The Use of Unripe Pawpaw for Wound Bed Preparation Following Radiation‑Induced Sacral Ulcer: A Case Report and Review of Literature

Radiation wounds are very difficult to manage due to poor vascular status, excessive matrix metalloproteinases, and abnormal  myofibroblast function. Such wound beds do not adequately support conventional resurfacing as do nonradiate beds. We present a 46‑year‑old female with a sacral radiation ulcer, which had earlier failed to support flap cover on two instances after bed preparation with conventional honey dressing and negative pressure dressing, but was subsequently successfully managed with unripe pawpaw wound bed preparation. Are‑elevation of the right gluteal myocutaneous flap proved successful and satisfactory. The finding may have resulted from both enzymatic properties of unripe pawpaw and its ability to break the biofilms and to locally supply the ascorbic acid necessary for collagen synthesis and granulation tissue formation. Keywords: Case report, radiation wounds, unripe pawpaw, wound bed preparatio

Gastric Duplication Cyst with Multiple Ectopic Pancreatic Tissues: A Case Report and Review of Literature

A gastric duplication cyst (GDC) is a type of enteric duplication cyst. It can co‑exist with an ectopic tissue. This was a female toddlerwith a GDC at the greater curvature. An abdominal ultrasound and a contrast‑enhanced computed tomogram suggested the cyst. Shehad laparotomy, complete cyst and partial gastric excision with the removal of extragastric pancreatic tissue. The histology reportcame out as a cyst with associated intracystic and an extracystic pancreatic tissue. She made a clinical improvement. GDC can beassociated with both intracystic and extracystic ectopic pancreatic tissues. This should be kept in mind when choosing the modalityof treatment. Keywords: Ectopic pancreas, gastric duplication cyst, intra‑peritoneal cys

Open Inguinal Hernia Repair: Our Experience with Tertiary Institution-Based Surgical Outreach

Background: Inguinal hernia afflicts the low socioeconomic class mostly in resource‑poor settings. The surgical outreach option greatly reduces this burden. Tertiary health institutions will be a good base for surgical outreaches in hernia repairs. Aim: The aim of this study was to determine the outcome of using a tertiary health‑care facility for a surgical outreach program. Methods: This was a prospective clinical study conducted among 195 patients who underwent open groin hernia repair in Alex‑Ekwueme Federal University Teaching hospital Abakaliki. Data were collected from admission, till discharge from hospital, and up to 3 months follow‑up after the surgery. Results: Out of 206 recruited, a total of 195 patients underwent open groin hernia repair with a male: female ratio of 6.5:1. Their age ranged from 0 to 88 years with a mean age of 33.94 ± 23.40 years. Among the patients, 69.2% of the hernias occurred in ages below 50 years, 58.4% had right, 38% left and 3.6% had bilateral hernias. Open hernia repair was performed in 63.1% and herniotomy in 36.9%. In those that had an open hernia repair, majority 91.8% had tissue repair, whereas 8.2% had mesh repair. Postoperative complication rate was 9.2%. Conclusion: Surgical outreach in a tertiary health facility offers standard care with skilled surgical personnel offering a better outcome with complication rate similar to what obtains in a conventional tertiary health care. Tertiary hospitals where available should be preferred in the surgical outreach for hernias in a low‑resource setting. Keywords: Low‑resource setting, Nigeria, open hernia repair, surgical outreach, tertiary health‑care facility&nbsp

Patterns of Antimicrobial Use in a Specialized Surgical Hospital in Southeast Nigeria: Need for a Standardized Protocol of Antimicrobial Use in the Tropics

Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost‑effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria. Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4. Results: A total of 127 inpatients  participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients. Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics. Keywords: Antimicrobial protocol in surgery, antimicrobial resistance, antimicrobial stewardship, prophylactic antibiotic

Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study

Introduction: chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing. Methods: sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5th post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge. Results: the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome. Conclusion: negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks

Abdominoplasty for male truncal obesity: case report

Truncal obesity and its associated health risk is an enormous burden. The traditional surgical treatment modality is liposuction or lipoabdominoplasty. An uncommon mode of the treatment is the use of abdominoplasty alone or as a surgical component. The aim of this report is to show a satisfactory outcome of abdominoplasty as the only surgical component in the management of severe truncal obesity in elderly male patient. We report a 75 year old Nigerian trader who had truncal obesity with gross abdominal asymmetry and cardiovascular and diabetes mellitus co-morbidities as well as bilateral knee osteoarthritis and social isolation due to truncal disfigurement. He was offered abdominoplasty as a sole surgical option for correction of anterior abdominal wall asymmetry. Apart from post operative wound complications and blood transfusion reactions, the patient had a good recovery and improved quality of life. Abdominoplasty is a rewarding treatment when used as a sole surgical option in centrally obese patients with anterior abdominal wall asymmetry and significant subcutaneous fat thickness