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CASE REPORTS
A rare case: Avulsion amputation of the hand with degloving of the soft tissues from the level of the arm
Rahul K Patil, Gopal Malhotra, Srinivasan Venugopal, Mahil Cherian, Abdullah Al Harthy
July-December 2015, 11(2):63-67
DOI:10.4103/0794-9316.178451  
We hereby report a case of avulsion amputation of the hand through the distal carpal row. The severity of the injury was such that it had avulsed the soft tissues from the forearm and the skin from the level of the arm as though a full sleeve of a shirt was being ripped off. Due to the extensive damage in multiple planes, the amputated part could not be saved. The below-elbow amputation stump though was covered with a new local flap based on the interosseous membrane and the periosteal flaps from the radius and ulna. The stump healed well and the patient recovered the full range of elbow movements.
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ORIGINAL ARTICLES
Lower limb reconstruction using propeller flaps
Sridhar Rajagopal, Santhanaraman Rajagopal, Sridharan Murugesan
July-December 2015, 11(2):45-50
DOI:10.4103/0794-9316.178450  
Background: The islanded pedicled perforator-based propeller design flap is a versatile local flap for reconstruction of defects of lower limbs from knee to leg to ankle to foot. Patients and Methods: All patients with small-and moderate-sized defects in lower limbs which required a flap cover are included in the study. Between October 2014 and September 2015, prospective study of patients undergoing perforator-based propeller flap procedure was performed. Patients were evaluated for defect size, defect location, procedure done, and donor site cover. Results and complications of the propeller flap were also analyzed. Atotal of eight flaps were done to cover defects of lower limbs. Results: Out of the eight flaps, seven were islanded on posterior tibial artery, one on the lateral geniculate artery perforator. Four flaps were used to cover lower one-third leg, three for middle one-third leg, and one for knee. The flap dimensions ranged from 3 cm×7 cm to 7 cm×19 cm. The median angle of rotation was 160°(ranging from 60° to 180°). Sixty-three percent of patients had associated fractures. Seven flaps survived completely and one flap had partial necrosis, which was managed with secondary split skin grafting. Conclusion: The islanded propeller design pedicled perforator flaps provides reliable coverage for small-to medium-sized defects for lower limbs, particularly lower one-third leg defects. This flap can provide an esthetically acceptable result as well.
  4,084 20 -
An analysis of skin cancer in albinos in Ibadan
Samuel Adesina Ademola
January-June 2015, 11(1):23-28
DOI:10.4103/0794-9316.166852  
Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.
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REVIEW ARTICLE
Management of Achilles tendon injuries: Current trends
Oluwafemi O Awe, Emmanuel E Esezobor, John Enekele Oniminya
July-December 2015, 11(2):34-39
DOI:10.4103/0794-9316.178455  
Introduction: Achilles tendon injuries have been on the increase worldwide, especially in the last two decades. The classification of the injury has not been explicit and the management protocols are confusing, especially with respect to specific injuries. There is a need to have a look at the current trends in the management of this common injury in order to create awareness and stimulate the need for standardization of the treatment protocols, possibly reaching a consensus. Materials and Methods: Information on the types of the injury, classification, and treatment modalities were obtained by searching the Pubmed, Medknow, Google Scholar, and other publications. These were collated and analyzed. Results: In most of the information on Achilles tendon injuries, these were inappropriately equated with Achilles tendon ruptures, which are actually supposed to be a subset. In the same vein, the diverse treatment options available were mainly those extensively used in ruptures. These procedures range from open surgery and minimal access surgery to close or conservative management followed closely with physiotherapy. Conclusion: There is a subtle misconception in the literature that we reviewed where Achilles tendon injuries were considered the same as Achilles tendon ruptures but this is not so. There are other injuries with different pathomechanisms and therefore, different managements. There is a need to include these other injuries and also broaden the management options. Minimal access surgery is preferred in ruptures.
  2,391 20 -
Reconstruction of soft tissue defects in the distal third of the leg, ankle, and foot: A meta-analysis
Samuel Adesina Ademola, Wasiu Olushola Adebayo, Olukemi Lawani
January-June 2015, 11(1):1-7
DOI:10.4103/0794-9316.166851  
Management of soft tissue defects in the distal third of the leg, ankle and foot has evolved over time despite its challenges. No option of coverage is universally recommended for defects in this region of the body. Our objectives were to review and analyze outcomes of reported options of reconstruction of soft tissue defects in this region. We conducted a search of PUBMED and HINARI databases from 2000-2014 to identify reported options of reconstruction of soft tissue defects of the leg, ankle, and foot. Pooled data from suitable articles were analyzed and the success and complication rates as well as the relative risks for failure and complications were computed. One thousand and thirty two articles were retrieved out of which thirty three met the inclusion criteria for analysis. All the 33 articles were uncontrolled cohort and descriptive studies. There were 14 reports on sural artery flap, 6 on perforator-based flaps, and 5 on free flaps. Cross leg flaps, adipofascial, peroneus brevis, and hemisoleus muscle flaps were reported in two studies each while medial plantar, supramalleolar, and skin grafts were reported in one study each. Flap failure was the commonest complication with free flaps while reconstruction with skin grafts had the lowest failure rate. Free flaps were, however, versatile for reconstruction of complex defect. Conclusively, meticulous planning is required in the reconstruction of defects of the lower third of the distal third of the leg, ankle, and foot in order to use the most appropriate method for best outcomes.
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CASE REPORTS
Split-hand/Split-foot malformation
Namgwa J Kortor, Williams T Yongu, Itodo C Elachi, Daniel D Mue
July-December 2014, 10(2):18-20
DOI:10.4103/0794-9316.155181  
Split-hand/split-foot malformation (SHFM), also known as ectrodactyly or lobster claw hand deformity, is a rare congenital limb malformation characterized by a median cleft of hands and/or feet due to the absence of the central rays. SHFM has a reported incidence of 1 in 90,000 live births. It may occur either as an isolated anomaly or as part of a syndrome. We present a rare case of a 9-year-old boy with SHFM who underwent surgical correction of the cleft hand, with improved cosmetic and functional outcome.
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ORIGINAL ARTICLES
University students and cosmetic surgery in Nigeria: A survey of perception, attitudes, and experiences
Amina I Abubakar, Mustapha A Jamda, Abdulrasheed Ibrahim, Abdulwahab Ajani, Kayode Iyun, Kingsley O Opara
January-June 2016, 12(1):12-16
DOI:10.4103/0794-9316.193733  
Introduction: A global trend to improve appearance has been observed with the advent of technological civilization and contemporary culture. This is related to social customs that places high premium on appearance, and the increased accessibility of cosmetic surgery. This article explores the perception of cosmetic surgery among university students in Nigeria. Materials and Methods: Self-administered questionnaires were used to collect data. It was divided into four sections; demographic, knowledge, attitude, and experience with cosmetic surgery. The association between knowledge, attitude, practice, and sociodemographic characteristics was sought using Chi-square statistical test. Statistical significance was set at P ≤ 0.05. Results: The respondents perceptions of what cosmetic surgery means include surgery for beauty 673 (52%), surgery on the face 84 (7%), use of chemicals for beautification 35 (3%), correction of deformity 37 (2.8%), and 116 (9%) were not sure. A significant association was found in attitude in the 15-25 age group, when asked about willingness to undergo cosmetic surgery. (P = 0.014) and recommending cosmetic surgery (P = 0.024). There was no statistically significant difference in gender when comparing the knowledge, attitude, and practice of cosmetic surgery. There was a significant difference in knowledge of cosmetic surgery among 3 rd and 4 th year students related to having heard about cosmetic surgery (P = 0.048) and knowledge of difference between cosmetic surgery and plastic surgery (P = 0.001). Participants that were single were more aware of cosmetic surgery (P = 0.013) and knew someone who had cosmetic surgery (P = 0.000). Conclusion: Attitudes toward cosmetic surgery are positively related to age, level of study, and marital status. However, there was no statistically significant difference based on gender. Our study also suggests that respondents are aware of the existence of cosmetic procedures, but they do not know what it actually means.
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Inventory of potential reconstructive needs in patients with post-burn contractures
Abdulrasheed Ibrahim, Ferdinand O Ijekeye, Malachy E Asuku
July-December 2014, 10(2):1-5
DOI:10.4103/0794-9316.155165  
Background: The inventory of potential reconstructive needs records the specific reconstructive needs of the patient with burns and allows systematic planning for future reconstruction and rehabilitation. It also assists patients to evaluate and prioritize reconstructive options with the guidance of the plastic surgeon, as well as facilitating the adoption of realistic expectations on the part of the patient and family. Materials and Method: A survey of the potential reconstructive needs was carried out using the inventory of reconstructive needs form. The form is applicable to all body regions and is divided into three sections. Each section is subdivided into anatomic units: head and neck (anatomic units 1-5); upper extremity (anatomic units 6-9); and trunk and lower extremity (anatomic units 10-13). The results are presented in tabular form and analyzed using simple frequency distribution. Results: The anatomic region with the highest number of reconstructive needs was the head and neck in adults 25 (42%).The trunk and lower extremity accounted for the least reconstructive needs in adults 12 (20%). When the reconstructive needs were stratified by anatomic units in the head and neck, the upper eyelids 8 (32%) and the neck 6 (24%) had the highest frequency of reconstructive needs in adults. The upper extremity had the highest reconstructive needs in children 51 (52%). The upper eyelid, mouth and neck accounted for 13 (76%) of the reconstructive needs in children. Seventy-eight (50%) of the 157 patients had at least two contractures. Conclusion: There were more reconstructive needs in children than adults. The anatomic region with the highest number of reconstructive needs was the head and neck in adults and the upper extremity in children. This study underscores the importance of positioning and intensive therapy intervention in the prevention of post-burn contractures.
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Impact of burn unit routine on outcome: A 5-year experience
Zainab Yunusa Kaltungo, Olabisi Shakir Olajide, Adamu Danladi Bojude
July-December 2014, 10(2):6-9
DOI:10.4103/0794-9316.155169  
Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients' case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars. Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.
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REVIEW ARTICLE
A simple penile dressing following hypospadias repair: Our institutional experience
Aditya Pratap Singh, Arvind Kumar Shukla, Pramila Sharma, Somya Ghosh
January-June 2016, 12(1):1-3
DOI:10.4103/0794-9316.193731  
Retaining a dressing on the phallus has always been difficult. Newer and innovative techniques are coming up in this regard. One such method is suggested which we find extremely useful. Advantages of this dressing are easy application, stability for long time, and easy and painless removal. Our dressing named as "Shukla dressing" is simple, cheap, easily available, and provides comfort to the patient as well as surgeon and caring nursing staff.
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ORIGINAL ARTICLES
Pattern of hand injuries seen in the accident and emergency unit of an urban orthopedic hospital
Ochuko Rex Dafiewhare, Adesina Ajibade
January-June 2015, 11(1):8-11
DOI:10.4103/0794-9316.166853  
Background: The development of hand surgery in our subregion is still very much in its infancy. At the national level, very little documentation exists on the patterns of hand injuries. This study was aimed at determining the patterns of hand injuries seen in an urban orthopedic hospital in Kano, Kano State, Nigeria. Patients and Methods: A retrospective study of 101 cases of hand injuries presenting between April 2009 and April 2010 in the accident and emergency unit was carried out. Results: There were 86 (85.1%) and 15 (14.9%) males and females, respectively. The mean age of the patients was 25.69 ± 14.04 years. Out of all the patients, 55.4% were presented within 6 h of injury. Traumatic amputations and fractures were the commonest types of injury. There was no significant difference between left and right hand involvement in injuries. The triad of occupational injuries, injuries from road accidents, and domestic accidents was the most common. Traditional bone setters played very little role in the prehospital management of injuries. Conclusion: Occupational hand injuries are most common among young working males. Early presentation of the patients and low involvement of traditional bone setters reflect the severity of hand injuries to victims.
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CASE REPORT
Final functional outcome in a case of wrist drop
Prasanta Kumar Bhattacharyya, Subhasish Ghosh, Arijit Roy, Manab Nandy
January-June 2015, 11(1):29-31
DOI:10.4103/0794-9316.166849  
Tendon transfers are used to restore balance and function to paralyzed, injured, or absent neuromuscular motor units. The goal is to improve the balance of a neurologically impaired hand. In the upper extremity, tendon transfers are most commonly used to restore function following injury to the radial, median, and ulnar nerves. We report the case of an Indian Border Security Force (BSF) jawan who had wrist drop following a bullet injury to the left upper arm.
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CASE REPORTS
Experience with a two-stage nasal reconstruction with the paramedian forehead flap
Abdulrasheed Ibrahim, Ferdinand O Ijekeye, Malachy E Asuku
July-December 2014, 10(2):21-23
DOI:10.4103/0794-9316.155185  
The unique anatomy of the nose combined with its aesthetic and functional importance makes its reconstruction a challenging but rewarding undertaking. The authors of this study present their experience in a two-stage nasal reconstruction with a paramedian forehead flap. The patient underwent reconstruction with a narrow pedicle to resurface the dorsum, and its distal wings covered the alae. He had a significant amount of residual intranasal lining and this was used for a pedicle flap. The reconstructed dorsum and nasal tip appeared bulky, and the soft triangle needed better definition after the second stage. The patient underwent two revisions with improvement in the projection, outline, and contour of the nose.
  1,930 9 -
ORIGINAL ARTICLES
Satisfaction of plastic surgeons with job, working environment, and practice in Nigeria: A pilot study
Emmanuel E Esezobor, Ojochide S Ebune, Festus A Okhimamhe
January-June 2015, 11(1):12-18
DOI:10.4103/0794-9316.166850  
Introduction: Dissatisfaction has serious consequences for both the physicians and patients. Studies had shown that job dissatisfaction among physicians is associated with increase rate of medical errors thus jeopardizing patients' safety. Plastic surgeons are not exempted from this problem. This study is aimed at knowing the level of satisfaction of plastic surgeons with their job, working environment and practice in Nigeria Materials and Methods: This is a cross-sectional study of plastic surgeons that attended the 19th annual scientific conference and annual general meeting of Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) in Lokoja Kogi State, Nigeria. Data on the determinant of Job satisfaction as described in “Medicine in Australia: Balancing Employment and Life (MABEL) questionnaire” was used. The level of significance was set at P ≤ 0.05. Result: There were 31 respondents with all the geographical zones except North-West represented. The mean age was 41.06 ± 5.84 years and the Female: Male ratio was 1: 5.2. There were more respondents who were indecisive on the level of satisfaction with the patients they see. Of those who were decisive (41.9%), more were dissatisfied (25.8%). Most respondents are dissatisfied with the level of support provided and work location. On objectively assessing the level of job satisfaction among this same group of plastic surgeons, only one (3.2%) respondent was satisfied. Conclusion: Plastic surgeons in Nigeria are not satisfied with their job. Remuneration seem to be far down the list of the causes of their job dissatisfaction.
  1,919 12 -
CASE REPORTS
Recalcitrant finger ulcer in HIV patient; think herpetic whitlow, save the finger
Zainab Yunusa Kaltungo, Emeka Nwakire
July-December 2015, 11(2):59-62
DOI:10.4103/0794-9316.178452  
This is a case report to highlight the atypical presentation of hand ulcers caused by herpes simplex virus (HSV) in immunocompromised patients. We report a case of a 43-year-old right-handed female who developed a nonhealing and progressive ulcer involving the left middle finger and extending to the palm for which she was referred to our facility. Initial clinical diagnosis following examination was squamous cell carcinoma. However, carefully observed similar new lesions she developed while being investigated was in favour of HSV infection. She had remarkable response on acyclovir which substantiated the diagnosis. Awareness and a high index of clinical suspicion are required of physicians who may come across similar lesions.
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ORIGINAL ARTICLES
Single cephalic vein as the only draining vein of radial forearm free flap: A comparative study of 154 cases
Nilamani Mohanty, Bibhuti Bhusan Nayak
July-December 2015, 11(2):40-44
DOI:10.4103/0794-9316.178454  
Background: Radial forearm free flap is the work horse in head and neck reconstruction. The venous drainage of the flap is by both superficial and deep group of veins. Aim of the Study: To compare the efficacy of venous drainage by single superficial vein (cephalic vein) with dual vein (cephalic vein & venae comitantes) in radial forearm free flaps and its impact on flap survival. Patient and methods- A total of 154 patients undergoing radial forearm free flap for reconstruction following resections of head and neck cancer were studied prospectively . In group 1 (75 cases) only cephalic vein was used as the draining vein and in Group 2 (79 cases) both cephalic vein & one venaecomitantes were used as the draining vein. Patients with non availability of cephalic vein as a result of chemotherapy or injury were excluded from the study. Data were retrieved frompatients' files and analyzed using SPSS computer software version 15.0. Observation and Results: The flap survival rate was 97.33% (73/75) in Group 1 versus 98.73% (78/79) in Group 2. The result is analysed statistically by using SPSS computer software version 15.0. and the P value > 0.50 (c2 with Yates' correction=0.00206555, df=1) stastically not significant. Conclusion: Though two vein anastomosis may provide a more fail safe theoretical advantage, single superficial vein (Cephalic) provides effective and adequate drainage with less operative time and no additional morbidity.
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An innovative method of repeated tie-over dressing for fixation of skin graft
Shabeer Ahmad Wani, Ovais Habib, Doaa Andejani, Faris Mugaren, Loai Abdullah Alsalmr
July-December 2015, 11(2):51-53
DOI:10.4103/0794-9316.178458  
Background: Tie-over dressing is an established method of fixation of skin grafts in areas of body where immobilization is difficult toprevent hematoma and seroma formationin addition to avoid shearing motion of the graft. Traditionally, using multiple silk sutures does this. This is a one-time procedure and refixation is difficult if we need to repeat the procedure. Methods: We assessed our initial experience with a repeated tie-over dressing method using cap and collar of normal saline bottles used for irrigation and silk suture threads infourpatients over the anterior chest wall. These patients underwent recurrent keloid excision with reconstruction by skin graft and postoperative radiotherapy. After the graft is applied on the floor, tie-over stitches are taken and paraffin gauze is applied over with adequate padding; the tie-over sutures are passed through the collar and the cap is tightened over it to complete the dressing. The cap can be unscrewed easily at any time to inspect the graft and can be easily reapplied in the outpatient department. Results: The skin graft take in all the patients was complete without any seroma or hematoma. An innovative tie-over dressing that enables simple fixation of the dressing, to maintain proper position of grafts that require repeated fixation, is reported here.
  1,793 18 -
CASE REPORTS
Amniotic band syndrome in a Nigerian cleft patient: A case report
Oladimeji Adeniyi Akadiri, Joycelyn Odegua Eigbobo, Barbara Edewele Otaigbe
July-December 2014, 10(2):15-17
DOI:10.4103/0794-9316.155175  
Amniotic band syndrome is a set of congenital malformations ranging from minor constriction rings and lymphedema of the digits to complex, bizarre multiple congenital anomalies that are attributed to amniotic bands that stick, entangle, and disrupt fetal parts. The most commonly associated anomalies include amputations, constriction bands, syndactyly, craniofacial defects, and club feet. A case of amniotic band syndrome involving limb anomalies and orofacial cleft deformity in a Nigerian child is reported.
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ORIGINAL ARTICLES
Post burn digital contracture our way: The pains, The gains
Zainab Yunusa Kaltungo, Adamu D Bojude, Olabisi Shakiru Olajide
January-June 2015, 11(1):19-22
DOI:10.4103/0794-9316.166848  
Background: Post burn digital contractures account for 30% of new outpatient clinic visits but 25% of elective surgery load in our practice. There is a lot of backlog and pressure to operate particularly in the pediatric age group. We were able to demonstrate in this series that irrespective of the duration, uncomplicated post burn contractures are usually not complicated by ankylosis and a single stage complete release is possible. Aims and Objectives: 1. To determine if multiplicity of joint involvement and duration between burn and corrective surgery affect outcome. 2. To determine the range of complications after post burn digital contracture release. 3. To determine if preoperative plain radiographs are necessary in uncomplicated post burn digital contractures. Materials and Methods: Retrospective analysis of the records of 33 patients. Data collected included socio demographic and disease characteristics, etiology of burns, duration of burns before corrective surgery, complications after corrective surgery. Data was analyzed using SPSS version 16.0. All patients with contractures in other joint other than digits and from other causes other than burns, or burns associated with mechanical trauma were excluded. Results: Mean age 8 yrs, nearly equal sex distribution. Scald 48.5%, flame 21.2%, contact burn 9.1%, others 21.2%. Mean duration between burn and contracture release 40months. Overall, 172 joints were involved in 33 patients, 69.7% had incision ,+ FTSG, 3% had incision+ STSG, 6.1% had Z plasty only and 21.2% had Z plasty + FTSG. In 32 patients (97%) complete intra op contracture release was achieved. Twenty patients (60.6%) healed without complications, recorded complications post op were wound infection (30%), graft shift and digital tip gangrence. Conclusion: Prolonged duration between burn and eventual contracture release does not affect achieving complete contracture release, neither does multiplicity of joint involvement.
  1,733 13 -
Psychiatric morbidity and quality of life among mothers of children with orofacial cleft disorders in Enugu: A pilot study
Ifeanyichukwu I Onah, Justin U Achor
July-December 2014, 10(2):10-14
DOI:10.4103/0794-9316.155170  
Introduction: This work investigates the prevalence of psychiatric morbidity and its impact on the quality of life of mothers of children with orofacial cleft. Mothers bear stresses and care burdens of ill family members and it affects their mental health. Little is known about the psychiatric morbidity of such mothers in South-eastern Nigeria. Materials and Methods: Participants were assessed using the Brief Screen for Depression (BSD), the EUROHIS-QOL 8-item Index, and the Self-Reporting Questionnaire (SRQ). The data was analyzed using SPSS version 15. Results: Of the 48 participating mothers, 50% screened positive for psychiatric morbidity with the SRQ, whereas 62.5% screened positive for depression using the BSD. Psychiatric morbidity was found more among mothers with lower levels of education, having more children; older index children and with over-representation of affected female children. The mean quality of life score was 3.34 ± 0.86. Mothers that screened positive for psychiatric morbidity reported a significantly lower quality of life than those without morbidity (2.82 ± 0.90 versus 3.85 ± 0.40). Conclusion: Features of psychosocial distress and depression are common among mothers of cleft children and exert negative effects on their quality of life.
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CASE REPORTS
Cenani–Lenz syndrome: A case report
Hayat Al-Nougidan, Shabeer A Wani, Ahmad Wafeeq Wafa
July-December 2018, 14(2):45-49
DOI:10.4103/njps.njps_1_18  
Cenani–Lenz syndrome is a rare autosomal recessive congenital malformation syndrome characterized by syndactyly and oligodactyly of fingers and toes, disorganization and fusion of metacarpals, metatarsals, and phalanges, radioulnar synostosis, and mesomelic shortness of the upper limbs, with lower limbs usually being less severely affected and associated with facial dysmorphism and renal abnormality. A case report of a 16-year-old Saudi male presented with four limbs syndactyly of fingers and toes, mild facial dysmorphism, dextroscoliosis, and crossed fused ectopia of the left kidney at the right side is presented here.
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ORIGINAL ARTICLES
The relationship between cleft width and oronasal fistula
Ezekwe Ekwueme Amirize
January-June 2016, 12(1):4-11
DOI:10.4103/0794-9316.193732  
Context: Width of cleft palate influences difficulty of surgical repair and indirectly the outcome. Palatoplasty complicated with oronasal fistula causes persistence of speech, feeding, and social problems. Subsequent closure of palatal fistula has high recurrence rate. Aim: To determine the relationship between palatal cleft width and oronasal fistula. Setting and Design: One-year prospective nonblinded study. Materials and Methods: All consecutive patients with cleft palate that presented to the study institutions within the period, and met inclusion criteria were studied. The width of the palatal cleft defect was measured intraoperatively. Statistical Analysis Used: Chi-square and Mann-Whitney U-tests were used. P < 0.05 were considered statistically significant. Results: Forty-six patients were studied out of 53 patients seen during the study period. These were 22 males and 24 females giving male to female ratio of 0.92:1. Patients' ages ranged from 10 months to 28 years; 52.17% of the study population were 2 years and below while 47.83% were aged over 2 years. Cleft width ranged from 4 to 25 mm. Nineteen patients developed fistula. Thus, the overall rate is 41.30%. Likelihood of fistula occurring increased as the width of cleft increased. Fistula rate was higher for patients with cleft width above 15 mm. Fistula rate for intravelar veloplasty was 30% and 50% for von Langenbeck repair; this was not statistically significant. Conclusion: Cleft width is a strong factor in the development of oronasal fistula. The fistula rate suggests a high burden of the problem. Efforts should be made to improve management outcome.
  1,639 16 -
Early experience with tangential excision and skin grafting of deep dermal burns of the hand among diabetics and nondiabetics
Akram Hussain Bijli, Mir Yasir, Tahir Saleem Khan, Hayat Al Daheri, Mohanad M Banoqitah, Ammar Bagdadi
January-June 2016, 12(1):17-20
DOI:10.4103/0794-9316.193735  
Introduction: Deep dermal injury of the hand should have a special management because it has a high potential to affect the functional capabilities of the hand. This study was established to measure the outcome of managing these special types of patients and comparing their outcome with nondiabetics. The goal was to intervene and cover the wound within a time limit of <14 days. Patients and Methods: Between the period of November 2011 and October 2013, we managed a total number of 12 patients with deep dermal burn to the hands in the Burn Unit at King Fahad General Hospital, Jeddah . Four patients were insulin-dependent diabetics, and eight were nondiabetics. An early tangential excision and skin grafting was done in these patients within 14 days of injury. Results: All 12 patients were male. The average age was 45 years. The average total body surface area (TBSA) burnt was 35%, with a range of 2-65%. Four patients were insulin-dependent diabetics, whereas eight patients had no medical comorbidity. Two of the diabetics had an isolated hand burn, and the other two had 30% and 50% of TBSA full-thickness burn, respectively. The graft take was satisfactory among the patients with no difference between the diabetics and the nondiabetics. The grafted hands underwent physiotherapy following the procedure. Satisfactory outcomes were seen among all the grafted hands, with near return to full function. Conclusions: Tangential excision is recommended during the first 5 days postburn to reduce the risk of infection and graft loss. Diabetic patients do not behave differently from nondiabetic patients in their response to graft take, wound healing, and return to work.
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EDITORIAL
Moving forward
Peter B Olaitan
July-December 2015, 11(2):33-33
DOI:10.4103/0794-9316.178456  
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CASE REPORTS
Combined turnover and deltopectoral flap in closure of persistent pharyngocutaneous fistula
Ayodele Oludare Ogunkeyede, Adebiyi B Aderibigbe, Ismaila Adigun Lawal, Habeeb K Omokanye, Olushola A Afolabi, Adekunle D Dunmade
January-June 2016, 12(1):21-25
DOI:10.4103/0794-9316.193737  
Pharyngocutaneous fistula (PCF) is an infrequent complication of salvage total laryngectomy with associated increased morbidity. Chemoradiation for advanced laryngeal cancer is associated with increased incidence of PCF. In this case report, we present the first successful repair of a major PCF with prior chemoradiation therapy after multiple attempts at repair of the fistula in our health-care service.
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