Necrotizing fasciitis in a plastic surgery unit: a report of ten patients from Ilorin

Background: Diffuse necrotizing fasciitis is the most treacherous soft tissue infection particularly because it may masquerade as simple cellulitis, thereby delaying diagnosis and treatment. Necrotizing fascitis correspond to deeper burns and require resuscitation, early debridement and skin coverage. It runs a rapid clinical course.Method: Ten patients with necrotizing fascitis were managed in the division of plastic and reconstructive surgery at the University of Ilorin Teaching Hospital, Nigeria. The hospital records of these patients were reviewed and form the basis of this report.Result: The duration of symptoms ranged between one day and three weeks. Most patients presented with associated high grade fever and rigor. Four of the patients had pre-morbid state which could have predisposed them to the infection. They were managed with intravenous fluids, antibiotics and analgesics, most patients had extensive debridement with subsequent wound dressing before skin grafting. Five patients survived while the remaining five died with a crude mortality of 50%.Conclusion: Early diagnosis, aggressive surgical intervention combined with supportive therapy is crucial to the successful treatment of the disease. If we must reduce the high mortality rate of the condition in our sub-region, early referral to a burns team should be considered as a treatment option by clinicians dealing with such cases

Fulminant necrotizing fasciitis following the use of herbal concoction: a case report

<p>Abstract</p> <p>Introduction</p> <p>Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer.</p> <p>Case presentation</p> <p>A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation.</p> <p>Conclusion</p> <p>The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.</p

Thread embedded into penile tissue over time as an unusual hair thread tourniquet injury to the penis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hair thread tourniquet syndrome has been recognized since the 1960s. Since then, sporadic reports have appeared in the literature describing different degrees of strangulation and/or amputation of the penis caused by a hair thread being inadvertently tied around the penis.</p> <p>Case presentation</p> <p>A 9-year-old boy presented with a 3-year history of hair thread tourniquet injury to his penis. Instead of the usual strangulation or amputation, the tourniquet had become embedded into the penile tissue, manifesting with exuberant granulation tissue and a tight urethral stricture. At surgery, the intact tourniquet was still in place, embedded in dense fibrous tissue and associated with a dense urethral fibrosis which measured about 2 cm long. The tourniquet was divided and removed, the fibrotic urethra excised and a distal penile pedicled skin flap used to perform a single-stage substitution urethroplasty. The patient has been voiding well for 28 months.</p> <p>Conclusion</p> <p>This case is unusual and is the first report of its kind. It is also the first report of a hair thread tourniquet as the cause of pediatric penile injury in Nigeria.</p

Soft tissue sarcoma of the thigh: Need for angiography in the developing

No Abstract

Microvascular free flap reconstruction: the challenges in the developing country

After years of development, microvascular free tissue transfer has been firmly established as the primary method for reconstrutive surgery. The concept of using a reconstructive ladder to repair complex defects has been revolutionized and the tradition of using free flap surgery as the last resort has been challenged. In a developing country like ours, surgeons are still contending with the basic problems of microvascular free tissue transplantation. An 18-year old student presented to our hospital with a diagnosis of osteomyelitis of the frontal bone. A radical debridement of osteomyelitic bone was done and the defect created was repaired with a microvascular free lattisimus dorsi musculocutaneous flap. The procedure lasted about 16 hours with a long duration of warm ischaemic time, but the flap survived. Institutional support is highly necessary for making available appropriate microvascular instruments, operating microscope, pharmacologic agents, allocation of operative time and post operative care, if we must make progress in the field of microvascular surgery in the West African sub-region. KEY WORDS: Microvascular Free Flap, Challenges, Developing Country Sahel Medical Journal Vol.7(2) 2004: 73-7

A review of soft tissue sarcoma

No Abstract. Nigerian Journal of Medicine Vol.16 (2) 2007: pp.94-10

Unoperated Adult Cleft of the Primary Palate in Ilorin, Nigeria

Congenital cleft lip deformity represents varying degrees of failure of mesenchymal migration and penetration from maxillary process into the naso-medial process. In Nigeria, and perhaps among other developing countries, the social attitude to congenital deformities has been appalling. It is widely acceptable that the repair of cleft lip should be done in infancy when the child has gained a constant weight of at least 10 pounds (4.5kg) and at least 10 weeks old with an haemoglobin concentration of at least 10g/dl. In the last 24 months, our hospital managed 12 cases of unoperated adult cleft lip despite the availability of plastic surgery services in almost all the geo-political zones in Nigeria. These patients during the pre-school and school years has to battle with the stigmas of the typical mid broad lip and flattened nose deformities. Three of our patients dropped out of secondary education because of social embarrassment and one has returned to school after repair. Although clefts were very wide on presentation, there was adequate well developed soft tissue in adults to achieve cosmetically and functionally acceptable repair. Public enlightenment programme is highly needed to help improve early presentation. (Key Words: Unoperated Adult Cleft, Primary, Palate) Sahel Medical Journal Vol.7(1) 2004: 18-2

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7 th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient

Non-cardiac Surgery in a Child with Major Congenital Heart Disease: A Challenge to Safe Anaesthesia

Surgery in children with congenital heart disease poses an increased risk of morbidity and mortality. Ideally such children should be managed in specialist cardiac centres. However, it is not unusual in developing countries for the patients to present in non-specialist centres. This was the case with a 5 month old baby who presented at our hospital with a major and severe cyanotic congenital cardiovascular anomaly for the repair of a bilateral complete cleft lip. The parents declined referal to a specialist cardiac centre. The surgery was successfully done under general anaesthesia despite the limited facilities. It is important that all anaesthetists are familiar with the basic principles involved in the management of these patients. Appropriate cardiologist consultation and close collaboration between the surgical, anaesthetic and nursing teams, is also critical to a successful outcome. Keywords: Anaesthesia, non-cardiac surgery, congenital heart disease, non-specialist cardiac centre, limited facilities