Hand Tumours in Lagos, Nigeria: A Clinicopathologic Study

Background: Hand tumours occur infrequently and are commonly benign, however when malignant they could be life threatening. This study was aimed at determining the prevalence, demographics, the clinical presentations and treatment outcome of hand tumours among patients attending the hand service of the Lagos University Teaching Hospital.Methods: We studied the clinical and pathological records of a 124  consecutive hand tumours that presented at hand clinic of the Lagos University Teaching Hospital(LUTH) between June 2003 and June 2013 .Results: A total of 124 patients were seen of which 98 had excision biopsies . The male to female sex ratio was 1: 1.3. The mean age at presentation was 32.7 years sd ± 8.44 years. An overwhelming majority (94.9%) had their procedures done under local/regional anaesthesia. Two patients died and three of the tumours recurred during the follow up period. The commonest histopathological diagnoses included ganglion cyst, giant cell tumor of the tendon sheath and pyogenic granuloma constituting 23.8%. 15.7% and 6.7% of the cases seen respectively.Conclusion: Hand tumours in Lagos tend to affect young adults with a slight female preponderance. Majority of the tumours were benign. Primary hand malignancy was uncommon and mortality was low. Nearly all (97%) of the surgically treated patients returned to their premorbid occupation.Key words: Hand tumours, biopsy, soft tissue

Morbidity of Open Tibia Fractures in Lagos, Nigeria

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Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients, investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision, colon segments, scrapes, tissues, pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 370C for 16-24 hours. Thereafter, isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75%) while those from colon segment was 30(37.6%), scrapes 8(16%) and pus 3(7.5%). Acinetobacter species found on incision was 15(7.5%) and pus 7(2.3%). Pseudomonas species was distributed on incision 5(2.5%), colon segment 4(5%), tissue 3(1.6%), scrapes 5(10%) and pus was 5(12.5%). Staphylococcus aureus which was isolated from incision was 2(1%), while scrapes and pus were 5(10%) and 7(17.5%) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7%), almost twice the rate of non-significant bacteriuria (35.3%); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt, Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound, showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery. Key Words: Bacterial pathogens, Endogenous indicators, NosocomiaI infection, Surger

Anatomic Variations in the Palmar Cutaneous Branch of the Median Nerve Among Adults in Lagos, Nigeria

Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries.Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.Keywords: Carpal tunnel surgery, median nerve, palmar cutaneous branc

Early Experiences with Microvascular Free Tissue Transfer in Lagos, Nigeria

Objectives: Microvascular free tissue transfer within our subregion is fraught with considerable challenges. We aim to highlight our experiences gained with our first fifteen cases of microvascular free tissue transfer at the Lagos University Teaching Hospital. We believe our report will be useful to colleagues embarking on such reconstructions in similar settings. Materials and Methods: The clinical records of the first 15 cases of free flaps done at our center were reviewed. The indications for surgery, choice of flap, recipient vessels, duration of surgery and complications were noted. Results: Fifteen cases were done, 10 flaps survived, ten defects occurred following trauma while remaining five followed cancer resections. Anterolateral thigh and radial forearm flaps were the most common flap used. The mean duration of surgeries was 7.1 hours SD ± 1.10 hours. Our take back rate was 13.3%, with a salvage rate of 50%. Three flaps failed on account venous congestion while remaining two failed due to arterial occlusion.Conclusion: 66.67% free flap success rate recorded reflect our early experiences in our institution. We believe meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead to much better success rates in microvascular reconstruction in our country.Keywords: Experiences, free, tissue, transfe

Upper extremity nerve injuries in a Nigerian Teaching Hospital

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Civilian Firearm and blast injuries of the Hand in Lagos, Nigeria

A 6 year review of 43 patients who sustained Civilian firearm and blast injuries of the hand at the Lagos University Teaching Hospital was done. Majority of patients seen were young males (93.1%). The firearm injuries occurred during armed robbery attacks (80.1%), while majority(82.7%) of the blast injuries followed firework accidents during New year celebrations. The commonest pattern of injuries were soft tissue lacerations and avulsions. Others such as amputations, fractures, tendon and nerve disruptions occurred less frequently. The commonest surgical procedures performed include multiple debridements, skin grafts/flaps and other forms of wound closures. Fracture stabilization, tendon and nerve reconstruction were less commonly done. Over 92% required more than three surgical procedures, 63% of the patients studied were able return to their pre morbid occupations. In spite of the devastating injuries many patients managed were able to carry out most of the of their daily activities .Keywords: Firearm , blast, hand , injurie

Keloid and Hypertrophic Scars: A Review of Recent Developments In Pathogenesis And Management

Aim: The treatment of keloid and hypertrophic scars remains a challenging clinical problem despite numerous proposed therapies reported in the literature. This is due to the fact that the mechanisms that bring about keloid/hypertrophic scars are not completely understood. This article reviews the pertinent literature regarding the pathophysiology and management of keloid and hypertrophic scars. Material and methods: A computerized literature search using MEDLINE was conducted for published articles on keloid and hypertrophic scars. The medical subject headings “keloid” or “hypertrophic scar” were combined with “treatment” or “management” or “mechanisms” or “pathophysiology” using the Boolean operator “AND” to narrow the searches. A review of selected relevant literature was undertaken. Results: Numerous advances have been made in understanding the process of formation of wound healing and scar formation. This increased knowledge has led to the introduction of new treatments as well as to a better understanding of how older treatments work. These include surgical excision, intralesional steroid injection, cryotherapy, laser therapy, irradiation, mechanical compression dressing, silicone sheet applications, intralesional interferon injection, or combination of techniques. Many of the treatment modalities have a defined biologic basis while others are based on anecdotal reports. Conclusions: Presently there is still no single, reliable and effective treatment protocol for keloid and hypertrophic scars. However, surgical excision followed by postoperative intralesional steroid injection seems to provide a reasonable treatment outcome with low recurrence rate. NQJHM Vol. 17 (4) 2007: pp. 134-13

Clinical and Proctosigmoidoscopic findings in Patients with Anorectal Sepsis in a Private Health Facility in Lagos, Nigeria

Background: Anorectal sepsis is a distressing condition which is sometimes inadequately treated.Objectives: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures.Method: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also notedResults: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found. Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity.Conclusion: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.KeyWords: Anorectal sepsis, fistula in ano, proctosigmoidoscop