The incidence and prevalence of chronic wounds from a major plastic surgery service from a metropolitan city in south western Nigeria: A sixteen-year retrospective review.

INTRODUCTION: Chronic wound presents a burden to the patient due to the effect on their quality of life and cost of care. The exact prevalence is difficult to assess due to insufficient data, different study designs, and deferent study definitions of chronic wounds. There is limited data on the prevalence and the burden of chronic wound in our subregion. This study was therefore carried out to establish the burden of chronic wound in order to document a baseline data for monitoring progress, as well as provide information for advocacy on equitable distribution of resources for wound care. METHOD: This was a retrospective review between January 2007 and December 2022. Data was analysed using SPSS. RESULT: A total of 866 patients with new chronic wounds were seen at an average of 54 cases per year. An average of 330 old and new chronic wounds are seen yearly. Chronic ulcers are developing at a rate of 1.2/1000 population, and the prevalence of chronic ulcer is 3.3/1000 population. Most patients were males (57.2 %), with a mean age of 41.7years ± 20.6. Post traumatic wound is the leading aetiology. Age correlates positively with aetiology, p=<0.001. Sickle cell and venous wounds are predominantly on the legs, p=<0.001. There is a correlation between increasing age and occurrence of chronic wound in the leg, p=<0.001. CONCLUSION: Post traumatic wound is the leading cause of chronic wound in our subregion. There is a need to improve care of acute wounds to reduce the burden of chronic wounds.

Presentation, Clinical Outcome, and Quality of Life of Patients Treated for Head and Neck Skin Cancer at the University College Hospital, Ibadan.

Introduction: Patients with head and neck skin cancer experience adverse functional, psychosocial, and financial impacts as a result of the disease and/or its treatment. This study aimed at evaluating the pattern of presentation, clinical outcomes, and quality of life of patients with head and neck skin cancer. Materials and Methods: A retrospective cross-sectional study of patients with head and neck skin cancer presenting to the Department of Plastic, Reconstructive & Aesthetic Surgery of the University College Hospital, Ibadan, from January 2017 to December 2021. Data obtained from the clinical records included sociodemographic characteristics, clinical and surgical details, as well as clinical outcomes. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Data were summarized using descriptive statistics. Results: Nineteen patients were reviewed with a median age of 38 years (ranging from 18 to 85 years) and a male-to-female ratio of 1:1.4. Eight (42.1%) of the patients were albinos. Squamous cell carcinoma was the predominant histologic type (63.2%), while the scalp was the commonest location (42.1%). Only one patient (5.3%) presented with metastatic disease. A greater percentage of treated patients, eight (61.5%), had surgery as the only treatment modality. After a mean follow-up period of 33 months, a recurrence rate of 10.5% (two patients) and a mortality rate of 15.8% (three patients) were recorded. Quality of life assessment revealed an adverse financial impact of the disease on our patients. Conclusion: Although albinism is a recognized risk factor for skin cancers, head and neck skin cancers can occur in the dark-skinned.

Experience with Liposuction for the Treatment of Subcutaneous Lipoma: A Case Series from a Tertiary Health Institution in Nigeria.

Background: Lipomas are the commonest benign tumours in the body. Treatment is often by excision biopsy. Liposuction has traditionally been used for body sculpturing, but recently, it was introduced for the operative management of lipomas. The aim of this study was to present our experience with liposuction lipectomy-assisted lipoma aspiration in terms of its efficacy, complications, risk of recurrence, and patient satisfaction. Materials and Methods: A retrospective review of 16 patients with solitary or multiple lipomas managed with liposuction over a 5-year period was done. All the patients had a prior fine needle aspiration cytology, which was reported as benign. Informed consent was obtained, and the procedures were performed as a day case under tumescent anaesthesia. Lipo-aspiration was done with manual liposuction device. The patients were discharged on oral analgesics and antibiotics. Results: Sixteen patients (10 females and six males) with 21 lesions were managed. The median age was 43 years (23-66 years). All the patients had satisfactory outcomes. The procedure was converted to open-excisional surgery in one patient, and the histology was reported as fibro lipoma. Friction burn at the cannula site occurred in one patient, which subsequently healed with scars. No recurrence was reported in any of the patients. Conclusion: In well-selected patients, liposuction-assisted lipectomy may have an advantage over the classical open technique. All patients should have a minimum investigation of fine needle aspiration cytology because of the risk of atypical lipomas or liposarcoma, which might have similar features as subcutaneous lipoma.

Concentric mastopexy for pubertal gynaecomastia in an African child.

Gynaecomastia refers to the enlargement of the male breast. It can be psychologically disturbing for children and adolescents as well as adults. While in children watchful waiting is advised as the gynaecomastia could resolve, surgical intervention becomes necessary where there is significant psychosocial disturbance. We present a case of an African child whose quality of life improved after correcting the gynaecomastia. We highlight the concentric mastopexy method in the surgical management of gynaecomastia.

Pattern of congenital hand anomalies at a tertiary plastic surgery service in South-Western Nigeria: A 10-year, cross-sectional retrospective review.

CONTEXT: Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice. AIMS: The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria. MATERIALS AND METHODS: This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student's t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05. RESULTS: One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality. CONCLUSIONS: Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.

Improving perioperative pain management: a preintervention and postintervention study in 7 developing countries.

INTRODUCTION: The burden of untreated postoperative pain is high. OBJECTIVE: This study assessed feasibility of using quality improvement (QI) tools to improve management of perioperative pain in hospitals in multiple developing countries. METHODS: The International Pain Registry and Developing Countries working groups, from the International Association for the Study of Pain (IASP), sponsored the project and PAIN OUT, a QI and research network, coordinated it, and provided the research tools. The IASP published a call about the project on its website. Principal investigators (PIs) were responsible for implementing a preintervention and postintervention study in 1 to 2 surgical wards in their hospitals, and they were free to choose the QI intervention. Trained surveyors used standardized and validated web-based tools for collecting findings about perioperative pain management and patient reported outcomes (PROs). Four processes and PROs, independent of surgery type, assessed effectiveness of the interventions. RESULTS: Forty-three providers responded to the call; 13 applications were selected; and PIs from 8 hospitals, in 14 wards, in 7 countries, completed the study. Interventions focused on teaching providers about pain management. Processes improved in 35% and PROs in 37.5% of wards. CONCLUSIONS: The project proved useful on multiple levels. It offered PIs a framework and tools to perform QI work and findings to present to colleagues and administration. Management practices and PROs improved on some wards. Interpretation of change proved complex, site-dependent, and related to multiple factors. PAIN OUT gained experience coordinating a multicentre, international QI project. The IASP promoted research, education, and QI work.

Pediatric keloids: A 6-year retrospective review.

BACKGROUND/OBJECTIVES: Keloids are reportedly rare at the extremes of life. We sought to describe the epidemiology of pediatric keloids seen at the plastic surgery outpatient department of the University College Hospital, Ibadan. METHODS: We retrospectively reviewed all children younger than 19 years who presented with nonburn keloids between 2008 and 2014. Data were obtained on age; duration, size, and location of the keloid; family history; mode of treatment; and outcome. Outcome variables were recurrence and wound complications. Data were analyzed using the Pearson chi-square test for discreet variables and the independent-sample t test for continuous variables. P < .05 was taken as statistically significant. RESULTS: Within the review period, 304 patients presented with keloids, of whom 40 (13.1%) were younger than 19 years. There was a female preponderance (n = 23, 57.5%). The mean age at onset of the keloid was 9.3 years (range 3 months-18 years). Thirty (75%) patients had keloids in the head and neck region. Keloids were sporadic in 31 (77.5%) patients. Nineteen (47.5%) patients had multimodal treatment for keloid. The recurrence rate was 20%. Recurrence was significantly associated with the size of the lesion (P = .003). CONCLUSION: Keloids during childhood are not rare. More attention should be paid to the management of keloids in this age group.

Point Prevalence of Chronic Wounds at a Tertiary Hospital in Nigeria.

BACKGROUND: Chronic wounds are a drain on resources both for the patient and health institution. Management of chronic wounds based on evidence-based practice requires baseline data for adequate planning. OBJECTIVES: This study was carried out to determine the point prevalence of chronic wounds in a tertiary hospital (University College Hospital, Ibadan, Nigeria) and utilize this information for subsequent wound care planning. METHODS: The study was carried out within a 1-month period and included all patients seen in the hospital with chronic wounds. The data obtained was entered into a designed form and was subsequently analyzed. RESULTS: There were 48 patients with 78 wounds representing approximately 11% of patients seen in the Department of Plastic, Reconstructive, and Aesthetic Surgery each month. Their ages ranged from 3 months to 80 years; the median age was 48 years. The male to female ratio was 1.6 to 1. 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) -1,248 cm(2) (median 24 cm(2)). The most common chronic wounds were diabetic wounds, followed by pressure ulcers, postinfection ulcers, posttraumatic ulcers, burn wounds, malignant ulcers, and venous ulcers. CONCLUSION: The point prevalence data serves as a basis for wound care planning. This, in turn, should result in improved wound management grounded in evidence-based practices.

The reverse sural artery flap for the reconstruction of distal third of the leg and foot.

Soft tissue defects around the distal third of the leg and the foot present a major reconstructive challenge. There is limited expertise with free tissue transfers in many developing countries, necessitating consideration of other options for the closure of such defects. The versatility and reliability of sural artery flap have made it an emerging popular option for the reconstruction of such defects. Twenty patients comprising of 13 males and 7 females with soft tissue defects of the lower third of the leg and foot requiring soft tissue cover were treated between January 2006 and December 2010. The age range was 7-58 years with a mean age of 30 years. Nineteen (95%) of the defects were post-traumatic while one (5%) was post-infective. All the defects were covered with reversed sural artery flaps, which were raised on the posterior aspect of the junction of the upper and middle third of the leg. The smallest flap was 4 × 4 cm(2) while the largest measured 20 × 12 cm(2). The donor defect was closed directly in 7 (35%) patients, while split skin graft was applied in the remaining 13 (65%) patients. There was satisfactory flap healing in 17 patients (85%), while 3 patients (15%) had complete flap necrosis. Two of these patients had significant comorbidities of haemoglobinopathy and poorly controlled diabetes mellitus. Sural artery flap remains a viable option for the reconstruction of soft tissue defects of the distal third of the leg and foot. Caution should, however, be exercised in patients with some significant systemic diseases.