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ABSTRACT
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 28-41

Abstracts of the Joint Conference of the Nigerian Association of Plastic and Reconstructive Surgeons and Nigerian Burn Injury Society Which Held Between September 2 nd and 5 th , 2015, at Osogbo, Osun State, Nigeria


Date of Web Publication10-Nov-2016

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How to cite this article:
. Abstracts of the Joint Conference of the Nigerian Association of Plastic and Reconstructive Surgeons and Nigerian Burn Injury Society Which Held Between September 2 nd and 5 th , 2015, at Osogbo, Osun State, Nigeria. Nigerian J Plast Surg 2016;12:28-41

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. Abstracts of the Joint Conference of the Nigerian Association of Plastic and Reconstructive Surgeons and Nigerian Burn Injury Society Which Held Between September 2 nd and 5 th , 2015, at Osogbo, Osun State, Nigeria. Nigerian J Plast Surg [serial online] 2016 [cited 2022 Jul 3];12:28-41. Available from: https://www.njps.org/text.asp?2016/12/1/28/193747

Reconstruction of open contaminated Achilles tendon injury using a composite reverse sural island flap

Opara KO, Uzoho A

Department of Surgery, Imo State University Teaching Hospital, Orlu, Imo, Nigeria

Open Achilles tendon injuries present a complex problem to the treating surgeon, especially if associated with tendon and soft tissue loss. Two modalities of the treatment have been described. One method is to do tendon reconstruction using various tendon grafts along with soft tissue cover either with a local flap or a free flap. The second method is to use a composite graft of tendon and soft tissue. This second option is thought to fair better in the presence of infection. However, it is usually accomplished using a free flap. Here, we present a case of open Achilles tendon reconstruction using a composite reverse sural island flap in an 8-year-old child.

Perception and attitude of Nigerians toward cosmetic surgery (a preliminary review)

Kamaldeen Gbadamosi, Dayo Salawu

Department of Surgery, Aminu Kano Teaching Hospital, Kano and Ekiti State Teaching Hospital, Ekiti, Nigeria

Aims and Objective: There is a worldwide increase in the demands for cosmetic surgery, but this cannot be said for Nigeria. This study aims to assess the perception and attitude of Nigerians toward cosmetic surgery, thus providing information on what may be demanded.

Methods: The study questionnaires were designed using Google forms, which were sent to respondents using social media platforms. Receipt of responses indicated consent. The study started on July 2015 and 100 responses had been received. Respondents were aged 16 years and above and Nigerian citizens.

Results: This is a preliminary report as more responses are expected. The highest age group was 21-29 years and female responded more. Most respondents were single and 64.4% of respondents learned of cosmetic surgery from cable television. While 53.4% agree that only trained plastic surgeons should perform cosmetic procedures, 50.7% of respondents are aware that cosmetic surgery can be done in Nigeria. 6.8% had cosmetic surgery done while 41.1% have considered having surgery. Of the respondents who have considered surgery, 56.7% want to improve an unsatisfactory body features. The most required procedures were abdominoplasty, mastopexy, and buttocks augmentation. Most respondents preferred the procedure in a usual hospital visit and 86.7% said that they would recommend it to others if they have satisfactory outcomes. Respondents who have not considered cosmetic surgery gave the reasons of satisfaction with the body, fear of complications, and religious belief.

Discussion: This study, though preliminary at this stage, has given insight into the perception of Nigerians toward cosmetic surgery. This should encourage more training and practice of cosmetic surgery to provide clients with optimum care.

Nostril types of Hausa-Fulanis attending outpatient clinics at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Malu TJ, Abubakar AI, Legbo JN 1

Department of Surgery, Plastic Surgery Division, University of Abuja Teaching Hospital, Gwagwalada, Abuja, 1 Department of Surgery, Usmanu Danfodio University Teaching Hospital, Sokoto, Nigeria

Background: Despite the growing interest in esthetic and reconstructive nose surgery, there is a dearth of information on normal nose parameters among black populations. The Hausa-Fulani tribe, who is one of the major tribes in Nigeria, has few documented norms on nose parameters.

Objectives: This study sought to establish norms of nostril types among the Hausa-Fulani group, and to determine any intra-racial and inter-gender difference in these parameters.

Methods: The study is a prospective one carried out at three outpatient clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. The study consisted of 405 patients from 18 to 70 years of age, selected by the convenience sampling technique. Nostril types were assessed based on the reviewed classification by Farkas.

Results: The nostril types cut across Types II to VII, with types V and III being the most common and Types II and VII the least common. No significant sex difference existed in the distribution of the nostril types.

Conclusion: The Hausa-Fulani group has several variations in nostril types but exhibits predominantly Types III and VI. There are no significant gender variations. We suggest that the Hausa-Fulani patient seeking nose surgery should not be treated as a group but as an individual.

Arteriovenous fistula with infiltration of entire right vastus lateralis muscle: A case report and review of literature

Yunusa Kaltungo Z, Samson S, Ogbeide JI, Nwakire EC

Division of Plastic Surgery, Federal Teaching Hospital, Gombe, Nigeria

Case Summary: A 25-year-old man presented with the right thigh swelling for 19 years before presentation. Swelling was occasionally painful. No difficulty in using the limb. He had similar swelling of the same region a year earlier following road traffic accident in which he sustained blunt injury to the thigh for which he was managed as a case of posttraumatic hematoma with resolution of swelling after 5 days. He has had initial exploration of the swelling with the findings of highly vascular mass necessitating referral. Essential findings on examination were 8 cm × 8 cm × 1 cm swelling over the distal third of the right thigh with a transverse scar of previous surgery on the overlying skin. Clinical diagnosis was traumatic arteriovenous fistula (AVF). Doppler ultrasound showed features suggestive of periarticular AVF but did not show extent of involvement and culprit vessels. He was planned for re-exploration and feeding vessel ligation. Intraoperative finding was a vascular mass within the distal half of the right vastus lateralis muscle. The main arteriovenous connection and feeding vessels were not visualized. The involved part of the muscle was excised and hemostasis secured. Histology report of the resected specimen showed features supportive of the diagnosis.

Conclusion: Infiltration of entire muscle should be considered following long-standing AVF and excision of the entire muscle should perhaps be considered if this will cause no functional deficit.

Neonatal scald burns management at Jos University Teaching Hospital, North Central Nigeria: A call for public awareness

Akintayo AJ, Karago CY, Yiltok SJ, Toma BO, Sankey BJ 1

of Surgery, Plastic Surgery Unit, Jos University Teaching Hospital, 1 Department of Paediatrics, Neonatology Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: Burns injuries presenting in neonatal period are uncommon and may be very challenging to manage because of peculiarity of the age and limitation of our environment. Most of the injuries are usually unintentional (not assault) and occurred outside the hospital as opposed to occurrence in developed countries which are hospital procedural related. Burns injuries are inflicted by caregivers (usually not the mothers) during the process of bathing.

Aims: The aim of this study is to draw attention to the need for proper supervision and education of caregivers who are usually not mothers during neonatal period, the delicate nature of baby skin and discourage tradition of hot water bath.

Methodology: All case notes of neonates with scald injuries that were managed at the Special Care Baby Unit of the Jos University Teaching Hospital were reviewed and presented in this report.

Results: Four neonates were managed. All patients had good outcome with period of admission varying between 10 days and 4 weeks and percentage burns between 10% and 35%. None of the patients require skin grafting.

Conclusion: Neonatal scald burns are uncommon. Good outcome can be achieved with adequate and proper team nonoperative management. There is a need for more public awareness campaign to discourage the occurrence this burns.

Inhalational injury in major burns following domestic gas explosion

Belie O Osinubi Olumuyiwa, Omosebi Taiwo, Ajani Abdulwahab, Fadeyibi Idowu Olusegun

Department of Surgery, Plastic Surgery Unit, College of Medicine, Lagos University Teaching Hospital, Ikeja, Nigeria

Aim: The aim of this study was to present our experience and sensitize the society of the catastrophic waste cooking gas has brought to lives in Lagos.

Methods: The study was carried out in the plastic surgery unit of the Lagos State University Teaching Hospital. The data of all the patients involved in domestic (cooking gas) explosion between June 2013 and June 2015 (2 years period) were retrieved from the medical record unit of the hospital. The parameters considered include age, sex, etiology of burns, percentage burns, and the presence of inhalational injury.

Results: During the period, a total of thirty patients were seen and treated from 2013-2015 with burns from cooking gas. The etiology was cooking gas explosion in all patients (100%), age ranged between 2 and 50 years. Six patients (20%) were below 20 years of age. Sixteen males (53.3%) and 14 females (46.7%) had major burns (100%), 20%-89% total body surface area. Twenty-seven had facial burns (90%). Depths were mixed thickness in all, mainly deep dermal burns. All patients with facial burns had clinical features of inhalational injury. Thirteen patients died (43.3%). All dead patients had inhalational injury and their age ranges between 30 and 50 years. All died within the first week of admission.

Conclusion: Domestic/cooking gas explosion is on the increase. Deaths from this are common. Many deaths occurred before hospital arrival, so they are unaccounted for. General education and awareness regarding handling of cooking gas are needed among the citizenry to prevent continual loss of working population through a preventable death.

Total calcaneal reconstruction with free fibula osteocutaneous flap

Belie O Osinubi Olumuyiwa, Omosebi Taiwo, Ajani Abdulwahab, Fadeyibi Idowu Olusegun

Department of Surgery, Plastic Surgery Unit, College of Medicine, Lagos University Teaching Hospital, Ikeja, Nigeria

Aim: The objective of this case report is to share our experience with the reconstruction of a complex calcaneal defect.

Methods: Complex total calcaneal defects represent a reconstructive challenge because it plays a key role in standing and gait. We report our experience of a 50-year-old man with complex total calcaneal defect due to chronic osteomyelitis. The soft tissue defects were reconstructed with an anterolateral thigh flap and the bone defect with a vascularized fibula osteocutaneous flap.

Conclusion: Bone maturation was seen radiologically 6-month postoperative period and patient can bear weight on both feet.

Photogrammetric analysis of nasal anthropometry in the Yoruba Ethnic Group of Southwest Nigeria

Kamaldeen Gbadamosi

Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria

Aim and Objective: The nose is an essential unit of facial esthetic that exhibits racial and ethnic variability and also shows sexual differences. The objective of this study was to use digital photography to assess and develop a reference of nasal anthropometry in the Yoruba Ethnic Group of the Southwest Nigeria that will be valuable for ethnic nasal reconstructions, rhinoplasty, and forensic evaluation.

Methodology: The study involved 212 participants, between the ages of 18 and 25 years, with a normal body mass index and of the Yoruba ethnicity. The participants had no facial anomalies, surgery, or trauma. Digital photographs of the participants were taken and landmarks were applied digitally. The parameters were measured digitally and the mean and standard deviation were calculated. Statistical significance for sexual dimorphism was assessed.

Results: The mean and standard deviation of parameters observed for male and female participants, respectively, are nasal length (44.19 ± 4.65 mm and 43.94 ± 3.68 mm); nasal width (44.0 ± 3.14 mm and 40.85 ± 3.24 mm); nasal bridge length (31.55 ± 4.65 mm and 31.34 ± 3.21 mm); nasal root width (17.29 ± 2.36 mm and 17.02 ± 2.56 mm); lobule height (17.46 ± 3.41 mm and 17.31 ± 2.14 mm); columellar length (8.40 ± 1.37 mm and 8.00 ± 1.60 mm); columellar width (7.6 ± 1.16 mm and 7.24 ± 1.14 mm); nostril length (8.42 ± 1.51 mm and 7.66 ± 1.3 mm); nostril width (12.27 ± 1.51 mm and 10.96 ± 1.52 mm); nasal bridge inclination (42.82 ± 7.25° and 40.54 ± 6.08°); columellar inclination (110.74 ± 13.42° and 110.49 ± 8.57°); nostril inclination (69.58 ± 10.09° and 72.77 ± 14.15°); frontonasal angle (124.49 ± 10.59° and 135.21 ± 7.16°); nasolabial angle (77.77 ± 16.67° and 79.66 ± 13.88°); nasomental angle (129.16 ± 5.37° and 131.75 ± 11.95°); nasal index (100.48 ± 9.75 and 93.22 ± 7.58).

Conclusion: This study showed that the Yoruba nose is platyrrhine as shown in previous studies, and it also evaluated other nasal parameters that have not been previously documented. The study also showed sexual dimorphism in nasal width, columellar width, nostril width, nostril length, nasal bridge length, frontonasal angle, and nasal index (P < 0.05).

Surgical complications and management of pentazocine dependence among health workers

Oseni OG, Olaitan PB, Olakulehin OA, Akanbi OO, Adebayo KO 1 , Oyewole AO 1 , Onilede DA 1

Departments of Surgery and 1 Psychiatry, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria

Objective: The objective of this study was to present some of the musculoskeletal hazards of pentazocine injection and create awareness for prevention and early detection of the complications to reduce morbidity and mortality associated with this injection in our environment.

Design: A retrospective cohort study.

Setting: Ladoke Akintola University of Technology Teaching Hospital Osogbo and Ogbomoso Centers.

Subject: Surgical management of 11 health workers with complications pentazocine injection between December 2013 and November 2014.

Results: Eleven health workers presented with complications of pentazocine that needed surgical interventions. Five of them were females and six were males. There were four medical doctors, three nurses, three attendants, and one medical student. Several surgical problems including pyomyositis, osteomyelitis, cellulitis, contracture of the elbow were observed and treated in all the patients.

Conclusion: Lack of knowledge of risk of pentazocine addiction, as well as, availability of this drug over the counter has contributed immensely to the insurgency of its surgical complications. Health education should be directed toward prevention, early diagnosis, and management to abolish or reduce morbidity associated with these complications.

Pattern of hand tumors among patients in a Southwestern Nigerian hospital

Gideon H Alabi, Anthony A Olekwu

Federal Medical Centre, Owo, Ondo State, Nigeria

Aims and Objectives: The study aims at showing the pattern of hand tumors among patients in a Southwestern Nigerian hospital. Objectives include to determine the most common type of hand tumors and to determine the best form of treatment of hand tumors among patients in a Southwestern Nigerian hospital.

Materials and Methods: A retrospective study of 21 patients seen at the surgery outpatient clinic and managed in the center was reviewed over a 4-year period. Data were collated using a data sheet and processed with SPSS (version 18, Chicago, IL, USA).

Results: The study revealed that hand tumors occur commonly among young adults (61.9%) at a mean age of 34.5 years with the right-hand dominance (61.9%). It affects more females (58.8%) than males (41.2%). 90% of all hand tumors are benign with the most common type of hand tumors being ganglion cyst (51%). Majority (71.4%) of hand tumors can be treated by excision and direct closure.

Conclusion: Hand tumors are majorly benign with the most common hand tumor being ganglion cyst. Majority of these tumors can be treated with excision and direct closure.

Ambulatory cleft lip surgery at the University College Hospital, Ibadan, Nigeria

Olawoye OA, Olusanya AA 1 , Ademola SA, Iyun AO, Michael AI, Akinmoladun VI 1

of Surgery and 1 Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Background: The standard of care for cleft lip surgery in most centers include outpatient preoperative evaluation, admission for surgery, operative correction, postoperative inpatient care for varying duration of days and outpatient follow-up care. Driven not by health-care economics but by the progressive difficulty in securing pediatric bed spaces for our cleft patients, the authors continue to gain experience in ambulatory cleft lip surgery at the University College Hospital, Ibadan.

Methods: A retrospective review of cleft lip surgeries performed by the authors between February 2007 and January 2010 was carried out. Data of patients who had cleft lip surgery were retrieved from our smile train database of uploaded patients, operation room surgery records, and the nurses' admission/discharge records on all the wards on which the patients were either received or admitted. The case notes of the identified patients were retrieved from the health records department and information obtained included the demographic characteristics of the patients, complications reported (if any) among the patients that were hospitalized and those treated as day cases, number of days on admission for hospitalized patients and the need for readmission before the first follow-up clinic appointment among the two groups.

Results: Eighty-two patients were identified, but complete data were obtained for 39 of them (retrieval rate of 48%). The patients were divided into two groups, the ambulatory group (n = 14) and the inpatient group (n = 25). The mean patient age was 5.7 years in the ambulatory and 9.7 years in the inpatient groups, respectively. Both groups were homogenous for other parameters. None of the patients in the ambulatory group were readmitted for any postoperative complications and only one patient in the inpatient group had postoperative complication necessitating prolonged hospitalization.

Conclusion: This study indicates that cleft lip repair performed in an ambulatory setting may be a safe alternative to the inpatient operation. Although many factors may affect the outcome after cleft lip repair, these data support the safety and continued practice of ambulatory cleft lip repair in our center.

Marjolin's ulcer arising from cutaneous lichen planus

Olawoye OA 1,2 , Michael AI 2 , Oluwasola OA 3

1 Department of Surgery, University of Ibadan, 2 Department of Plastic and Reconstructive Surgery, University College Hospital, 3 Department of Pathology, University of Ibadan, and the University College Hospital, Ibadan, Oyo State, Nigeria

Background: Association between cutaneous lichen planus and squamous cell carcinoma has been controversial. The rarity of documented cases has led some to suggest that it may represent a chance association. While there have been many reports of Marjolin's ulcer arising from oral lichen planus, literature remains replete with reports of squamous cell carcinoma arising from or associated with cutaneous lichen planus. The aim of this study is to report the case of a patient with a lesion previously diagnosed as cutaneous lichen planus, who developed Marjolin's ulcer in the same location, in the absence of known exposure to exogenous carcinogens.

Conclusion: The development of Marjolin's ulcer from cutaneous lichen planus is not as rare as previously believed although the pathogenic mechanism for the transformation remains largely unknown.

Macrostomia repair; comparison of the Z-plasty repair with the straight line closure

Olawoye OA, Fatungashe OM 1 , Ayoade BA 2 ,Tade AO 2

Department of Surgery, University College Hospital, Ibadan, Oyo State, Departments of 1 Anaesthesiology and 2 Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Background: Macrostomia is a rare congenital anomaly which results from the failure of fusion of the maxillary and mandibular processes of the first branchial arch. It could be syndromic or isolated, unilateral or bilateral. Various methods of repair which attempt to restore normal anatomy have been proposed.

Case Report: The two patients who presented to the Plastic and Reconstructive Surgery unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu with bilateral macrostomia over a 3-year period from April 1, 2004 to March 31 2007 form the basis for the report. One patient had a Z-plasty repair while the second patient had a straight line closure. The outcome in the two patients managed at the hospital is presented.

Conclusion: Although the scar in the patient with the Z-plasty repair appeared more prominent, both patients had normal appearing commissures. The fears of scar contracture in simple line closure appear to be exaggerated.

Deep palmar space lipoma: Case report and review of literature

Olawoye OA 1,2 , Enemo ON 3 , Iyun AO 2 , Akang EE 4

1 Department of Surgery, College of Medicine University of Ibadan, Departments of 2 Plastic Surgery and 3 Surgery, University College Hospital, 4 Department of Pathology, University of Ibadan and University College Hospital, Ibadan, Oyo State, Nigeria

Background: Although lipoma is the most common benign tumor in the body, it is rarely found in the hand. Subcutaneous lipomas have characteristic distinguishing features which place them among the most easily diagnosed cutaneous lesions. However, the diagnosis of deep lipomas of the hand is often missed because of the rarity of the condition and the inelastic aponeurosis of the hand which obscures the usually commonly distinguishing features of lipoma.

Case Presentation: We present the case of a 55-year-old right-hand dominant woman who had an 18-month history of painless swelling on the right hand. The physical examination and plain radiograph were uncharacteristic, and it was difficult making a definitive diagnosis. With a presumptive assessment of the right palmar soft tissue swelling, an excision biopsy was planned which revealed a lipomatous mass diagnosed as right palmar lipoma on histology.

Conclusion: The rarity of lipoma of the hand makes the clinical preoperative diagnosis challenging. A high index of suspicion along with the use of appropriate imaging techniques such as magnetic resonance imaging becomes critical in the preoperative diagnosis and management of deep lipoma of the hand.

Survey of split thickness skin graft donor site management in the West African Sub-region

Olawoye OA, Ademola SA, Iyun AO, Michael AI,

Oluwatosin OM

Department of Plastic Reconstructive and Aesthetic Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Background: Split skin grafting (SSG) is one of the most commonly performed operations on any Plastic and Reconstructive Surgery Service. It involves the harvesting of a sheet of skin comprising epidermis and varying thickness of the dermis resulting in the creation of a superficial wound. The rate of healing of the donor site is affected by various factors including the type of dressing agent applied. Various newer dressing agents have been introduced. The aim of this study was to audit the practice of Plastic Surgeons in the Sub-region with respect to the management of SSG donor site.

Methods: Structured questionnaires on various aspects of the harvest and the management of SSG donor site were distributed to plastic surgeons attending the 53 rd annual general meeting of the West African College of Surgeons at Lome, Senegal, in March 2013. Results were analyzed using descriptive statistics.

Results: There were 47 respondents from four West African countries. Eighty-three percent were from Nigeria, 10.6% from Ghana, 4.3% from Ivory Coast, and 2.1% from Burkina Faso. All the respondents performed SSG regularly and all employed the thigh as the most commonly used donor site while the other sites used with some regularity were the upper arm (23.4%), instep of the foot (14.9%), and the forearm (8.5%). Only 21.3% of the respondents practiced over graft of the donor site in the elderly. Different types of paraffin gauze remained the most commonly used primary dressing of the donor site while kaltostat and the adhesive fabrics are sparingly used. Surprisingly, only 17% of the respondents apply any form of topical local anesthetic agent on the donor site.

Conclusion: The most commonly employed split skin graft donor site dressing in the West African Sub-region is the tulle dressings, and it would appear that the predominant reason for the choice of dressing is product availability. With improvement in the economy of many countries in the Sub-region and improved health-care funding, access to newer and better dressings should be easily provided that there is a demand for them by the practitioners. Dressings offer shorter healing time and are more comfortable with improved skin quality after healing even if more expensive comparatively should offer a better quality of life to the patients and should be sourced, stocked, and used generously in the Sub-region.

A novel technique in closing persistent pharyngocutaneous fistula

Ogunkeyede AO, Aderibigbe AB, Lawal IA, Dunmade,

Afolabi OA, Omokanye HK

Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Introduction: Pharyngocutaneous fistula (PCF) is an infrequent complication of total laryngectomy with devastating psychological disturbance and continuous loss of fluid, electrolyte, and nutrients. It occurs in 3%-65% of patients with laryngeal cancer who had salvage total laryngectomy. The principle of closure of PCF involves closure with two epithelial surfaces; the first to provide airtight internal lining and the second for external cover. Few techniques of closure of PCF exist in literature, but each of them is with its merits and demerits. In this report, we present the first successful repair of major PCF according to Horgan and Dedo classification, in our health-care service with the use of "turn over" flap and deltopectoral flap as a single stage procedure.

Patients and Methods: A 57-year-old man with histologic diagnosis of T2NoMo invasive squamous cell carcinoma of the subglottic larynx who had chemoradiation with excellent outcome. He was lost to follow-up. Three years after the initial treatment, he represented in the upper airway obstruction with associated weight loss. He had tracheostomy and eventual salvage laryngectomy complicated with PCF. The conservative management failed and he underwent various procedures with poor outcome.

Conclusion: The PCF was successfully repaired with "turn over" flap and deltopectoral flap as a single stage procedure. This is a simple, easy to perform and effective technique in closing PCF in postirradiated neck.

Use of free vascularized fibular graft for congenital pseudo-arthrosis of the tibia

Orkar KS, Yiltok SJ, Amupitan I, Karago CY, Akintayo AJ, Sankey BJ, Ibrahim JS 1 , Taiwo O

Department of Surgery, Plastic Surgery Unit, Jos University Teaching Hospital, 1 Department of Orthopaedic and Trauma, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: The use of free vascularized fibular graft for congenital pseudarthrosis of the tibia, whether as a primary procedure or as a salvage procedure, has been well documented. There has been no report of such procedure in our environment due to the limitations of microvascular surgery. We report a case of free vascularised fibular graft for congenital pseudoarthrosis of the tibia in an 8-year-old boy.

Methods: GB, an 8-year-old boy, presented with congenital pseudoarthrosis of the right tibia. He was evaluated and due to the limb shortening of more than 5 cm on the affected side, had free vascularised fibular graft with end to side anastomosis of the vessels and intramedullary docking of fibular graft to tibia. Postoperative X-ray showed good aposition of bone ends. Limb lengthening procedure was planned for a later period.

Conclusion: The use of free vascularised fibular graft is the best option in the treatment of congenital pseudoarthrosis of the tibia, where the defect is more than 3 cm or the limb shortening is >5 cm, as reviewed by Simonis et al. (1991). This gives a satisfactory outcome.

Open burn wound dressing: A practical option in resource-constrained settings

Olawoye OA, Olubunmi OO 1 , Babatunde AA 2

Department of Plastic Surgery, University College Hospital, Ibadan, Oyo State, Departments of 1 Medical Microbiology and 2 Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Background: Occlusive dressing is often the option of choice for burn wound dressing in most burn centers. However, access to costly wound products is not an option in many resource-limited settings, hence innovation and creativity calls for viable alternatives in the context of the local environment.

Patients and Methods: Consecutive burn patients admitted over a 4-year period (March 2004 to February 2008) were included in the study. All the patients had routine burn care which included daily open wound dressing with silver sulfadiazine. The demographic and clinical characteristics of the patients were retrieved from prospectively collected data using the ISBI pro forma and analyzed using the SPSS version 16. Outcome measure for the study was the time taken for the burn wound to heal as reflected by the length of hospital stay (LOS).

Results: One hundred and forty-four patients with a M:F ratio of 2.3:1 presented during the study period. There was a wide variation in the age of the patients with a range of 81.9 years and a median of 26 years. The total body surface area of the burn similarly had a wide variation with a range of 99% and a median of 28.5%. The mean LOS of the subset of patients who were managed till discharge with open burn wound dressing was 21.5 days with a median of 17 days.

Conclusion: Open burn wound dressing has proved to be a suitable and effective alternative to occlusive dressings in low-income countries and centers with limited funding.

The use of free composite anterolateral thigh flap with vascularized fascia lata for reconstruction of Achilles tendon and soft tissue loss

Orkar KS, Yiltok SJ, Karago CY, Akintayo AJ, Sankey BJ

Department of Surgery, Plastic Surgery Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: The reconstructive challenges of combined loss of Achilles tendon and overlying soft tissue/skin are well-documented (Kuo 2003). Acceptable repair and rehabilitation requires adequate soft tissue and skin coverage, and functional repair of the Achilles tendon. An option for one-stage reconstruction of such complex defect is the use of the free composite anterolateral thigh (ALT) flap with vascularised fascia lata. We report the use of free ALT flap for coverage of Achilles tendon/soft tissue loss, as a one-stage procedure, in a 12-year-old girl. The vascularised fascia lata was used to reconstruct the Achilles tendon.

Case Report: LS was a 12-year-old female whose right ankle was accidentally caught in the spokes of the rear wheel of a motor-cycle of which she was a passenger. She sustained a partial avulsion injury to the posterior ankle, with transection of the Achilles tendon. She had two failed attempts at reconstruction. She had a free composite ALT flap with vascularised fascia lata repair. The ALT flap skin and subcutaneous tissue was used for the soft tissue defect while the vascularised fascia lata was used for the segmental tendon loss. Postoperative result was good with 100% flap survival. She has commenced physiotherapy, and a good functional outcome is expected.

Conclusion: Where microvascular surgical expertise is available, the free composite ALT flap with vascularised fascia lata is the best option for reconstruction of complex Achilles tendon and overlying soft tissue loss. It has the advantages of being a one-stage procedure; having the required tissues for replacement in one place; minimal donor site morbidity; and a good functional outcome.

Burns patients' admission to the Intensive Care Unit of Jos University Teaching Hospital, from January 2010 to January 2014

Yiltok SJ, Karago CY, Akintayo AJ, Sankey BJ

of Surgery, Plastic Surgery Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Introduction: We analyze the admission of burns patients to the Intensive Care Unit (ICU) of the Jos University Teaching Hospital, Lamingo, Jos, from January 2010 to January 2014.

Analysis: A total of 65 patients were admitted to the ICU within the period. Thirty-eight (58.5%) were males while 27 (41.5%) were females. The youngest age was 2 months and the oldest was 63 years. The range of percentage body surface area (%BSA) burnt was from 8% to 99% with a mean of 53% BSA burnt. The shortest duration of the ICU stay was 2 h; the longest duration of the stay was 108 days. Of the total admission in this period, 54 (83.1%) were due to flame burns, 9 (13.8%) due to scald, and 2 (3.1%) due to electrical burns. Of the total admission due to flame burns (54 patients), half (27 patients) had an inhalational component. Total mortality was 45 patients (69.2%). Based on the burn injury type, mortality was 68.5% for those admitted with flame burns. However, mortality was higher in patients who had flame burns with inhalational component (74.1%) compared with flame burns alone (63%). Mortality from scald burns admission was 66.7%. None of the patients admitted with electrical burns survived (100% mortality).

Conclusion: Flame burns accounted for the highest number of ICU admissions for the period. More than 2/3 of all burns admission to the ICU did not survive. Patients with inhalation burns had higher mortality compared with patients having flame burns alone. No case of chemical burns was admitted to the ICU within this period.

Management of facial scars: A case report

Olabanji JK, Oladele AO, Omoyibo EE

Department of Surgery, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria

Background: This review is aimed at illustrating the challenges encountered in managing posttraumatic scars particularly facial scars.

Materials and Methods: The review illustrates the management of a 42-year-old woman with posttraumatic facial scars resulting from injuries sustained from vehicular road traffic accident. The patient was planned to have serial surgical review of the facial scars. She initially had nonsurgical (silicone gel) scar therapy, then surgical revision of one of the facial scars using fusiform excision and Z-plasty and this was followed by continuation of the silicone gel therapy after wound healing. The progression of the scar was monitored with clinical photographs.

Results: There was an esthetic improvement in the scar after the surgical review which was further improved with silicone gel therapy. She expressed satisfaction with the improvement in the scar so far though she is awaiting further review of other facial scars.

Conclusion: The management of facial scars can constitute an immense challenge but with careful patient and surgical technique selection and attention to surgical details, an esthetically pleasing outcome with patient's satisfaction can be obtained.

Experience with external beam radiotherapy following keloid excision at the University College Hospital, Ibadan, Oyo State, Nigeria

Ademola SA, Olawoye OA, Iyun AO, Michael AI,

Oluwatosin OM, Abdusalam AA, Aderibigbe RO 1

Departments of Plastic, Reconstructive and Aesthetic Surgery and 1 Radiotherapy, University College Hospital, Ibadan, Oyo State, Nigeria

Background: Keloid is a fibroproliferative condition of the skin that often follows trauma or infection and is characterized by formation of excessive fibrous tissue during healing process. Keloids are difficult to treat because of their propensity for recurrence. Radiation therapy after surgical excision is reported to effectively reduce recurrence risk. The aim of this paper is to evaluate the effectiveness of postoperative radiotherapy in prevention of keloid recurrence.

Methods: A survey was conducted among patients who had keloid excision and postoperative radiotherapy between 2005 and 2013 at the University College Hospital, Ibadan. Demographic data, information relating to keloid scar, treatment and outcomes were collected. Descriptive analysis of the data was done using Statistical Package for Social Sciences (SPSS) version 20.

Results: There were 26 patients with 53 keloids comprising 15 males and 11 females with mean age of 37 years (standard deviation [SD] 12.34). The mean age at onset of keloid was 24 years (SD 10.35) while at the time of treatment mean age was 32 years (SD 12.80). Majority of the keloids were on the head and neck region and this influenced the desire of the patients for treatment. Thirty-two (60%) of the fifty-three keloids were treated with radiotherapy, but only 28% of these number did not develop recurrence. The role of family history and the time between surgery and radiotherapy were also noted.

Conclusion: Ideal treatment for keloids remains elusive in spite of research efforts to determine the best treatment option. Use of postoperative external beam radiotherapy requires further evaluation to determine its effectiveness, optimal dosing regimen for effectiveness, and justify its continued use.

Point prevalence of chronic wounds at a tertiary hospital in Nigeria

Iyun AO, Ademola SA, Olawoye OA, Michael AI,

Abdullahi YO, Oluwatosin OM

Department of Plastic and Reconstructive Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Objectives: The study was carried out to determine the point prevalence of chronic wounds in a tertiary Nigerian hospital and also to evaluate assessment of chronic wounds within a health-care facility to provide data for wound care planning.

Methodology: The study was carried out within a month including all patients seen in the hospital with chronic wounds. The data obtained were entered into a designed pro forma and were subsequently analyzed.

Results: There were 48 patients with 78 wounds reviewed during the period. This represents approximately a point prevalence of 11% of our potential patients. Male to female ratio was 1.6-1. Their ages ranged from 3 months to 80 years, the median age was 48 years. The duration of the wounds ranged from 6 weeks to 780 weeks, the median duration of the wounds was 10 weeks. The area of the wounds ranged from 1 cm 2 to 1248 cm 2 (median 24 cm 2 ). The most common chronic wounds were diabetic wounds, followed by pressure ulcers. There was statistical significant difference in the distribution of wound types and location.

Conclusion: Wound management can be improved with appropriate wound assessments providing the foundation for plan of care and prevalence data for wound care planning based on best evidence practices.

Demographic characteristics and prognostic indicators of pediatric burn in a developing country

Olawoye OA, Iyun AO, Ademola SA, Michael AI,

Oluwatosin OM

Department of Plastic Reconstructive and Aesthetic Surgery, University College Hospital Ibadan, Ibadan, Oyo State, Nigeria

Background: Burn injuries are among the most devastating of all types of trauma and one of the most expensive to treat. Burn injuries have reached epidemic proportions in recent years in many developing countries. The pediatric age group is particularly vulnerable. This study characterizes the demographic parameters and prognostic indicators of pediatric burn in developing nation.

Patients and Methods: Six hundred and thirty-four patients with acute burn injuries managed during a 10-year period from January 2001 to December 2010 at our burn unit was done. Data of patients aged 0-16 years were analyzed using descriptive statistics.

Results: Two hundred and eighty-nine pediatric patients (46.6%) of the burn patients were managed. The M:F ratio was 1.1:1 with a mean age of 5.1 ± 0.26 years. The mean percentage burn was 28.1% ± 1.41. 63.7% were within the 0-5 year age group, 21.1% in the 6-10 year age group, and 15.2% in the 11-16 year age group. The most common etiology was flame burn (46.1%) followed by scald (41.2%). Accidental causes were responsible for 89.6% cases and most of the injuries (88.6%) occurred at home. A mortality of 39.5% was recorded. The significant prognostic factors were the presence of inhalation injury and the severity of burn injury.

Conclusion: Most of the pediatric burn injuries in many developing countries are from preventable causes. Effective burn prevention strategies will be useful in controlling the scourge.

Full leg length defect reconstruction with two parallel bipedicled fasciocutaneous flaps and peroneus brevis muscle flap

Akunekwe MI, Abonyi PO, Ibeanusi S 1

Plastic Surgery Unit, Professor Kelsey Harrison Hospital, 1 Orthopaedic Surgery Unit, Professor Kelsey Harrison Hospital, Mile I. Port Harcourt, Nigeria

Background: Full leg length soft tissue defect is faced with reconstructive challenges due to lack of robust blood supply, especially in the distal third and limited options. Fasciocutaneous flaps are still valuable in reconstruction of leg defects.

Patients and Methods: This is a retrospective study for the information obtained from the patient's case note. It is a case of 9-year-old Nigerian female that had a defect with pandiaphyseal osteomyelitis of the left leg. Two parallel bipedicled fasciocutaneous flaps combined with peroneus brevis muscle flap was the option of cover.

Conclusion: Two parallel bipedicled fasciocutaneous flaps combined with peroneus brevis muscle flap was the option of cover. The defect was covered and the outcome was satisfactory.

Complete upper lip reconstruction with bilateral nasolabial flaps, mucosa graft, and mental flap

Oseni OG, Olaitan PB

Plastic and Reconstructive Surgery Unit, Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria

Background: Lip reconstruction following resection for tumor or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed.

Materials and Methods: We present a case of lip reconstruction following a complete resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a mental flap and buccal mucosal graft lining.

Results: The result was esthetically satisfactory to the patient and functionally good as the patient was able to move the lip in all directions without any restriction.

Conclusion: We believe this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis.

Burn prevention in Nigeria: Informing the uninformed

Osenike Ajadi, Ayo Olaribigbe, Iyabo Obafemi

Department of Plastic Surgery, National Orghopaedic Hospital, Igbobi, Lagos, Nigeria

Aims and Objectives: The paper is aimed at enlightening the entire members of Nigerian Society on the need to recognized burns as a monster which can destroy lives and/or properties of its victims irrespective of the age, gender, academic, social, or economic status. The cost of managing burn injuries is expensive; the cheapest and best option is prevention.

Materials and Methods: The statistical data of patients (adults and children) admitted in Burn Centre of National Orthopedic Hospital, Lagos, from 2009 to 2014 were tested. Causes of burns, educational and social status of the adult patients, and parents of admitted children were considered. Public opinion polls on cases of fire disasters in our immediate environment and implication of severe burns on victims and caregivers were examined.

Results: It was detected that about 98% of causes of burns in the admitted cases were preventable. Irrespective of education, gender, social, or economic status. The need for statistical record and publicity of agonizing effect of burns in Nigeria, cannot be overemphasized. No doubt the financial implications are enormous.

Conclusion: No one has immunity against burn injuries except those who are thoroughly exposed to the preventive measures. The role of burn care professionals in educating the masses on how to preserve life and properties through effective, carefully planned, and harmonized national burn prevention program by Nigerian Burn Injuries Society is mandatory. We have all seen burns as a moving truck driven by a partially sighted on a sloppy terrace in a very high speed consequently every object on its way and the driver will be destroyed. The time to stop the truck and the driver is now.

Lip reconstruction with wedge excision/direct closure, supraclavicular full thickness skin graft, and Estlander flap in complex dog bite injury: A case report in a pediatric patient

Salawu AI, Ogundipe KO, Kadiri AI, Obimakinde OS 1

Department of Surgery, Burns and Plastic Surgery Unit, Ekiti State University Teaching Hospital, 1 Department of Maxillofacial Surgery, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria

Aims and Objective: Dog bite to the face is an uncommon form of injury seen in the plastic surgery defect can be utilized in this circumstance as well.

Materials and Methods: A 2-year-old female presented to the pediatric emergency of our hospital with fourteen hours history of dog bite to the lower lip. Analysis of defect revealed the right check defect/right side commissural lip defect and midline dry vermilion defect of the lower lip. Delayed primary wound closure of wounds was done by wedge excision and direct closure of central vermilion defect, Estlander flap for the right side commissural defect, and supraclavicular full thickness graft for the adjacent check defect.

Results: The Estlander flap survived 100%; however, there was significant full thickness skin graft loss. However, with secondary contraction, the functional outcome of the reconstruction was excellent with acceptable esthetic result.

Conclusion: Dog bite to the lip can present with diverse combination of defects, the reconstructive toolbox concept is useful in managing the reconstructive challenges of these patients.

Cupping therapy burn: A case report

Michael AI, Akande TO

Department of Plastic and Reconstructive Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Cupping therapy is an ancient alternative medicine practice with origins in the Middle East. It involves mobilization of blood flow to promote healing through either heat or suction. It is rare in Sub-Saharan Africa. The authors present an 80-year-old known Nigerian diabetic female with 2% deep dermal burns to the left shoulder from cupping therapy for back pain. The methods of cupping therapy and the potential adverse events from a plastic surgery perspective are discussed.

Myonecrosis in sickle cell anemia - A management challenge

Iyun AO, Aderibigbe RO

Department of Plastic and Reconstructive Surgery, University College of Hospital, Ibadan, Oyo State, Nigeria

Muscular manifestation of sickle cell anemia is often overlooked, leading to unforeseen complication. Only a handful of publications detailing muscular problems exist. We report a case of myonecrosis in a 29-year-old woman with sickle cell anemia and the management challenge.

Trends in burn injury at the University College Hospital, Ibadan: A 14-year review

Ademola SA, Olawoye OA, Iyun AO, Michael AI,

Olekwu AA, Oluwatosin OM

Department of Plastic and Reconstructive Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Aims and Objectives: This study aimed at determining the current trends in burn injured patients managed at the University College Hospital, Ibadan. The objective is to determine the presence of factors responsible for the trends in burn injury and to compare these trends with the economic situation of the nation during the review.

Materials and Methods: A retrospective study of 831 patients seen at the accident and emergency wards (Adult and Children) and burn unit of the study setting was reviewed over a 14-year period (2000-2014). For ease of analysis, the period was divided into 5: 2000-2002, 2003-2005, 2006-2008, 2009-2011, 2012-2014. The trends in age and gender distribution, etiology and mortality rate were analyzed using Chi-square test for trends. The level of significance for all the tests was at 5%.

Results: Highest incidence (24.7%) of burn occurred between 2009 and 2011. There is a change in age group affected as the number of young adults with burn is on the increase, thus having an effect on the outcome of burn injured patients (P = 0.0001). In comparison to a decade ago, burn injury affects more males than females. More (35%) burn injury result from flame burns (petrol). Burns from road traffic accident (RTA) was on a gradual increase. An upsurge in burn injury from generating set was observed from the second period (2006-2008). Mortality rate has reduced in the past 3 years by 1.38%. The following factors were observed to have statistical significance on the outcome of the patients' age group (P = 0.001), etiology (P = 0.001), total burn surface area (P = 0.0001), and the presence of inhalational injury (P = 0.00001).

Conclusion: Burns are a leading cause of death among all age groups. Commonly, result from petrol incidents and a steady rise in injuries follows RTA. There is a significant relationship between the current trends in burns and the situation of the nation. There is a need for preventive measures to be put in place.

An initial experience with single-staged use of permanent dermal substitute and split thickness skin grafting on recurrent ulcers and unstable scars: A review of four cases

Otene CI, Ogbomo RO, Brotobor O

Department of Surgery, Plastic Surgery Unit, Delta State University Teaching Hospital, Oghara, Nigeria

Background: Recurrent ulcers, unstable scars, and certain sites when covered with split-thickness skin grafts are often prone to further recurrence or leaves resultant skin that are also of poor texture and cosmetic appeal as well as being prone to contractures, blistering, abrasion, and so on because they are too thin and unable to adequately withstand wear and tear. We aim to present another alternative to definitive treatment of recurrent ulcers, unstable scars, prevent contractures, and increase dermal component in places where wear and tear are prevalent.

Materials and Methods: A case series of four patients with recurring ulcers and unstable scars who had application of dermal substitute and split thickness skin grafting as a single procedure. Dermal substitute used for all patients is 1 mm matriderm. Matriderm is a dermal substitute with the collagen-elastin matrix. The patients are being followed up to determine outcome, oldest is about 6 months postoperative.

Results: Two females and two males were involved with two traumatic ulcers, one venous, and one diabetic foot ulcers. Previous split thickness skin grafting done for three of the patients. All had 1 mm thickness matriderm and split thickness skin grafting done. All healed like split thickness skin grafts.

Conclusion: Dermal skin substitutes quicken and increase scar stability and reduce the chances of ulcer recurring as well as resulting in better aesthesis.

Case Report: A unique case of an eclamptic patient with thermal burns

Ogbomo RO, Otene CI, Amukpo A

of Surgery, Plastic Surgery Unit, Delta State University Teaching Hospital, Oghara, Nigeria

Background: Eclampsia is often the end spectrum of preeclampsia (pregnancy-induced hypertension). It follows untreated pregnancy-induced hypertension (PIH), or failed treatment of PIH. It is a rare association and/cause of burn injuries. This report aims at high lightening a careful attitude toward one's health and a resultant uncommon secondary burn injury.

Case Summary: An unbooked 32-year-old homemaker, a para 2 who presented through the emergency unit of Delta State University Teaching Hospital with a day history of burn injury following a seizure attack while cooking in the kitchen. She was term with respect to gestational age. She sustained 8% full thickness flame burns.

Conclusion: Eclampsia is an uncommon cause of burns. Incidental burns in a pregnant woman without a medical history of seizures is not common, but this patient's condition has shown that it is possible.

Cervicopectoral flap in cheek reconstruction: A report of two cases

Opara AC, Dan Aliu, Nazish PA, Francis Mark, Legbo JN

Department of Surgery, UDUTH, Sokoto, Nigeria

Objectives: To assess the reliability of cervicopectoral flap in the reconstruction of cheek defects.

Methods: Two cases of parotid tumors were treated with extensive resection. The defects created involved the cheek which was reconstructed using a cervicopectoral flap, at the same sitting.

Results: There was good esthetic and functional outcome.

Conclusion: Cervicopectoral flap is a good choice for cheek reconstruction. It is easy to harvest and has a rich vascularity.

Quality of life among patients with lower limb lymphedema at the University College Hospital, Ibadan: A preliminary report

Michael AI, Ademola SA, Olawoye OA, Iyun AO,

Olekwu AA, Oluwatosin OM

University College Hospital, Ibadan, Oyo State, Nigeria

Aims and Objectives: This study aims at assessing the quality of life of patients with lower limb lymphedema at the University College Hospital, Ibadan. Objective is to identify specific factors that affect the quality of life of patients with lower limb lymphedema.

Materials and Methods: A retrospective study of 21 patients seen at the surgery outpatient clinic and managed in the study setting was reviewed over a 10-year period. Information as assessed with the lymphedema quality of life tool leg.

Results: Twenty-one patients participated in the study; 56.5% of whom had impairment in function, 49.8% are concerned about symptoms, 87.7% had their appearance affected and 95.6% had a change in their mood, as a result of lymphedema. Majority (95%) of cases admit to a poor or fair quality of life. Of the 8 patients who had been treated, the overall quality of life was observed to have changed to fair/average. A significant relationship exists between the age of the patients and appearance (P = 0.035).

Conclusion: Lymphoedema is a progressive chronic condition that affects a significant number of people and can have deleterious effect on patient's physical and psychosocial health. Surgical intervention with or without conservative intervention has a positive impact on the quality of life of patients.

Current state of cleft lip and palate management in Nigeria


Akinmoladun VI, Ademola SA, Olusanya AA, Aladelusi TO

Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria

Background: Cleft management should be interdisciplinary and comprehensive to meet required standard and best global practices. This study was carried out to ascertain the scope of practice in Nigeria.

Materials and Methods: Structured questionnaire was mailed to individuals on the Nigerian association of cleft lip and palate. Mailing list and others by virtue of their surgical specialties ascertain the scope of practice in Nigeria.

Results: Of the 34 responders, there were 25 (73.5%) oral and maxillofacial surgeons and 9 plastic surgeons. Majority (29, 85.3%) were based at the teaching hospitals. Nineteen (61.8%) of the respondents were ten years or less, post fellowship. While 32 responders were holders of the National or West African fellowship, only nineteen had cleft specific training. Majority of practitioners operated less than 10 cases of cleft lip and palates per year. Millard rotation advancement and von Langenbeck techniques were overwhelmingly the method for the lip and palate repair, respectively. Majority of practitioners (24, 70.6%) did not carry out ear assessment as part of the protocol for cleft palate cases and only 15 (45.5%) had an orthodontic plan for the patients. No assessment for velopharyngeal incompetence by majority of responders (27, 79.4%). Closed rhinoplasty was method of nose repair by the 20 of the 22 responders who did rhinoplasty. Visual and photography were the most commonly used for assessment of treatment outcome.

Conclusion: Significant changes need to take place in the practice of cleft lip and palate care in Nigeria.

Injectable fillers: The Nigerian experience

Aranmolate RA, Puddicombe OT, Malu TJ

Grandville Medical and Laser, 36 Ogunlana Drive, Surulere, Lagos, Nigeria

Background: Injectable dermal fillers are skin care products that are used in filling aging defects involving the face and the hands. Simply, they are biological products that are injected into the dermis. Application of these agents has increased to involve the breast and buttocks. They can be used alone or in combination with other antiaging procedures such as Botox injection and/or platelet rich plasma. They are either absorbable or nonabsorbable (permanent). The minimum time for replacement is usually 3 months, but some could be permanent. Dermal fibers are useful treatment in the aging process.

Materials and Methods: This is a report of randomized selection of clients between April and July 2015 which comprises three females and one male. Cannulas or syringes are used in the administration of the products. Follow-up confirmed satisfaction by three and unsatisfied outcome by one patient.

Results: Our experience shows that Nigerians are skeptical about its use. The concerns arise from a perception that it is too foreign to our culture as well as fears of the possible complications. In our clinic, between April and July, we had four patients with indications for treatment of the nasolabial fold, nasojugal trough, and acne scars.

Conclusion: The future, however, is bright because an increasing number of patients are accepting the procedure.

Botox treatment: The Nigerian experience

Aranmolate R, Puddicombe OT, Malu TJ

Grandville Medical and Laser, 36 Ogunlana Drive, Surulere, Lagos, Nigeria

Background: Botox toxin is the highest used product in the esthetic world. Its source is the Gram-negative anaerobic bacterium Clostridium botulinum. Its use transcends many areas of medicine spanning from surgical to nonsurgical. There are seven serotypes: A, B, C, D, E, F, and G. The A and C (C1 and C2) serotypes are the ones commonly manufactured. In recent years, its use in the esthetic world has increased greatly. There is limited literature on Botox use in Nigerian citizens traveling abroad for the same procedure. We share our experience on Botox treatments carried out at Grandville Medical and Laser.

Materials and Methods: The study is a continuous selection of patients as they walk into our clinic and requesting Botox treatment.

Results: We had a total of five clients for Botox treatments; two had indications for crow feet, two for full face facial rejuvenation in combination with dermal fillers, and one client for blepharospasm and other for bladder instability with referral to Urologist. Clients express satisfaction with treatment with follow-up starting from day 3 with one requesting for top up treatment after two weeks of treatment.

Conclusion: We conclude that with continued use and advocacy will bring more Nigerians to accept the procedure.

Lymphedema of the groin: A case report

Aranmlate RA, Olusoga O

Grandville Medical and Laser, 36 Ogunlana Drive, Surulere, Lagos, Nigeria

Background: Lymphedema is a pathology involving the lymphatic drainage of the body with resultant collection of protein-rich fluid in the interstitium. There are skin changes associated with the pathology. Lymphedema of the groin is a rare disease, more especially of the size noticed. Most lymphedema cases affect the extremities.

Case Report: The case is a 45-year-old oil and gas, retroviral positive man who was admitted on account of swelling in both the right and left lower limb with an involvement of both groins. Had progressive swelling of the lower limbs and the groin of ten years. He had surgical excision of the groin lesion at a single stage and histology result confirmed lymphedema. The estimated weight of the groin tissue excised was 10 kg. There was postoperative dehiscence of the wound on the right groin which was closed secondarily. He is scheduled for the next stage of debulking surgery of the lower limbs.

Facial rejuvenation

Aranmolate R, Puddicombe OT, Malu TJ

Medical and Laser, 36 Ogunlana Drive, Surulere, Lagos, Nigeria

Background: The face is usually the first part of the body noticed at a glance. Rejuvenation of the face, especially in the aged is very important and needs proper assessment before treatment plans are drawn. Initial assessment and clinical photographs are very useful tools in the handling of patients. Several options exist for rejuvenation ranging from chemical peeling, Botox, injectable fillers, fat grafting, platelet rich plasma, and SE of topical products. Others include laser treatment, ultrasound, and radiofrequency devices.

Materials and Methods: The study was collated for patients between January 2014 and June 2014 as well as April 2015 and July 2015. Selection criteria were for patients requesting for Botox, dermal fillers, laser resurfacing, and chemical peeling.

Results: A total of thirty-two patients were seen within this period with indications ranging from acne scar, postacne hyperpigmentation, aging face, periorbital hyperpigmentation, color variegation, and facial hair. Different methods were used in restoring the face either as single treatment or multiple approach with cosmeceutical products to follow-up treatment.

Conclusion: An increasing number of patients demand for facial rejuvenation.

Platelet rich plasma as adjuvant to hair regrowth

Aranmolate R, Puddicombe OT, Malu TJ

Grandville Medical and Laser, 36 Ogunlana Drive, Surulere, Lagos, Nigeria

Background: Platelet-rich plasma (PRP) is a component of blood that has high concentration of platelets, which when activated can release growth factors that can be used in many areas of medicine. It has come to the fore of medical practice involving its use in esthetic medicine, orthopedic care, wound care, and hair growth. There is still conflicting evidence in its use in daily medical practice, however, more are tuned toward positive result and with little or no side effects. It can be combined with dermal fillers and Botox to reduce the aging seen on the face and hands. While PRP increases production of other things because of the degranulation which contains PGF, FGF, EGF to mention a few, injection fillers, and Botox reduces effect over time because of degeneration of the dermal fillers or reneurotization in Botox. This is a single case study seen in our clinic this year on account of frontal hair loss (alopecia) after 12 sessions of cold laser for hair regrowth. The client has express initial satisfaction of certain areas of hair regrowth, however, desire more advanced treatment for hair restoration.

Challenges of nasal reconstruction post-human bite-a report

Ogunkeyede A, Alabi H

Department of Surgery, Federal Medical Centre, Owo, Ondo State, Nigeria

Background: Human bite wounds are known for their infection rates, which can be as high as 10%-15%. It is not a common occurrence in the head and neck region as compared to a clenched fist. Hence, we presented an occlusive human bite to the nose following a brawl, the need for adhering to principle of care for human bite and consequent challenges with reconstruction. Nasal reconstruction requires acute attention to detail and preservation of the nasal three-dimensional integrity for excellent esthetic and functional outcome.

Objectives : To highlight the challenges that a plastic surgeon may go through when reconstructing a nose posthuman bite and the importance of keeping to basic nasal reconstruction.

Methodology: We present a 30-year-old Nigerian homemaker with nasal defect postocclusive human bite. She initially had basic wound care for the bite and reconstruction of the nose started 4 weeks postbite. A proper assessment was done to analyze the full thickness loss of the nose. The reconstruction was done with forehead flap with excellent esthetic and functional outcome.

Results: Forehead flap remains the gold standard in nasal reconstruction in any race and in managing full-thickness nasal defect.

Conclusion: Keeping to basics in nasal reconstruction algorithm will always ensure excellent functional and esthetic reconstruction.

Acquired gynatresia; etiologies, and reconstruction in Oosgbo, case series

Oseni OG, Onilede DA, Komoafe OO, Olaitan PB

Department of Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Background: Acquired gynatresia is becoming common in our environment. Several factors are implicated. These include increase patronage of nonorthodox practitioners, insertion of caustic soda, and other concoction containing irritants to treat infertility as well as dissolving uterine fibroids.

Materials and Methods: Records of patients presenting with gynatresia were reviewed. Identified etiological causes and options of treatment are discussed.

Results: Good functional outcome was observed among seven patients managed.

Conclusion: There are several causes of acquired gynatresia seen in our environment. Education of our women on the causes of infertility and fibroids as well as treatment needs to be vigorously pursued.




 

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