A cadaveric study of first dorsal extensor compartment in Africans: Clinical implications

While several reports have been made regarding the anatomic variations in the first dorsal extensor compartment, very few have emanated from Africa.  This study looked at this compartment with respect to variations in the superficial branch of the radial nerve and the enclosed tendons. The first dorsal  extensor compartment of the hand was studied in 32 formalin preserved adult African cadavers. The superficial branch of the radial nerve emerged from  underneath the brachioradialis 8.4cm(sd±2.2cm) proximal to the radial styloid and branched 6.2cm (sd ±1.5cm) proximal to it as well. This nerve along  with the cephalic vein or its tributary transversed part of the compartment in all the hands. A double Extensor pollicis longus was found in one hand.  Septations were observed in 31.3 %(n=10) of the hands. Abductor pollicis longus tendon was fused in three hands, and had more than one slip in 94% of  the hands. A single extensor pollicis brevis tendon was found all dissected hands. Clinical implications of these findings are highlighted in this work.&nbsp

Self-Assessment of Final Year Medical Students’ Proficiency at Basic Procedures

BACKGROUND: Procedural tasks are important in patient management, with varying degrees of proficiency expected at different levels of medical training. Little has been done in this region to assess the medical students’ proficiency at performing basic procedures.AIM: The aim of this study is to determine their self-assessed proficiency, degree of participation in performing these procedures and the use of skill-lab training.MATERIALS AND METHODS: The study is questionnaire-based, amongst final year medical students of University of Lagos, Nigeria.RESULTS: One hundred and forty students participated in the study.  A significant number (82{58.6%}) self-reported level of proficiency for venepuncture was above average or excellent; for IV line placement it was  a little less than half (65{46.4%}) and for urethral catheterisation 44 (31.7%); however it was quite low for the other procedures. Many students self-reported high level of participation for venepuncture (83{59.2%}); sixty one (43.6%) for IV line placement and 30 (21.7%) for urethral catheterization. The correlations between self-assessed levels of proficiency and participation were significant for all procedures. There was no exposure to the use of mannequins.CONCLUSION: Self-reported proficiency is lacking for basic procedures in a significant proportion of students with a low level of participation

Early experiences with microvascular free tissue transfer in Lagos, Nigeria

Objectives: Microvascular free tissue transfer within our subregion is fraught with considerable challenges. We aim to highlight our experiences gained with our first fifteen cases of microvascular free tissue transfer at the Lagos University Teaching Hospital. We believe our report will be useful to colleagues embarking on such reconstructions in similar settings. Materials and Methods: The clinical records of the first 15 cases of free flaps done at our center were reviewed. The indications for surgery, choice of flap, recipient vessels, duration of surgery and complications were noted. Results: Fifteen cases were done, 10 flaps survived, ten defects occurred following trauma while remaining five followed cancer resections. Anterolateral thigh and radial forearm flaps were the most common flap used. The mean duration of surgeries was 7.1 hours SD ± 1.10 hours. Our take back rate was 13.3%, with a salvage rate of 50%. Three flaps failed on account venous congestion while remaining two failed due to arterial occlusion. Conclusion: 66.67% free flap success rate recorded reflect our early experiences in our institution. We believe meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead to much better success rates in microvascular reconstruction in our country

Complex Lower Extremity Reconstruction with Free Perforator Flap in a 20 Month Old Child

Free perforator flap reconstruction in toddlers is rare. A 20-month-old toddler sustained a complex ankle injury following a motor vehicle accident. At the initial debridement, a joint spanning external fixator frame was placed for ankle stabilization. The wound was covered with free anterolateral thigh flap a week later. Perforator free flap for complex lower extremity defects is feasible in very young children, even in low resource settings.

Early outcomes of reconstructing complex distal leg defects in Lagos, Nigeria

Background: Complex defects in the distal third of the leg are often difficult problems for the reconstructive surgeon. Objective: This study aims to identify the early outcomes of reconstruction for complex defects of the distal leg. It explores basic demographics and presentation challenges associated with these defects. It further highlights various methods of reconstruction, complications, and outcomes. Materials and Methods: Between 2008 and 2013, all patients with lower leg and ankle defects that had definitive flap cover were prospectively studied. Age, sex, duration of defect, cause of defect, comorbidity, size of defects, and the reasons for delay in intervention were obtained for each patient. The type of flap used, complications, duration of hospital stay, early outcome, and ambulation status at 6 months were noted. Results: Twenty five patients were studied during the period with a male to female ratio of 3:2. Sixty eight percent (17) of the defects were trauma related. The inability to pay for treatment was the commonest cause of intervention delay. The mean size of the defects was 31 cm2. Diabetes and peripheral vascular disease were the commonest comorbidities. Perforator-based fasciocutaneous flaps were the most commonly used (48%;12), while muscle flaps (24%;6) and adipofascial turnover flaps (20%;5) were less utilized. Two patients died and one underwent a below-knee amputation. Late infection persisted in 16%(4) of the patients seen. Conclusion: Trauma-related defects predominated in this study, and financial issues delayed definitive intervention in many cases. Inspite of this, successful coverage was obtained in 84% of the patients. There was, however, a trend toward increasing infection and mortality among older patients

Determinants of Specialty Choice amongst Resident Doctors in Lagos

Background: Despite the long term effect of specialization choices by doctors, on the efficiency of healthcare delivery, consideration is not often given to under-served fields. The distribution of resident doctors across specialties will subsequently determine the balance and adequacy of healthcare provision in the future.Objective: To evaluate the factors that influence choice of specific specialties and to make recommendations targeted at meeting the medical specialist manpower needs of the populace.Methods: This is a cross-sectional study of resident doctors at the Lagos University Teaching Hospital, Lagos conducted in March 2014 using a self-administered, structured questionnaire. Data collected included biodata and important factors that influenced choice and analyzed.Results: There were 100(57.1%) males and 74 (42.3%) with age ranging from 26 to 45 years with a mean of 31.8 ± 0.3 years and a median of 31 years. The commonest areas of interest by the time of graduation, from medical school were the core clinical specialties of surgery 19(10.9%), paediatrics 17 (9.7%), obstetrics and gynaecology 11(6.2%) and internal medicine 3(1.7%). The factors that were rated to be very important in influencing specialty choice include availability of more time for family, leisure and vacation 81(46.3%), high intellectual content 67(38.3%), clinic based practice 66(37.7%), employment opportunity 62(35.4%), opportunity to operate 61(34.9%) and good financial prospects 58(33.1%).Conclusion: The preferred specialties are the core clinical specialties with the females showing less interest in the surgical specialties. The opportunity to operate and decreased workload are the most important predictors. Keywords: Determinants; Specialty choice; Resident doctor

Microvascular Anastomosis of Vessels Less Than 0.5 mm in Diameter: A Supermicrosurgery Training Model in Lagos, Nigeria

The development of reconstructive microsurgery has now reached the supermicrosurgery stage. However the anastomosis of vessels under 0.5 mm is still out of the comfort zone of the many microsurgeons. To confirm the technical feasibility and the reliability of this technique We relate our own experience in this regard using the free superficial inferior epigastric flap of the rat as a model for supermicrosurgery training at the Microsurgery Laboratory of the Lagos University teaching hospital. 18 of the 20 free flaps transferred survived at 1 week. Two flaps necrosed and two flaps dehisced. We believe based on our work that the average microsurgeon can become comfortable working with these vessels