Hand injuries in children at King Fahd Hospital of the University in Saudi Arabia (1989-1991).

We study the pattern of hand injuries in children presenting to a university hospital in the eastern province of Saudi Arabia. A retrospective study evaluating all pediatric patients 12 years old or less with hand injuries excluding burns that attended the plastic surgery clinic at King Fahd Hospital of the University between January 1989-December 1991. One hundred and one cases were identified. Male to female ratio was 1.5:1, 68% were Saudis. Most injuries were domestic and caused by doors. The commonest type of injury was laceration (32.5%), fingertips were involved in 50.5% of cases. Nerve injury occurred in 21.8%, only digital nerves were affected. Most hand injuries in children occurred at home and are preventable. Familiarity with such injuries by the healthcare providers in emergency situations is of diagnostic and therapeutic importance. This attitude will lead to the best possible outcome functionally and cosmetically. Furthermore, such a practice will go along way in improving the morbidity and mortality pattern of these surgical casualties among innocent children.

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects.

A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.

Initiating a new renal transplant program: problems and results.

Patients from the North-West area of Saudi Arabia had to travel to Riyadh or Jeddah for renal transplantation and post-transplant follow-up. The administration of the North-West Armed Forces Hospitals Program provided medical expertise and financial support to set up a renal transplant program in this area. Suitable staff members including nephrologists, transplant surgeons, staff nurses social workers and laboratory personnel were recruited. A strong link was established with the Saudi Canter for Organ Transplantation in Riyadh. At the end of two years since establishment, 25 renal transplants (11 cadaver donor and 14 living donor) have been performed. During follow-up, nine patients developed serious infection including pneumonia, wound infection and tubercu-losis; all were managed successfully. Three grafts were lost necessitating graft nephrectomy and there were four deaths. The two-year graft survival is 83.3% and patient survival, 84%. These results are highly satisfactory taking into consideration the fact that our transplant program is new.

Laparoscopic orchidopexy: one-stage alternative for non-palpable testes.

Laparoscopy was utilised in the evaluation of 24 non-palpable undescended testes in 19 children. The procedure was accurate in all patients while ultrasound (US) and magnetic resonance imaging (MRI) failed to localise the testes in most cases. At the same time laparoscopic orchidopexy was performed on 15 testes (62.5%). The remaining testes were either absent or atrophic, in which case they were excised. There were no complications from these procedures and the hospital stay was short. Paediatric laparoscopy is safe and effective in the definitive management of non-palpable undescended testes.

Outcome of commercial renal transplantation: two years follow-up.

The results of living non-related renal transplants from India involving unethical exploitation of the donor are inferior. We followed-up 12 patients from our unit who went to a center in Bombay for renal transplantation and compared the results with our local new renal transplant programme. Two-year graft survival was 70% compared to 88% with our new renal transplant program. Also, we emphasised the human side of the problem. We addressed the problem of shortages of organ donation locally because failure to obtain consent from relatives and the need for intensive public education is required to overcome this problem. Finally, Islamic principles and rules that are related to organ transplantation have been discussed in detail, and the main purpose is to enlighten the Western reader.

[The first- and second-arch syndrome. A treatment analysis and plan]. / Syndrome du premier et du deuxième arc. Analyse et plan de traitement.

There is a very great lesion staging in these syndromes, and a great number of procedures have been described, according to the age and severity of the lesions. The initial assessment is therefore important, since it allows classifying these malformations according to their severity in key sectors. Scheduling the treatment in time must take account of: growth, the necessity to perform successive operations in one region, since no operation must hinder a subsequent one. It is essential to determine the optimum time for bone reconstruction. An early treatment with a conventional bone graft, without any intrinsic growth potential, condemns the reconstructed region to immobility, therefore to a progressive degradation of the result in time and to successive corrections. Early reconstruction is justified only if the available reconstruction means allow the reconstructed area to grow, either naturally or with the aid of orthopaedic stimulation. Some means seem to be available to date. A choice must therefore be made between: delayed morphological surgery, early functional surgery. Considering the extent of the means implemented, this is reserved for severe cases. The other great problem is the reconstruction of the auricle, which most often requires a series of operations scheduled over 2 years. The middle ear may not be operated if the lesions are unilateral. The other malformations, including macrostomia, muscular and neural abnormalities, involvement of the eyelids, sometimes require correction, which must fit in a repair schedule that must be established as soon as possible and must take account of the predictable procedures in order to prevent them from hindering each other.

[Osteosynthesis using a screwed plate in fractures of the mandibular condyle]. / L'ostéosynthèse par plaque vissée dans les fractures du condyle mandibulaire.

The surgical treatment of sub-condylar fractures allows rapid reestablishment of the bite, temporo-mandibular joint function and facial appearance. A pre-auricular approach is used involving dissection of the facial nerve and its upper branch. Surgical reduction is performed under direct vision. Fixation is via a plate with 4 screws. The condylar fragment needs to be large enough to accept at least two screws and hence this needs to be confirmed preoperatively by CT scan examination. In the adult we feel that fixation is indicated for low displaced sub-condylar fractures. We do not feel that surgery is indicated for recent trauma in children.