Surgery
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Item Management of split skin graft donor site in the west african sub region: survey of plastic surgeons’ practice.(2017) Olawoye O.A.; Ademola S.A.; lyun A.O.; Michael A.I.; Oluwatosin O.M.Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.Item Wound bed assessment in patients at a tertiary hospital in Nigeria—a preliminary report(2016) Iyun O.A.; Ademola S.A.; Michael A.; Olawoye O.; Oluwatosin O.Introduction: Wound assessment is fundamental for the management of wounds. It is the foundation in the care plan and helps in determining the effectiveness of interventions. Wound assessment also assists in making appropriate decisions regarding the type of wound dressing to be applied. Detailed wound assessment takes into account all aspects of the patient’s well-being and not just the wounds the patient has. Objectives: The study assessed chronic wounds in the patients at a tertiary Nigerian hospital (University College Hospital, Ibadan) and utilized the information for preparing a standardized wound assessment format for health facilities in the subregion. Materials and Methods: The study was conducted at the University College Hospital, Ibadan, South West Nigeria. Patients with chronic wounds from various causes were treated prospectively in the hospital for over a month and had detailed assessment of their wounds performed. The data obtained were entered into a predesigned form, and this was subsequently analyzed using Statistical Package for the Social Sciences version 21 software. Results: Seventy-eight wounds were reviewed during the study period. The area of the wounds ranged from 1 to 1248 cm2 (median 24 cm2). The type of granulation tissue related to the wound type was not statistically significant. Assessment of the exudates of the wounds revealed that 44.9% of the wounds had seropurulent or purulent discharge, whereas 19.2% had serous discharge. Conclusion: Wound care management can be improved with appropriate wound assessments, which form the foundation in the care plan. Wound assessment will enhance objective measurement of the status of the wound and helps in choosing appropriate wound care dressing to promote wound healing.Item Perception of healthcare professionals in university college hospital, ibadan toward wound care(2016) Iyun O.A.; Ademola S.A.; Michael A.; Olawoye O.; Oluwatosin O.Background: A survey of perception of healthcare workers in a tertiary hospital [University College Hospital (UCH), Ibadan] was done with a view to determine the need to introduce a curriculum in wound care for healthcare workers. Materials and Methods: A self-administered questionnaire was used to capture data related to knowledge and practices on wound care from healthcare workers in UCH, Ibadan. Descriptive analysis was done using the Statistical Package for the Social Sciences version 21 software (SPSS Inc., Chicago, IL, USA). Results: One hundred and four healthcare professionals working in UCH, Ibadan, comprising doctors, nurses, and physiotherapist, with 61.1% over 10 years of experience in wound care were surveyed. Seventy- seven percent agree or strongly agree that healthcare professionals are knowledgeable about best practices in wound care. 50.5% agree or strongly agree that UCH operates best practices in wound care while 49% agree or strongly agree that wound assessment is standardized in the hospital. 96.2% agree or strongly agree that an interprofessional wound care course will be beneficial to healthcare professionals and that it will enable healthcare professionals speak the same language with regard to wounds. Conclusion: Teamwork and definite wound care policy/protocol are essential for excellent outcomes in wound care. Introduction of this approach will enhance knowledge translation and encourage best practice in our health institutions.Item Point prevalence of chronic wounds at a tertiary hospital in Nigeria(2016) Iyun A.O.; Ademola S.A.; Olawoye, O.A.; Michael A.I.; Oluwatosin O.M.Abstract: 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 cm2 -1,248 cm2 (median 24 cm2). 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.Item Comparative review of burns with inhalation injury in a tertiary hospital in a developing country(2016) Iyun A.O.; Ademola S.A.; Olawoye, O.; Michael A.I.; Oluwatosin O.M.Objective. Inhalation injury is an acute respiratory tract insult caused by direct thermal injury, carbon monoxide poisoning, or toxic chemical inhalants, such as fumes, gases, and mist. The aim of this study is to review the authors’ experiences in a regional burn unit in a developing country. Methods. The university college Hospital, Ibadan, Nigeria prospective burn unit database was retrospectively reviewed from January 2001to December 2013and analyzed using SPSS software, version 16 (SPSS Inc, Chicago, IL). Results. There were 840 patients in all, 63% (527) had cutaneous burns only, while 37%(313) had associated inhalation injury. There was a male preponderance in both groups. Those with cutaneous burns only and those with associated inhalation injury had a male to female ratio of 1.6;1 and 1.5:1, respectively. The mean ages were ears (inhalation injury) and 21 years ± 17 years cutaneous burn only) (P < 0.05). The mean total body surface area (TBSA) of the burn injuries was 55% (inhalation injury) and 25% cutaneous burn only) (P < 0.05). Burn injury occurred most frequently between 19.00 hours and 24.00 hours, and 56% of burn es that occurred during this time were associated with inhalation injury (P < 0.05). Major causes of burns were flames and scalding (86.2%). Mortality was 71% in patients with inhalation and 26% in patients with cutaneous burns only (P < 0.05). Conclusion. The association of inhalation injury with cutaneous burns portends a grave condition. An upgrade of expertise and infrastructure in the management of these patients is necessary in order to improve outcomes.Item Normal values of key pinch strength in a healthy nigerian population(2015) Michael A.L.; Iyun A.O.; Olawoye O.A.; Ademola S.A.; Nnabuko R.E.; Oluwatosin O.M.Background: With the severity of machine hand injuries in our environment, the need to determine the normal values for key pinch strength with which to compare restorative surgeries was justified. Methods: A cross sectional survey of participants who had no previous hand injuries limiting hand function. Data obtained included age, gender, body mass index, hand dominance and hand span. The Baseline Hydraulic Pinch Gauge was used to obtain key pinch strength. The influence of the above variables on measured pinch strength was analyzed using independent sample t-tests and Pearson’s correlation. Results: Of the 242 recruited participants, age range between 20 and 80 years, 163(67.4%) were male and 79 (32.6%) were female. Males had higher pinch strength (right-8.3 ±2.7kg, left-7.6±2.5kg) than females (right-6.3±1.5kg, left- 5.8±1.5kg). Pinch strength varied with age peaking in the fifth decade in males and females. Interestingly, the left handed dominant female had higher right pinch strength than her right handed counterpart (p<0.009). Height, and hand span correlated with pinch strength in females. Conclusion: Normal values for key pinch strength in this Nigerian population are lower than that of Caucasians.Item Temporoparietal scalp keloid: an unusual occurrence(2013) Ademola S.A.; Michael A.I.Item Propeller flap for complex distal leg reconstruction: a versatile alternative when reverse sural artery flap is not feasible(Wolters Kluwer, 2015) Ademola S.A.; Michael A.I.; Oladeji F.J.; Mbaya K.M.; Oyewole O.Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator-based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained Gustilo 3B injuries from gunshot. The donor area for reversed sural artery flap was involved in the injuries. They had early debridement, external fixation, and wound coverage with perforator-based propeller flaps. The donor sites were covered with skin graft. All flaps survived. There were minor wound edge ulcers due to the pressure of positioning that did not affect flap survival and the ulcers healed with conservative management. Perforator-based propeller flap is a versatile armamentarium for reconstruction of soft tissue defects of the distal leg in resource-constrained settings, especially when the donor area for a reverse flow sural flap artery is involved in the injury.Item Reconstruction of soft tissue defects in the distal third of the leg, ankle, and foot: a meta-analysis(2015) Ademola S.A.; Adebayo W.O.; Lawan O.Management of soft tissue defects in the distal third of the leg, ankle and foot has evolved over time despite its challenges. No option of coverage is universally recommended for defects in this region of the body. Our objectives were to review and analyze outcomes of reported options of reconstruction of soft tissue defects in this region. We conducted a search of PUBMED and HINARI databases from 2000-2014 to identify reported options of reconstruction of soft tissue defects of the leg, ankle, and foot. Pooled data from suitable articles were analyzed and the success and complication rates as well as the relative risks for failure and complications were computed. One thousand and thirty two articles were retrieved out of which thirty three met the inclusion criteria for analysis. All the 33 articles were uncontrolled cohort and descriptive studies. There were 14 reports on sural artery flap, 6 on perforator-based flaps, and 5 on free flaps. Cross leg flaps, adipofascial, peroneus brevis, and hemisoleus muscle flaps were reported in two studies each while medial plantar, supramalleolar, and skin grafts were reported in one study each. Flap failure was the commonest complication with free flaps while reconstruction with skin grafts had the lowest failure rate. Free flaps were, however, versatile for reconstruction of complex defect. Conclusively, meticulous planning is required in the reconstruction of defects of the lower third of the distal third of the leg, ankle, and foot in order to use the most appropriate method for best outcomes.Item An analysis of skin cancer in albinos in ibadan(2015) Ademola S.A.Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.