The use of sural island musculo fasciocutaneous flap, in the management of chronic osteomyelitis of the tibia.

BACKGROUND: : The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. AIM: : This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. MATERIALS AND METHODS: : Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed. The study was prospective in nature. RESULTS: : There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3rd and 4th decades of life. Twelve patients had involvement of the distal third of the tibia, eight involved the middle third, while five patients had involvement of the proximal third. Most of the patients (17) developed osteomyelitis following open fractures of the tibia; thirteen of these were from road crashes and four from gunshot injuries. Four patients developed osteomyelitis through the hematogenous route. Flap sizes ranged from 8 × 7 cm to 16 × 11 cm. There was tip necrosis in 2 flaps and full survival in 19 flaps. The flaps with partial necrosis were managed by simple dressing. Fifteen patients (71%) had cessation of drainage within 4 weeks of surgery. Two patients presented with recurrence of infection within the period of follow-up. Mean follow-up period was 23 months. All donor sites were skin grafted primarily, with 95%-100% graft take. CONCLUSION: The sural Island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and soft-tissue defects in chronic osteomyelitis of the tibia. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia.

Reconstruction of complex soft-tissue defects around the knee using the proximally based sural Island fasciocutaneous flap.

BACKGROUND: : Complex soft tissue defects around the knee are not common. They pose significant reconstructive challenges; hence, several methods have been tried. In this study, the use of proximally based sural island fasciocutaneous flap is evaluated. AIM: : The aim of this study is to report our experience with the use of proximally based sural island fasciocutaneous flap in the reconstruction of complex soft tissue defects around the knee. PATIENTS AND METHODS: This was a prospective study. All patients that presented to the unit with complex soft tissue defects around the knee between December 2012 and November 2014 were included in this study. Data on age, sex, etiology, anatomical location of the defect, and flap size were noted and analyzed using descriptive statistics. Follow-up was for a minimum of 6 months. RESULTS: : There were 15 cases: 11 males and 4 females. Their ages ranged from 6 years to 47 years with an average age of 29 years. Ten of the defects resulted from road traffic accidents, while five were missile injuries. The anterior and lateral surfaces of the knee were more often involved, while the posterior surface was least involved. The flap sizes ranged from 8 cm × 6 cm to 16 cm × 12 cm, and the pedicle length ranged from 6 cm to 12 cm. All 15 flaps had full survival. A total of 13 patients had their donor sites skin grafted primarily with 96%-100% graft take. The other two patients had their donor sites closed directly. CONCLUSION: The proximally based sural island fasciocutaneous flap is a simple and reliable method of reconstruction for soft tissue defects around the knee.

Burn Injuries in Enugu, Nigeria - Aetiology and Prevention. A Six-year Retrospective Review (January 2000 - December 2005).

Background.Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives.The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%.

Cleft lip and palate repair: the experience from two West African sub-regional centres.

Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.

Groin flap for coverage of upper extremity defects in Enugu, Nigeria.

BACKGROUND: Extensive tissue loss of the hand has remained a big challenge to the Plastic and Reconstructive Surgeon. The objective of this study is to review the use of pedicle groin flap for coverage of distal forearm and hand defects in our centre, and to find out problems of using the flap and make suggestions for improvement. METHOD: This is a retrospective study done using case records of patients treated with pedicle groin flaps for upper extremity defects at the National Orthopaedic Hospital Enugu from January 1999 to December 2004 (six year period). Information on biodata, clinical presentation, treatment, complications and outcome was extracted and analyzed using descriptive statistics. RESULTS: Thirteen (13) patient's case files met the inclusion criteria and were analyzed. There were seven (7) males and six (6) females with mean age ranges between 9 years and 42 years. Four (4) had distal forearm and nine (9) hand wound coverage's. Flap survival was very good to excellent in all cases and the outcome quite satisfactory. CONCLUSION: Use of pedicle groin flap for coverage of defects of the hand and distal forearm remains a very valuable treatment option in our environment.

Pattern of severe electrical injuries in a Nigerian regional burn centre.

BACKGROUND: Electrical injuries, though uncommon usually have devastating consequences. They are largely preventable. The objectives of the study were to highlight the pattern of severe electrical injuries seen in our environment, the management problems faced here compared with other studies and proffer suggestions for improvement and prevention. METHODS: A 10-year retrospective study of case files of patients seen with electrical injuries in our centre was carried out from January 1995 to December 2004. Case notes were retrieved and data collated from them were analysed by descriptive statistics. RESULTS: Twenty four (24) case files met the inclusion criteria and were analysed. Electrical burns constituted 2.8% of total burn admissions. Patients' ages ranged from 15 months to 42 years. Male: Female ratio was 4.8:1. Seven (29%) had high voltage injuries, mostly work-related. Sixteen (67%) had low voltage injuries while one (4%) had a lightening injury. Fourteen (58%) presented or were referred more than 24 hours post injury. Fifteen (63%) had a form of surgical treatment with wound debridement (33%) skin grafting (38%) and amputations (29%) being the commonest ones. The mortality was 12.5% with septicaemia as the leading cause of death. CONCLUSION: Late presentation of patients to specialised centres, inadequate management at the primary centres of treatment, poverty and inadequate facilities even at the specialised centres were the main problems encountered. We recommend re-education of the populace including medical practitioners, enforcement of safety rules in the home and workplaces and upgrading of our health facilities to decrease the menace of severe electrical injuries.