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

Congenital malformations in paediatric and neurosurgical practices: problems and pattern (A preliminary report)

Aim: To determine the pattern and identify problems and outcome of management of congenital anomalies in Ilorin, Nigeria. Methodology: We retrospectively studied all children presenting over a 5-year period (1998 to 2002) with congenital anomalies to the Paediatric Surgery and Neurosurgery units of the University Teaching Hospital, Ilorin, Nigeria. Clinical data abstracted and analyzed include age, type of congenital anomaly, management, complications and outcome. Results: There were 803 children with various systemic congenital malformations. Of these, 588 (73.2%) were operated, constituting 54.4% of the total operations performed on children (1080) during the study period. Malformations of the gastrointestinal tract (536) including hernias (317), anorectal malformations (61), Hirschsprung\'s disease(45), and omphalocoeles(19), were the most frequent. Next in frequency were malformations of the central nervous system (114), the commonest being spinal dysraphism (50) and hydrocephalus (44). Less common malformations included urogenital (105) and biliary (3) anomalies as well as lesions of the neck (35), skin (8) and soft tissues(2). The overall mortality rate of 3.4% (20/586) was predominantly due to the deaths of infants with oesophageal atresia, gastroschisis, and ruptured myelomeningocoele. Conclusion: The commonest systemic congenital malformations encountered by the paediatric and neurosurgical units in this center are in order of decreasing frequency gastrointestinal, central nervous and genitourinary. Keywords: congenital malformation, pattern, management, outcome Sahel Medical Journal Vol. 8(1) 2005: 4-

Primary intra-orbital optic nerve sheath meningioma in an adolescent: a case report

Background: Primary optic nerve sheath meningioma is rare, but nearly always results in blindness; whether left alone or surgically treated. Case report: A 19-year-old male student without antecedents presented to the ophthalmic service of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, with a two-month history of progressive proptosis, pain, and a foul smelling discharge in the right eye. Upon clinical examination with a Hertel's exophthalmometer, the degree of axial proptosis of the right eye was found to be 20mm compared with 16mm in the left eye. Visual acuity was 6/18 in the right eye and 6/5 in the left eye, with a right relative afferent pupillary defect. An ocular ultrasound revealed intra-orbital soft tissue mass. Computed tomography (CT) scanning of the head was not done at this time due to financial constraints on the part of the patient. He thereafter defaulted from follow-up but re-presented a year later with more severe proptosis, conjuctival chemosis, infected exposure keratitis and total loss of vision in the right eye. A computed tomography of the head revealed an enhancing right retro-bulbar intra-orbital soft tissue mass. Enucleation of the right eye and complete extirpation of both the tumour and the intra-orbital optic nerve were carried out without complications. The histopathology revealed transitional meningioma of the optic nerve sheath. The patient is now socially rehabilitated, wears an artificial eye and has returned to his former occupation and society. Conclusion: This case typically illustrates the complications that could arise if a treatable benign condition is left untreated because of limited affordable diagnostic facilities or the adoption of an unmonitored ‘observational strategy' in the early phase of the disease. Nigerian Journal of Ophthalmology Vol. 14(1) 2006: 35-3

Outcome of Intensive Care management of neurosurgical patients before and after the commencement of neurosurgical service in a resource poor centre: A Nigerian perspective

Background: Outcome of intensive care management of neurosurgical patients depends not only on the standard and effectiveness of the treatment obtained but also on the available technical and human resource. We aimed at evaluating the impact of a new neurosurgeon-led team on the outcome of neurosurgical patients managed in our multipurpose resource scarce ICU. Patients and Methods: Demographics, neurological data, length of stay (LOS) and mortality rates (MR) of patients admitted 5 years before (n=22) and five years after (n=159) the commencement of the neurosurgical service were collated and analysed. Outcome was retrospectively compared between the two periods. Results: Neurosurgical patients (n=181) constituted 24.6% of 735 admissions into the ICU during the ten-year period. The commonest indications for admission were head injury (157, 86.6%), spinal cord injury (9, 5%) and postbrain tumour excision (13, 8.2%). From the first to the second period, the overall MR declined from 77.3% to 47.2%, while MR in head and spinal cord injured patients dropped from 83.3% to 49.6% and 50% to 40% respectively. Among the head injured, outcome was significantly influenced by post-resuscitation GCS (

Vagal cervicomediastinal neurofibroma in neurofibromatosis type 1 mimicking pulmonary tuberculosis in infancy: a case report

No Abstract. Nigerian Journal of Paediatrics Vol. 31(4) 2004: 140-14

Diagnosis And Outcome Of Chronic Subdural Haematomas In Ilorin

No AbstractKeywords: Chronic, subdural haematoma, burr hole, cranisotomy, drainag