Parental views on plastic surgery for Down syndrome: an African perspective

Introduction: plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child. Methods: consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant. Results: most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery, most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87. Conclusion: the parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature

Cranial-entry electrical burns with neurological sequelae: A case report

Cranial-entry high-voltage electrical burn injury rarely occurs. Hence, early presentation is rare. We herein present a case of a teenage male with mainly fullthickness electrical burn injury covering 9% of the total body surface area, with gangrenous mid-fronto-parietal scalp and calvarium, moderate head injury with bihemispheric deficits, and left frontoparietotemporal intracerebral hematoma and exit wounds (right thumb, thigh, and toes). He underwent initial outer-strip and, later, inner-strip corticectomy, covered with splitthickness skin graft (STSG) and bilateral posteriorauricular artery-based flap, respectively, as well as tangential burn wound excisions with STSG and louvre flap cover for the digits. He also underwent right upper eyelid contracture release and tarsorrhaphy. He developed late post-traumatic seizures, which were managed with anti-epileptic drugs. Definitive calvarial reconstruction is underway. Cranial-entry electrical injury had high morbidity and mortality risks. The spectrum of nervous damage causation mimics nervous syndromes and their presentations. Although elaborate surgical and medical care offers the possibility of survival, the neurological and neuropsychological syndromes in the post-acute and rehabilitative phases of care should be taken care of

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study.

BackgroundCleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs.ObjectiveTo determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria.MethodsA retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis.ResultsThere were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005).ConclusionThere has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip

Annual incidence of cleft surgeries per 1000 live births.

Annual incidence of cleft surgeries per 1000 live births.</p

Association between survival time and gender and type of primary surgery.

Association between survival time and gender and type of primary surgery.</p

Association of demographic and clinical parameters with age at primary surgery.

Association of demographic and clinical parameters with age at primary surgery.</p

Annual trends in cleft surgeries.

Annual trends in cleft surgeries.</p

Cox proportional regression of the hazard of late primary repair among babies with cleft lip and palate.

Cox proportional regression of the hazard of late primary repair among babies with cleft lip and palate.</p

Steri-stripTM versus subcuticular skin closure of paediatric groin wounds: A randomised study

Background: A technique that offers the best chance of an optimal result is most appropriate to be employed for wound closure. Aims: We set out to compare the cosmetic outcome, and wound complication rates associated with clean paediatric groin wounds closed using Steri-Strip™ or subcuticular suturing. Settings and Design: A prospective randomised study. Subjects and Methods: Children of African descent with unilateral and bilateral clean groin wounds were randomised into subcuticular suture skin closure and Steri-Strip™ groups and followed up postoperatively. Cosmetic assessment and outcome were scored based on parents' satisfaction using the visual analogue scale (VAS) and a single Plastic Surgeon assessed pictures of the scars using the Hollander Wound Evaluation Scale (HWES). Statistical analysis was used SPSS version 18. Results: Seventy-five wounds were assessed, (n = 35, Steri-Strips™) and (n = 40, suturing). Closure with Steri-Strips resulted in scars with comparable cosmesis as those with subcuticular suturing. Wound complications were also similar. There was no statistically significant difference between mean VAS scores on the 5th day (P = 0.320), 2nd week (P = 0.080), 4th week (P = 0.070) and 8th week (P = 0.080). The HWES scores were also comparable at those times. Conclusions: We conclude that skin closure of clean paediatric groin wounds with SteriStrips™ gives comparative cosmetic outcomes with subcuticular suturing

Trends in the annual number of clefts and incidence (2007–2019).

Trends in the annual number of clefts and incidence (2007–2019).</p