Sural nerve preservation in reverse sural artery fasciocutaneous flap-a case report.

BACKGROUND: The reverse sural artery flap is a generally accepted means of soft tissue reconstruction for defects of the distal third of the legs. The routine sacrifice of the sural nerve with its consequential temporary loss of sensation on the lateral aspect of the foot can be of concern to early rehabilitation of some patients. METHOD: This is a case report of a 24 years old male who had Gustillo and Anderson type IIIB injury involving the upper part of the distal 3rd and the middle 3rd of tibia. A reverse sural artery flap was raised without transecting the sural nerve to cover the distal part of the defect. RESULT: The distal part of the exposed bone was covered with the reverse sural artery flap without loss of sensation at anytime to the lateral part of the foot. CONCLUSION: The reverse sural artery flap can be raised to cover the upper portion of the distal leg without severing the sural nerve.

A five-year review of burn injuries in Irrua.

BACKGROUND: The management of burns remains a challenge in developing countries. Few data exist to document the extent of the problem. This study provides data from a suburban setting by documenting the epidemiology of burn injury and ascertaining outcome of management. This will help in planning strategies for prevention of burns and reducing severity of complications. METHODS: A total of 72 patients admitted for burns between January 1st, 2002 and December 31st, 2006 at the Irrua specialist teaching hospital were studied retrospectively. Sources of information were the case notes and operation registers. Data extracted included demographics as well as treatment methods and outcome RESULTS: The results revealed male to female ratio of 2.1:1. Over 50% of the injuries occurred at home. There was a seasonal variation with over 40% of injuries occurring between November and January. The commonest etiologic agent was flame burn from kerosene explosion. There were 7 deaths in the series. CONCLUSION: Burns are preventable. We recommend adequate supply of unadulterated petroleum products and establishment of burn centers.

Performance of a trained traditional bonesetter in primary fracture care.

BACKGROUND: In developing nations traditional bonesetters (TBSs) play a significant role in primary fracture care. However, despite high patronage the TBS remains an untrained quack whose practice is often associated with high morbidity. This study evaluated the performance of a trained TBS in primary fracture care. METHODS: Between 2002 and 2004 a prospective study was undertaken comparing the performance of a trained TBS with that of an untrained TBS at two separate locations. The two centres selected were both popular in traditional bone setting. A 1-day instructional course was given to the TBS at Afuje study centre, while the TBS at Ogua control centre received no instruction. The outcome of treatment of tibial shaft fractures at the two centres was evaluated and compared to assess the success of the course. RESULTS: There was a considerable decrease in the rate of gangrenous limbs, infection, non-union and malunion at the trained TBS centre compared with the untrained TBS centre (2.5% v. 10%, 5% v. 12.5%, 7.5% v. 15%, and 20.0% v. 30%, respectively). The observed difference between the trained and untrained TBSs was statistically significant (p < 0.05). CONCLUSION: It appears that training TBSs can reduce morbidity rates following TBS treatment.

Outcome of surgical zipper technique.

In the period between March 2003 and February 2005, we carried out a randomized controlled prospective study to evaluate the outcome of the surgical zipper technique in closing 50 clean surgical skin wounds in our centers. The gender, age and wound distribution were similar for the surgical zipper study group and the conventional nylon suture control group. The outcome of scar was rated as good if the emerging scar was a thin, linear (< 2 mm wide) scar and bad if it was a broad, flat (> 2 mm wide) or a heap-up scar. The outcome of scar was good in 43 (86%) in the study group as compared with 21 (42%) in the conventional control group. The observed difference between the two groups was statistically significant (p < 0.05). We observed superficial wound infection in two (4%) in the study group, compared with 12 (24%) in the conventional control group. The outcome of our study clearly showed that the surgical zipper is a superior technique of closing surgical skin wounds, and we recommend its use in our environment.

Misadventure in traditional medicine practice: an unusual indication for limb amputation.

Limb amputation is a major cause of disability in Nigeria, and inadequate health facilities for limb salvage procedures and rehabilitation have increased the burden of amputation surgery in our environment. The common indication for limb amputation in Nigeria is limb gangrene due to trauma. A road traffic accident is an important cause of the trauma, and the role of the traditional bonesetters in the increasing incidence of limb gangrene has been reported. The complications of the traditional bonesetter's practice in Nigeria account for about 50-60% of the limb gangrene necessitating amputation in our hospitals. Misadventures in traditional medicine practice are not new to us. People have lost their lives in the cause of testing the efficacy of traditional medicine. This paper reports an unusual indication for limb amputation in Nigeria following misadventure in a traditional medicine practice in a rural community.