Paediatric Post Burn Flexion Contracture Release: Early Outcomes Using Two Bloodless Techniques.

Post burn flexion contracture of the hand in children constitutes a significant proportion of post burn complications. We compared the early clinical outcomes of reconstruction of pediatric post burn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomised study of pediatric patients requiring contracture release and wound resurfacing with full thickness skin graft between September 2020 and August 2021. Patients were randomised into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t-test, and Chi-squared test were performed. Twenty-two (22) patients were randomised into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade three (3) flexion contracture was the most common (72.1%). Ninety four (94) digits and one hundred and seventy eight (178) joints were operated on with the proximal interphalangeal joint (PIPJ) being the most common (48.9%). The mean surface area of graft take on post operative day ten (10) was significantly higher for the tumescent group than the tourniquet group, p =0.001. The total active motion across the joints at six (6) and nine (9) weeks post operative showed a strong correlation between the total active motion across joints and the technique of release, p=0.004 and 0,001 respectively. Tumescent technique is a feasible alternative to the tourniquet method for post burn flexion contracture release of the digits in the pediatric burned hand.

Keloid masking a parotid tumor: A rare case presentation.

A 37-year-old Nigerian woman presented with an itchy and occasionally painful scar that appeared after the healing of an acne lesion over the left parotid region, 13 years ago. She noticed a progressive increase; however, there was no history of facial weakness. Examination revealed a keloid lesion overlying a firm nontender mass. Ultrasound scan and fine-needle aspiration cytology indicated a benign tumor of the left parotid. Superficial parotidectomy was performed, and the histology revealed a keloid overlying a pleomorphic adenoma. This is an unusual presentation of keloid which developed over a pleomorphic adenoma. Hence, we report the above case for its rarity.

Résumé Une femme Nigériane de 37 ans s'est présentée avec une cicatrice qui démangeait et parfois était douloureuse, apparue après la cicatrisation d'une lésion acnéique sur le région parotide gauche, il y a 13 ans. Elle a remarqué une augmentation progressive; cependant, il n'y avait aucun antécédent de faiblesse faciale. Examen révélé une lésion chéloïde recouvrant une masse ferme non sensible. L'échographie et la cytoponction à l'aiguille fine ont révélé une tumeur bénigne du côté gauche parotide. Une parotidectomie superficielle a été réalisée et l'histologie a révélé une chéloïde recouvrant un adénome pléomorphe. C'est un peu inhabituel présentation d'une chéloïde qui s'est développée sur un adénome pléomorphe. Par conséquent, nous signalons le cas ci-dessus pour sa rareté. Mots-clés: Cicatrice chéloïde, adénome pléomorphe, rare.

Management of facial burns: an update.

PURPOSE OF REVIEW: This article reviews literature on the recent progress made on management of facial burns. The discussion focuses on those aspects of the management in which recent studies brought new ideas, and reviews some that failed to change practices in the management of facial burns. RECENT FINDINGS: Recent innovations and models have been proposed in an attempt to reduce the incidence of unnecessary intubations in patients with burns to the face and with suspected inhalational injury. However, the decision to secure the airway is still a challenging one. A new escharotomy method based on facial subunits principles has been described, while the practice of early tangential excision is still debated in the literature. Tarsorrhaphy without occluding the eyes has also been described in the management of peri-oral burns. Self-retaining and expandable stents for the nose have also been demonstrated to be effective in preventing nasal stenosis. 3D printed face masks have been more recently developed to improve the current wound-care methods used in facial scar management. SUMMARY: This article highlights recent developments in the management of facial burns in areas such as acute facial burn care, subsequent wound care and facial scar management. It highlights areas wherein progress has been made, as well as the need for further studies in certain areas.

The millennial generation plastic surgery trainees in sub-Saharan Africa and social media: A review of the application of blogs, podcasts, and twitter as web-based learning tools.

The delivery of education and training in plastic surgery in Sub-Saharan Africa face increasing challenges. These include endemic shortages of plastic surgeons within postgraduate medical school faculties, the erosion of financial and clinical resources for teaching, and more recently, the millennial generation paradigm shift. It is generally accepted that the millennial generation will be more discerning and comfortable in their requirements for web-based learning content to support their education and training in plastic surgery. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google Scholar, and hand searching of bibliographies of published articles using the keywords: social media, Blogs, Twitter, plastic surgery, and millennial generation. This article defines and explores Blogs, Podcasts, and Twitter, as web-based learning tools, and discusses how to leverage social media to maximize their educational value and effectiveness.s.

Résumé L'offre d'éducation et de formation en chirurgie plastique en Afrique subsaharienne est confrontée à des défis croissants. Il s'agit notamment de la pénurie endémique de chirurgiens plasticiens au sein des facultés de médecine de troisième cycle, de l'érosion des ressources financières et cliniques pour l'enseignement et, plus récemment, du changement de paradigme de la génération du millénaire. Il est généralement admis que la génération du millénaire sera plus exigeante et plus à l'aise dans ses exigences en matière de contenu d'apprentissage en ligne pour soutenir son éducation et sa formation en chirurgie plastique. Nous avons examiné la littérature actuelle, y compris les articles originaux et critiques obtenus grâce à une recherche dans la base de données PubMed, Medline, Google Scholar, et une recherche manuelle dans les bibliographies des articles publiés à l'aide des mots clés: médias sociaux, blogs, Twitter, chirurgie plastique et génération du millénaire. Cet article définit et explore les blogs, les podcasts et Twitter, en tant qu'outils d'apprentissage basés sur le Web, et explique comment tirer parti des médias sociaux pour maximiser leur valeur éducative et leur efficacité.

Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice.

BACKGROUND: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. MATERIALS AND METHODS: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P < 0.05 were considered significant. RESULTS: The most important factors influencing the decision of medical students to choose plastic surgery as a career include; plastic surgeons appear happy in their work 93 (85%), Plastic surgeons have rewarding careers 78 (71%), and plastic surgeons provide good role models for medical students 96 (87%). An overall score of > 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. CONCLUSION: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students.

Vascular surgeries in West Africa: challenges and prospects.

BACKGROUND: The field of vascular surgery is evolving in sub-Saharan Africa but the practice is bedeviled by lack of expertise and infrastructure challenges. The consequences are a low volume of operations and a dearth of data. Available data are not representative of the wider picture, therefore, this study was undertaken to evaluate the practice of vascular surgery in a tertiary institution, in the light of the prevailing challenges. METHODS: Data from all patients with vascular-related pathologies managed in our surgical outpatient clinic and accident and emergency wards were obtained from the clinic and in-patient records from January 2008 to December 2012. Age, sex, diagnosis, treatment, and complications were noted. There were 73 patients comprising 45 (61.6%) males and 28 (38.4%) females. The age range was 1-90 years (mean 43.5 years). RESULTS: The pathologies managed included end-stage renal disease (n = 36, 49.3%), nontraumatic and posttraumatic aneurysms (n = 13, 17.8%), vascular trauma (n = 12, 16.4%), peripheral vascular disease (n = 5, 6.9%), congenital vascular malformations (n = 4, 5.5%), and thrombotic diseases (n = 3, 4.1%). Fifty-four (74.0%) surgeries were performed, with a complication rate of 5.5% and 2.7% mortality. CONCLUSIONS: The practice of vascular surgery in Zaria, Nigeria, is fraught with challenges. The gap created by the dearth of skilled vascular surgeons is filled by competent cardiothoracic surgeons. Infrastructure decay and lack of prostheses limit the number and variety of operable cases. These challenges result in preventable morbidity and mortality.

Perceived role of the journal clubs in teaching critical appraisal skills: a survey of surgical trainees in Nigeria.

BACKGROUND: Critical appraisal skills allow surgeons to evaluate the literature in an objective and structured manner, with emphasis on the validity of the evidence. The development of skills in critical acquisition and appraisal of the literature is crucial to delivering quality surgical care. It is also widely accepted that journal clubs are a time-honored educational paradigm for teaching and development of critical appraisal skills. The aim of this study is to determine the perceived role of journal clubs in teaching critical appraisal skills amongst the surgical trainees in Nigeria. MATERIALS AND METHODS: The West African College of Surgeons and the National Postgraduate College of Nigeria have mandated that all residency programs teach and assess the ability to develop critical appraisal skills when reviewing the scientific literature. Residents at the revision course of the West African College of Surgeons in September 2012 evaluated the role of journal clubs in teaching critical appraisal skills using a 17-item questionnaire. The questionnaire addressed four areas: Format, teaching and development of critical appraisal s kills, and evaluation. RESULTS: Most of the journal clubs meet weekly [39 (59%)] or monthly [25 (38%)]. Thirty-nine residents (59%) perceived the teaching model employed in the development of critical appraisal skills in their institutions was best characterized by "iscussion/summary by consultants" and "emphasis on formal suggestion for improvement in research." Rating the importance of development of critical appraisal skills to the objectives of the residency program and practice of evidence-based medicine, majority of the residents [65 (98%)] felt it was "very important." The commonest form of feedback was verbal from the consultants and residents [50 (76%)]. CONCLUSION: The perceived importance of journal clubs to the development of critical appraisal skills was rated as very important by the residents. However, residents indicated a need for a formal evaluation of the journal clubs. It is our hope that the results of this survey will encourage postgraduate coordinators to evaluate the quality of their journal clubs in the development of skills in critical appraisal of the literature.

Single Stage Reconstruction of Type IIA Defect of the Ear Lobule: The Limberg flap Technique Revisited.

The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. Such defects are typically seen in individuals having an unattached ear lobule. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg-flap technique using a doubled-over skin flap allows a one stage reconstruction of the ear lobule. It is technically simple and may be performed under local anesthesia. The aesthetic results are generally well acceptable and there is a good color match between the neolobule and the surrounding skin.

Sub-specialization in plastic surgery in sub-Saharan Africa: capacities, gaps and opportunities.

The skill set of a plastic surgeon, which addresses a broad range of soft tissue conditions that are prevalent in sub-Saharan Africa, remains relevant in the unmet need for surgical care. Recently, there has being a major paradigm shift from discipline-based to disease-based care, resulting in an emerging component of patient-centered care; adequate access to subspecialty care in plastic and reconstructive surgery. Given the need for an evolution in sub-specialization, this article focuses on the benefits and future role of differentiation of plastic surgeons into sub-specialty training pathways in sub-Saharan Africa.

Teaching the surgical craft: surgery residents perception of the operating theater educational environment in a tertiary institution in Nigeria.

BACKGROUND: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. MATERIALS AND METHODS: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. RESULTS: A total of 33 residents were participated in this study. Twenty nine (88%) males and 4 (12%) females. 30 (90%) were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident's perception of workload/supervision/support P < 0.05; however, there was no significant differences in junior registrar versus senior registrar's perception of the education environment in all the subscales P > 0.05. CONCLUSION: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.

Challenges in disclosure of adverse events and errors in surgery; perspectives from sub-Saharan Africa.

Surgery in sub-Saharan Africa is widely known to be done against a background of poverty and illiteracy, late presentation with complicated pathologies, and a desperate lack of infrastructure. In addition, patient autonomy and self determination are highly flavored by cultural practices and religious beliefs. Any of these factors can influence the pattern and disclosure of adverse events and errors. The impact of these in the relationships between surgeons and patients, and between health institutions and patients must be considered as it may affect disclosure and response to errors. This article identifies the peculiar socioeconomic and cultural challenges that may hinder disclosure and proposes strategies for instituting disclosure of errors and adverse events services in Sub-Saharan Africa.

Post-burn axillary contractures in pediatric patients: a retrospective survey of management and outcome.

Over a 5-year period, 63 children aged 15 years and less had surgical correction of 74 axillary contractures in our center. They were grouped into three severity categories based on the Kurtzman and Stern's classification. Accordingly, 56 were type I, 11 were type II and 7 were type III axillary contractures. While local flaps sufficed in all the type I contractures, skin grafts and fasciocutaneous flaps were required in types II and III. The principal movements at the shoulder joint were assessed at 2 years after, and functional outcome classified into three outcome categories. Excellent result (A) was obtained in all the type I contractures, 82% of the type II contractures and 28% of the type III contractures. Good result (B) was obtained in 18% of the type II and 57% of the type III contractures and poor result (C) was obtained in 14% of the type III contractures.