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

Experience with the emergency vascular repair of upper limb arterial transection with concurrent acute compartment syndrome: two case reports

Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Gastrointestinal Perforation in Neonates: Aetiology and Risk Factors

Background: Gastrointestinal perforation (GIP) in neonates presents important challenges and mortality can be high. This is a report of recent experience with GIP in neonates in a developing country.Patients and methods: A retrospective review of 16 neonates treated for GIP in a 3 year period.Results: There were 9 males and 7 females, aged 0-28 days (median age =7days). Their weights at presentation ranged from 0.9 - 4.7kg (median =2.6). Five infants were premature. Twelve infants presented more than 72 hours after onset of symptoms. Plain abdominal radiographs showed peumoperitoneum in 9 infants. The cause of perforation was necrotising enterocolitis 6, intestinal obstruction 6, iatrogenic 3 and spontaneous 1. The site of perforation was ileum in 12 infants, stomach in 4 and colon in 4; 4 patients had involvement of more than one site. All the neonates underwent exploratory laparotomy with primary closure ( n=5) , resection and anastomosis( n=6), colostomy (n=3), Ileostomy ( n=2), partial gastrectomy (n=2) ,or gastrojejunostomy ( n=1). Two neonates had multiple procedures. Two very sick preterm babies had an initial peritoneal lavage. Surgical site infection is the commonest postoperative complication occurring in 9 infants. Anaesthesia sepsis and malnutrition is responsible for the seven deaths recorded.Conclusions: Neonatal GIP has multiple aetiologies; NEC is the most common cause. Major mortality risk factors include NEC, multiple perforations, delayed presentation and prematurity.</jats:p

Buruli ulcer of the foot in an urban dweller: a case report and review of the literature

Buruli ulcer (BU) is a chronic cutaneous ulcer caused by Mycobacterium ulcerans. It is the third most common mycobacteria infection of immunocompetent host, after tuberculosis and leprosy. The index case is a 24year-old male with a left foot ulcer of 3weeks duration. It initially started as a single painless papule, then subsequent suppuration and necrotic ulceration followed. Complete wound healing was achieved following long course of treatment with rifampicin and clarithromycin; and wound care with debridement, dressing and split-thickness skin grafting. A high index of suspicion for the diagnosis of BU is necessary for a foot ulcer in the tropics, especially when there is no response to initial conventional wound care. A work-up for BU should be instituted and it responds to rifampicin and wound care

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:&nbsp;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:&nbsp;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&nbsp;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:&nbsp;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:&nbsp;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