Pattern and Management of acquired Facial defects in Imo State University Teaching Hospital, Orlu, Nigeria.

Background: The face combines function with important aesthetic implications. With organs and units so closely related a fine balance and symmetry must be maintained in reconstructing facial defects. Imo State University Teaching Hospital Orlu, has the bulk of its patients drawn from neigbouring rural communities and are mainly of a low socioeconomic group. They therefore tend to present late with relatively complicated pathologies. This article looks at the pattern, aetiology and management approach for facial defects in our centre and highlights the challenges faced in managing these patients.Method: A review of clinical records of consecutive patients with acquired defects of the face managed at the Imo State University Teaching Hospital over a 12 month period was performed. Socio-demographic and clinical data were retrieved and analyzed.Results: There were 31 patients (15 males and 16 females) with 33 facial defects, and a mean age of 36.2 years. The lips were most commonly involved (30%). The eyelids and eyebrows were least affected. Most defects (48%) followed excision of neoplastic tumors and 87% of these were in Albinos. Human bite was the commonest cause of lip defects. The nasal defects more often required a combination of procedures with multiple theatre sessions. Ninety one percent (91%) of the defects were reconstructed primarily with good results.Conclusion: Surgical excision of squamous cell cancers in albinos and human bite are the commonest causes of facial defects in our  environment. In reconstructing facial defects of diverse aetiologies, adherence to laid down principles of facial reconstruction is necessary to achieve consistently acceptable results. We recommend primary repair of acquired facial defects as this gives optimal results. Keywords: Acquired facial defects; Pattern; Management; Nigeri

Burn injuries in Enugu, Nigeria

Background: Burn injury has been observed as a world wide problem.. The knowledge of the epidemiology is important for planning of management and preventive programmes and every community is encouraged to study the epidemiology of burns since this important problem varies from community to community. Method: This is a retrospective review of all our burn patients who presented with acute burn injuries between January 1993 and December 1997. Admission registers and patients' folders were the sources of information. The information obtained include age, sex, place of injury, month of injury, cause of injury, management and outcome. Results: A total of 285 patients with acute burn injuries were studied. Males were 180 [63.2%] while females were 101 [35.4%]. Flame was the single most common cause of burn injury [147 or 49.1%] while electrical burns was less frequent [4 or 1.4%]. Majority of burn injuries occurred in the months of December and January. The mortality rate was 23.2%. Conclusion: The incidence and mortality of burn injury has remained high in this environment. We suggest a well targeted prevention campaign program to reduce this high incidence and high mortality in this environment. Keywords: burn injuries, epidemiology, flame mortality, December/ January Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 271-27

An appraisal of medical waste management in four tertiary hospitals in Enugu, Nigeria

Background: In the last two decades, the World Health Organisation has issued several position papers and fact sheets on the management of medical wastes and the hazards these wastes pose to man and the environment. However, anecdotal reports from parts of Nigeria show that medical waste is yet to be appreciated as hazardous waste, requiring a planned programme of collection, treatment and disposal.Aim: To appraise the medical waste management practice in tertiary health care centres in Enugu State, Nigeria.Methods: The study utilized field investigation with questionnaires, personal observations and  interviews. Four tertiary health- care centres were appraised, one run by the State  Government and the other three by the Federal government. Data was collected on  quantity of waste generated, composition, segregation, collection, treatment and  disposal in each centre.Results: The study revealed that waste segregation is carried out in only one hospital.  Hospital wastes are collected with wheel barrows and trolleys.  Refuse is transported to treatment or disposal site by open trucks in two centres, the other two by Enugu State Waste Management Agency (ESWAMA) refuse trucks.  Only one centre employs low temperature incineration for treatment of refuse, while in the other three, there is no form of refuse treatment.Conclusion:  Medical waste is poorly managed in all four hospitals with attendant hazards to humans and the environment. Keywords:  Medical waste, Waste management, Tertiary hospital

Rare high origin of the radial artery: a bilateral, symmetrical case

Arterial variations in the upper limb can occur at the level of the axillary, brachial, radial and ulnar arteries as well as the palmar arches. This is a report of bilateral, symmetrical high origin of the radial artery from the axillary artery. Knowledge of such variations is important in vascular and reconstructive surgery. (Nig J Surg Res 2003; 5: 70 – 72) Key words: High origin, radial artery, bilateral, symmetrica

Advanced squamous cell carcinoma of the upper lip in an albino: A reconstructive challenge

Background: Albinos are prone to developing non melanomatous skin cancers. Late presentation constitutes a reconstructive challenge. We present an adult albino who presented with an advanced squamous cell carcinoma.Patient and method: A case of a 68 year old woman with a near total loss of the upper lip (loss of the upper lip sparing both commissures) following tumour resection presented with an 18 month history of an upper lip growth. The fungating mass occupied almost the entire upper lip, sparing about 1 to 1.5 cm of lip tissue on both sides. Its upper limit was about 0.7cm from the floor of the nasal cavity. The tumour was resected with a 0.5 cm margin and the lip reconstructed primarily using bilateral cheek advancement and an Abbe flap under local anesthesia. Flap division and inset was done after two weeks and sutures removed one week later. The patient tolerated the procedure very well. The early results appeared satisfactory both at rest and with lip animation.Conclusion: Near total loss of the upper lip can be reconstructed with bilateral cheek advancement for the lateral part and an Abbe flap for the central portion. The procedure is simple, can be performed under local anesthesia and is recommended for this type of defect as it tries to replace like tissue with its kind.Keywords: Albino, squamous cell carcinoma, local flap, local anaesthesi

Acquired lip defects - presentation and management at Orlu, Nigeria

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