Interventional studies for preventing surgical site infections in sub-Saharan Africa - A systematic review.

BACKGROUND: There is a great need for safe surgical services in sub-Saharan Africa, but a major difficulty of performing surgery in this region is the high risk of post-operative surgical site infection (SSI). METHODS: We aimed to systematically review which interventions had been tested in sub-Saharan Africa to reduce the risk of SSI and to synthesize their findings. We searched Medline, Embase and Global Health databases for studies published between 1995 and 2010 without language restrictions and extracted data from full-text articles. FINDINGS: We identified 24 relevant articles originating from nine countries in sub-Saharan Africa. The methodological quality of these publications was diverse, with inconsistency in definitions used for SSI, period and method of post-operative follow-up and classification of wound contamination. Although it was difficult to synthesise information between studies, there was consistent evidence that use of single-dose pre-operative antibiotic prophylaxis could reduce, sometimes dramatically, the risk of SSI. Several studies indicated that alcohol-based handrubs could provide a low-cost alternative to traditional surgical hand-washing methods. Other studies investigated the use of drains and variants of surgical technique. There were no African studies found relating to several other promising SSI prevention strategies, including use of checklists and SSI surveillance. CONCLUSIONS: There is extremely limited research from sub-Saharan Africa on interventions to curb the occurrence of SSI. Although some of the existing studies are weak, several high-quality studies have been published in recent years. Standard methodological approaches to this subject are needed

Sites of Autologous Bone Grafts in Orthopaedic Traumatology. Analysis of complications

Background: The use of autologous bone graft in orthopaedic traumatology is not uncommon. But little work, from West African subregion, has been devoted to sites used as sources of autologous bone grafts. Objective: The purpose of this study was to evaluate the evolution of these different sampling sites of autologous graft. Materials and methods: The authors report the results of a retrospective study of 84 patients operated on between 2000 and 2005 for various bone diseases requiring autologous bone graft at CHU Treichville (in Abidjan). Excluded from this study were bone grafts sourced from femoral heads harvested during arthroplasty of the hip. The series consist of 52 men and 32 women. Sites of bone autografts were iliac in 55 patients, 18 ends of the upper tibia, 7 olecranons, 3 fibulas and 1 greater trochanter of the femur. The evaluation of patients was clinical and radiographic and included the existence or not of pain, stiffness, assessment of the scar and the existence of a local deformation. Results: Outcome was satisfactory in 72 patients. 6 patients reported pain in the iliac crest. In 11 patients, the scar to the iliac crest was unsightly. Conclusion: The authors conclude that the commonly used donor sites for autologous bone grafts are safe. Keywords:autologous bone graft, pseudoarthrosis, bone reconstructionNigerian Journal of Orthopaedics and Trauma Vol. 7 (1) 2008 pp. 20-2