Day-care Plastic Surgery in Nigeria: Coping With Limited Resources

Background: The main problems facing acute surgical services in most countries are shortages of resources and finance, and long waiting lists. The concept of day-care surgery has been well established since the early nineties. Since then, enthusiasts have also indicated that day-care surgery represents a safe, cost-effective and efficient practice. Methods: A 3-year retrospective analysis of all day-care plastic surgical cases undertaken in the unit from January 2001 to December 2003 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Folders of such patients were obtained from the hospital's medical records department. The information obtained was analyzed for demographic data, surgical problems, type of anaesthesia and postoperative complications. Results: A total of 148 procedures were carried out in 137 patients. This represented 37.2% of all procedures done and 36.5% of all patients treated within the same period in the unit. The ages ranged between 2 weeks and 58 years (mean = 23.1 years). There were 66 males and 71 females, giving a male: female ratio of 1:1.1. The most frequently performed procedure was lipomectomy (11.7%), followed by biopsy of skin tumours (10.9%), incision of tongue tie (10.2%), excision of breast lump (9.5%), reconstruction of facial structures (8.8%), ganglionectomy (8.0%) and others. The anaesthesia used was loco-regional with lignocaine in 92(67.2%) patients, intravenous ketamine in 41(29.9%) patients and inhalation anaesthetics in the remaining 4 (2 .9%). postoperative complications were observed in 13 (9. 5%) patients, the commonest of which was wound infection (8. 0%), followed by bleeding (5.1%), pain (5.1%) and haematoma (2. 9%). Readmission rate was 3.6%, mainly due to bleeding and delayed recovery from anaesthesia. Neither significant wound disruption nor mortality was recorded. Conclusions: Good preoperative patient selection and preparation are essential prerequisites for day-care plastic surgery especially in resource-limited environments like ours. It is safe and cost-effective.Fond: Les probl\ue8mes principaux qui charact\ue9risent les services chirurgicaux aigus dans la plupart des pays sont des manques de ressources et de finance, et \ue9galement de longues listes d'attente. Le concept de chirurgie d'assistance sociale a \ue9t\ue9 bien \ue9tabli depuis le d\ue9but des ann\ue9es quatre-vingt-dix. Depuis, les fervents ont indiqu\ue9 aussi que cette chirurgie d'assistance sociale repr\ue9sente une pratique s\ufbre, rentable et efficace. M\ue9thode: Une analyse r\ue9trospective de 3 ann\ue9es de tous les cas chirurgicaux, en plastique et d'assistance sociale entrepris pendant la p\ue9riode du 2001 janvier au 2003 d\ue9cembre \ue1 l'h\uf4pital d'enseignement de l'Universit\ue9 d' Usmanu Danfodiyo, Sokoto. Les dossiers de tels malades ont \ue9t\ue9 obtenus du d\ue9partement de rapports m\ue9dical de l'h\uf4pital. L'information obtenue a \ue9t\ue9 analys\ue9e pour les donn\ue9es d\ue9mographiques, les probl\ue8mes chirurgicaux, le type d'anesth\ue9sie et de complications postop\ue9ratoires. R\ue9sultats : Un total de 148 proc\ue9dures a \ue9t\ue9 ex\ue9cut\ue9 dans 137 malades. Ceci a repr\ue9sent\ue9 37,2% de toutes proc\ue9dures faites et 36,5% de tous malades trait\ue9s dans la p\ue9riode pareille dans l'unit\ue9. Les \ue2ges se sont \ue9tendus entre 2 semaines et 58 ann\ue9es (moyen= 23,1 ann\ue9es). Il y avait 66 m\ue2les et 71 femelles, donnant une proportion de m\ue2le : femelle de 1:1,1. La proc\ue9dure le plus fr\ue9quemment ex\ue9cut\ue9e \ue9tait la lipomectomie (11,7%), suivi par la biopsie de tumeurs de peau (10,9%), l'incision de match nul de langue (10,2%), l'excision de tas de sein (9,5%), la reconstruction de structures du visage (8,8%), la ganglionectomie (8,0 %) et les autres. L'anesth\ue9sie utilis\ue9e \ue9tait loco-r\ue9gional avec xylocaine dans 92(67,2 %) malades, ketamine intraveineux dans 41(29,9 %) malades et l'anesth\ue9siologie inhalationale dans les 4 (2,9%) restants. les complications postop\ue9ratoires ont \ue9t\ue9 observ\ue9es dans 13 (9,5%) malades, dont le plus commun \ue9tait l'infection de blessure (8,0%), suivi par le saignement (5,1%), la douleur (5,1 %) et l'haematome (2,9%). Le taux de r\ue9admission \ue9tait 3,6%, principalement en raison du saignement et le r\ue9tablissement retard\ue9 de l'anesth\ue9sie. Ni l'interruption de blessure significative ni la mortalit\ue9 a \ue9t\ue9 enregistr\ue9e. Conclusion: La bonne s\ue9lection pr\ue9op\ue9ratoire des malades et la pr\ue9paration sont des conditions pr\ue9alables essentielles pour la chirurgie esth\ue9tique d'assistance sociale surtout dans les environnements de manque de ressources comme le n\uf4tre. C'est s\ufbr et rentable

Palatal avulsion injury by a foreign body in a child

A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic

Cystic lymphangioma in an unusual site: The misdiagnosed scrotal mass

Background : Cystic lymphangioma (CL) is a congenital lymphatic malformation that is a rare cause of extratesticular scrotal masses in children, frequently misdiagnosed preoperatively. Complete excision is curative, but recurrence may result following incomplete excision. Aim: This case is presented to alert the medical fraternity on the possibility of CL in a rare site as the scrotum, and to consider same in the differential amongst commoner causes of scrotal masses in children and adults. Methods : A case report, Results : We report a case of cystic lymphangioma of the scrotum in a 7-year-old boy, which had been previously diagnosed as an epididymal cyst. Scrotal ultrasonography and operative findings were consistent with cystic lymphangioma, which was confirmed by histological examination of the excised specimen. The mass was completely excised and the child is free of recurrence at 3 years of follow-up. Conclusion : Scrotal masses may result from unusual causes like cystic lymphangioma, which must be taken into account in the differential diagnosis in such cases. High-resolution ultrasonography, followed by Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), are useful tools in diagnosis

Compartment syndrome of the extremity: Matters arising

Background: Compartment syndrome (CS) is a limb-threatening and a life-threatening condition that occurs when pressure within a musculofascial compartment exceeds tissue perfusion pressure. Morbidity and mortality from CS stem from delay in diagnosis and treatment. Aim: To highlight the various clinical and experimental aspects of CS, in order to increase the awareness of clinicians and reduce unnecessary morbidity and mortality resulting from this condition. Methods: A review composed through Medline Internet search, literature search and contributions from our individual and collective experiences over the years, as well as shared experiences from colleagues. Results: The compartments of the lower leg, foot and the volar forearm are particularly prone to developing CS. Many aetiological factors have been implicated, but the diagnosis is based on clinical, manometric, radiological and laboratory parameters. Although medical treatment may suffice in early cases, surgical decompression should be performed appropriately where necessary. Tendon transfers and stabilization may be indicated as late treatment. Conclusion: CS constitutes a threat to both limb and life. Prompt recognition of this condition is necessary in order to institute the appropriate management schedule

Day-care plastic surgery in Nigeria: coping with limited resources

Background: The main problems facing acute surgical services in most countries are shortages of resources and finance, and long waiting lists. The concept of day-care surgery has been well established since the early nineties. Since then, enthusiasts have also indicated that day-care surgery represents a safe, cost-effective and efficient practice. Methods: A 3-year retrospective analysis of all day-care plastic surgical cases undertaken in the unit from January 2001 to December 2003 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Folders of such patients were obtained from the hospital's medical records department. The information obtained was analyzed for demographic data, surgical problems, type of anaesthesia and postoperative complications. Results: A total of 148 procedures were carried out in 137 patients. This represented 37.2% of all procedures done and 36.5% of all patients treated within the same period in the unit. The ages ranged between 2 weeks and 58 years (mean = 23.1 years). There were 66 males and 71 females, giving a male: female ratio of 1:1.1. The most frequently performed procedure was lipomectomy (11.7%), followed by biopsy of skin tumours (10.9%), incision of tongue tie (10.2%), excision of breast lump (9.5%), reconstruction of facial structures (8.8%), ganglionectomy (8.0%) and others. The anaesthesia used was loco-regional with lignocaine in 92(67.2%) patients, intravenous ketamine in 41(29.9%) patients and inhalation anaesthetics in the remaining 4 (2 .9%). postoperative complications were observed in 13 (9. 5%) patients, the commonest of which was wound infection (8. 0%), followed by bleeding (5.1%), pain (5.1%) and haematoma (2. 9%). Readmission rate was 3.6%, mainly due to bleeding and delayed recovery from anaesthesia. Neither significant wound disruption nor mortality was recorded. Conclusions: Good preoperative patient selection and preparation are essential prerequisites for day-care plastic surgery especially in resource-limited environments like ours. It is safe and cost-effective