Nigerian Journal of Plastic Surgery

Evaluation of the reliability of Levine method of wound swab for microbiological studies in chronic wounds: a pilot study

2013-10-08T20:40:39+00:00

Background: All chronic wounds habour microorganisms which may stall spontaneous healing of the wounds or impair success of wound closure. Wound biopsy for microscopy, culture and sensitivity is the preferred method of isolating microorganisms present in a wound but the procedure is resource intensive and unpleasant to patients. The aim of this paper is to evaluate the reliability of Levine swab in accurate identification of microorganisms present in a wound and identify the necessity for further studies in this regard. Methods: A semi structured questionnaire was administered and physical examination was performed on patients with chronic wounds who meet the inclusion criteria for the study. Full thickness wound biopsy and wound swab using the Levine method were taken from the wound of each patient. The data generated was analysed using Statistical Package for Social Sciences (SPSS) version 20. Results: There were 21 ulcers from 19 patients but only nineteen ulcers were suitable for analysis. The mean age of the patients was 42 years (range 13-69 years). There were nine males and 10 females. Most of the ulcers were posttraumatic (67%), were located on the right side of the body and the commonest site was the right leg (24%). More than half of the ulcers had at least moderate discharge. Only one species of microorganism was isolated per wound swab or wound biopsy specimen. Comparison of results from wound swabs with wound biopsy from each of the patients revealed that isolated microorganisms were similar in 60% of cases. Conclusion: Wound swab by the Levine method may be as reliable as wound biopsy specimens for microbiological studies in chronic wounds due to certain causes. Larger studies that evaluate wounds due to different causes separately will be required to validate this observation.

Keywords: Levine swab, chronic cutaneous ulcer, microbiology, wound sampling

Nigerian Journal of Plastic Surgery, Vol. 9, No 2, September 2013

Parental adjustment to cleft lip and palate anomaly: a preliminary study

2013-10-08T20:40:39+00:00

Background: Cleft lip/palate is the commonest congenital craniofacial anomaly and the birth of a child with this anomaly can be devastating to the parents. This study aimed to describe the early adjustment of parents to children with cleft lip/palate anomaly. Materials and methods: Inquiry into taking the baby out, taking photographs, parental attitude to surgery, decision on having more children, parental relationship and feeding difficulty was made among parents/caregivers of infants with cleft lip/palate anomaly who were less than 6 months of age in the University College Hospital, Ibadan. Frequencies and percentages of variables were reported. Chi square test was used to test associations at 5% level of significance. Results: Parents of 34 infants participated in the study. There were 19 females and 15 males. The mean (+S.D.) age of the infant was 2.19 (1.88) months. There was a statistical significance between ‘type of cleft’ and ‘taking of photographs’ (p=0.011) as well as ‘taking the baby out’ (p=0.012) but there was no statistical significance between the type of cleft and parental adjustment as well as feeding difficulties. Conclusion: Most parents of children with cleft lip/palate anomaly avoided taking pictures of their children and did not readily take them out. However, the type of cleft lip/palate did not seem to affect how the parents adjusted to their children and the difficulty they experienced in feeding them.

Keywords: cleft lip and palate, parental adjustment

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Gingival Overgrowth and Associated Factors among Epileptic Patients of Lagos University Teaching Hospital, Lagos, Nigeria

2013-10-08T20:40:39+00:00

Background: Gingival Hyperplasia (GH) may occur as a hereditary disorder or linked to certain factors such as drugs. Drug induced GH; now referred to as Gingival Overgrowth (GO) typically develops in a susceptible individual within 1-3 months of commencing medication. It is the most common oral side effect reported with the use of anticonvulsants and aesthetically displeasing. This study aims to evaluate the proportion of epileptic patients attending the Neurology Clinic of LUTH that present with GO and assess the associated factors. Patients and methods: 300 dentate subjects consisting of 150 epileptics and 150 controls matched for age and sex participated in this study. Bio-data and medical history were collected using a structured self-administered questionnaire and confirmed from patients’ case file. Oral hygiene was assessed using the Simplified Oral Hygiene Index (S-OHI) of Green and Vermillion and GO, the New Clinical Index for Drug-Induced Gingival Overgrowth (DIGO). Result: The age range was between 10 and 74 years. Male to female ratio for cases and control was 1:1.8 and 1:1.7 respectively. The mean S-OHI score in the cases was 1.89 ± 0.758. The proportion of epileptic patients who presented with GO was 32.7%. Conclusion: The proportion of patients who presented with GO was significantly higher among the epileptics.

Keywords: Gingival Hyperplasia, Gingival Overgrowth, Epileptics, Anticonvulsants

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Management of gunshot injuries to the maxillofacial region at University of Port Harcourt Teaching Hospital, Nigeria

2013-10-08T20:40:39+00:00

Background: The management modalities for gunshot injuries differ slightly from conventional trauma. The purpose of this study was to document the pattern, mechanism and management outcome of gunshot injuries seen in our center. Method: Information regarding patients’ demographics, site and type of injury, tissue involved as well as presence of associated injuries was documented. Patients were categorized into two groups; those that sustained soft and hard tissue Injuries and those with only soft tissue injuries. Soft tissue injuries were classified as laceration, penetrating, perforating or avulsions. The presence of either entry and exit wounds or only entry wound was also examined. The investigations, treatment done and outcome of treatment were also documented. Result: A total of 20 patients presented with gunshot injuries within this period of study out of 132 patients with craniofacial trauma. Of the 20, 15 (75%) were males and females were 5(25%), 9(45%) had both soft and hard tissue injuries, 11(55%) cases had only soft tissue injuries. Age range was 8-55 years with mean (SD) of 29.7 (10.7) years. All injuries were confined either to the midface or the lower face. The bones of the midfacial region (zygomatic bone and, medial wall of the orbit, ethmoidal and nasal bones) were involved in 2(10%) patients and the lower jaw (mandible) was affected in 7(35%).The outcome of treatment was successful in 18(90%) and satisfactory in 17(85%) cases. Conclusion: Secondary repair is more relevant than delayed repair in portions of the face that have less sufficient blood supply that sustain gunshot injuries.

Keywords: Gunshot, Injury, repair, Maxillofacial

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Homograft in burn therapy – any relevance? A case report

2013-10-08T20:40:39+00:00

Background: The problem of permanent skin coverage in severely burned patients is a question which, despite progress in the last few years has still not found a definite solution. The use of homograft is a way of avoiding graft rejection and reducing patient morbidity and a case in which it was used is hereby presented. Patient: A 14 year old boy presented with a 31% burn wound which was auto-grafted with meshed skin graft. The wound got infected and there was a total loss of graft. A skin graft from his twin was used to cover the wound. Results : Seven month post-surgery, his scar has remained stable. Conclusion: The use of homograft reduces patient morbidity and overall hospital stay. This method still has a place in extreme cases.

Keywords: Burns, skin grafting, homo-grafting

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Traumatic radial artery aneurysm at National Orthopaedic Hospital, Enugu

2013-10-08T20:40:39+00:00

Background: Traumatic radial artery pseudo aneurysms are rare and infrequently present to the plastic surgeon. At National Orthopaedic, Enugu, between January 2003 and June 2012 repair of aneurysms constituted 0.04% of all elective surgical procedures carried out by plastic surgeons. Repair by excision and vein conduit is well established but not many reports in children abound. Our aim is to share our experience, review the literature, and propose treatment options. Methods: Theatre records, photographs and case notes of patients that presented with traumatic radial artery aneurysm between 2003 and 2012 were retrieved and examined. Results: Three patients presented with radial artery pseudo-aneurysms within the period. All the three patients had excision of the aneurysms and reversed cephalic vein interposition graft. The outcomes were satisfactory.

Keywords: radial artery aneurysm, vein graft

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Incidental hand injuries in assault: a report of two cases

2013-10-08T20:40:39+00:00

Background: Hand injuries are common occurrences in domestic settings. However, unintentional injuries to a third party who mediates a brawl between two individuals is unusual. Two patients who sustained hand injuries in this circumstance are presented. Method: The patients had initial wound debridement, antibiotic therapy and daily wound dressing till infection was controlled and re-exploration performed. Extensor pollicis longus was found to be severed with a gap of 4 centimeter after mobilization and traction. Palmaris longus tendon graft from the same hand was used to bridge the gap. Case 2 had wound exploration evacuation of Hematoma and ligation of feeding dorsal arch arteries. Results: Both patients made an uneventful postoperative functional recovery of the hands. Second case was lost to follow up. Conclusion: Unintended injuries to the hand can result from arbitration in physical fight which could be life threatening and disabling. Prompt attention from appropriate specialist will curtail the morbidity from such injuries.

Keywords: hand injuries, incidental, assault

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

An unusual implanted foreign body in the oral tissue.

2013-10-08T20:40:39+00:00

Background: Foreign bodies in the mouth can cause injuries, especially at playtime among children. Foreign body injuries in the mouth are relatively uncommon making most clinicians not to be vast in the management. Diagnosis and management of foreign body injury (FBI) in the mouth could be very challenging. Missed diagnosis or mismanagement of FBI can lead to serious sequelae or fatal outcome. Although numerous types of foreign bodies and injuries have been reported, traumatic implantation of pencil erasers in the oral tissue is rarely noted Material and method: We report a case of traumatic implantation of the broken eraser end of a lead pencil in the buccal soft tissue of a 7-year-old Nigerian girl to illustrate some of the challenges in the management of oral/oropharyngeal foreign body injuries. Result: The diagnosis was missed at the initial presentation but was detected at a subsequent visit. The embedded eraser end of the lead pencil was removed using blunt dissection under local anaesthesia. Conclusion: In the management of FBIs, prompt and adequate assessment supplemented with appropriate investigation for diagnosis followed by appropriate treatment is essential to ensure good outcomes and prevent complications.

Keywords: Foreign body injuries, lead pencil erasers, traumatic implantation, oral/oropharyngeal

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013

Combining abdominoplasty with mesh repair of incisional hernia: a case series

2013-10-08T20:40:39+00:00

Background: Incisional hernia is a common general surgery referral. The gold standard of repair is considered to be retrorectus mesh placement. Open repair through a midline incision invariably leaves the patients with obvious long scars. We are presenting a case series where patients had repairs through abdominoplasty incision. Patients: In this retrospective study, six women aged between 29 and 48 years, presenting with incisional hernia between November, 2010 and July, 2011 were operated. Information on the number of previous surgeries was obtained. They all had open retro-rectus mesh hernia (Rivers–Stopp-Wantz) repair and a classic abdominoplasty. Results: All patients had 32cm supra-pubic scar. Three percent had a midline infra-umbilical scar and had wound dehiscence that required dressings. Our patients used post-operative girdles for six weeks. Conclusion: Retro-rectus mesh repair of incisional hernia is considered the gold standard. Open repair results in an unaesthetic long midline anterior abdominal wall scar. Combining the produce with an abdominoplasty ensures an all-round satisfactions.

Keywords: Abdominoplasty, incisional hernia, prosthetic mesh

Nigerian Journal of Plastic Surgery Vol. 9, No 2, September 2013