty four consecutive patients who had abdominal surgeries were studied at the Lagos University, Teaching Hospital over a one year period. Demographic, clinical and other parameters were obtained with aid of a proforma. Those who developed surgical site infection had swabs taken for aerobic, anaerobic cultures and antimicrobial sensitivity. RESULTS: Wound infection rate was 17.4%. Surgeries involving the small bowels and the colon made up 75% of all infected cases. The predominant organisms isolated were Pseudomonas, enterobacter, proteus species Bacteroides was the most frequently isolated anaerobic organism. The predictive factors for infection were long surgeries, surgical procedures classified as contaminated or dirty, high ASA (American Society of Anaesthesilogist) scores, SENIC (Study of Efficacy of Nosocomial Infection Control), NNIS (National Nosocomial Infection Surveillance Index) scores. CONCLUSION: The predictive scores can be utilized to identify high risk surgeries and institute appropriate measures to reduce surgical site infections.

Microvascular Anastomosis of Vessels Less Than 0.5 mm in Diameter: A Supermicrosurgery Training Model in Lagos, Nigeria.

The development of reconstructive microsurgery has now reached the supermicrosurgery stage. However the anastomosis of vessels under 0.5 mm is still out of the comfort zone of the many microsurgeons. To confirm the technical feasibility and the reliability of this technique We relate our own experience in this regard using the free superficial inferior epigastric flap of the rat as a model for supermicrosurgery training at the Microsurgery Laboratory of the Lagos University teaching hospital. 18 of the 20 free flaps transferred survived at 1 week. Two flaps necrosed and two flaps dehisced. We believe based on our work that the average microsurgeon can become comfortable working with these vessels.