The Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons (NAPRAS) instituted a lecture in honor of the doyen of Plastic Surgery in Nigeria, Professor Joseph Olatunde Oluwasanmi. A man who took up the challenge to specialize in plastic surgery thus becoming the first indigenous consultant plastic surgeon in 1967. He rose through the ranks to become a professor in 1973. The 2017 annual conference of the association took place in Sokoto and the lecture focused on the history and practice of plastic surgery in Nigeria. The lecture chronicled those who practice plastic surgery in Nigeria beginning from Mr Michael Norbert Tempest, a British Surgeon who worked in University College Hospital (UCH), Ibadan as a consultant, while Mr J.O. Oluwasanmi (now Prof J.O. Oluwasanmi) worked under him as a Senior Registrar. Oluwasanmi was later appointed as the first indigenous Consultant Plastic Surgeon in1967 after returning from the UK where we went for his specialty training in plastic surgery. Many other centers sprang up providing plastic surgery services. These centers include Lagos University Teaching Hospital, Lagos; National Orthopedic Hospital, Igbobi Lagos; National Orthopedic Hospital, Enugu; Ahmadu Bello University Teaching Hospital, Kaduna; Mangu Rehabilitation Centre, Mangu Plateau State and ECWA Evangel Hospital Jos (now Bingham University Teaching Hospital). Most of these centers have continued to provide plastic surgery services and training while several others have joined the train. Plastic surgery is now well established in Nigeria, however there are still challenges that affect the provision of excellent service. These challenges include; inadequate personnel, lack of awareness of the practice of plastic surgery, limited infrastructure, poverty and lack of universal health coverage, cultural practices and believes, patients’ expectations, complications, complexity of cases and workload.
Context: The female breast is a symbol of femininity. With recent developments in the surgical management of breast pathology, women now demand better aesthetic outcomes. Data on breast morphometry which should guide Nigerian breast surgeons in decision making is scarce. Aims: This study was aimed at measuring morphometric breast values in nulliparous Nigerian females, thus establishing reference data for the region. Settings and Design: This was a prospective and community-based study in which volunteer female students from the study hospital and 3 secondary schools in the community underwent breast measurements in order to establish reference data. Methods and Material: Physical measurements were carried out using measuring tape and meter rule, in the standing position. Statistical Analysis Used: Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 16 and Student’s t-test analysis carried out.Results : Five hundred female volunteers with age range 15–30 years were studied. The average distance from the suprasternal notch to the right and left nipples were 19.76 cm and 20.09 cm respectively. The average distance from right and left nipples respectively to their inframammary folds were 8.13 cm and 8.28 cm. Breast dimensions were symmetrical in >50% of subjects. In the subjects with asymmetry, more were found to have greater left breast dimensions than right. Conclusions: Physical measurements of the Nigerian female breast are comparable with ranges in other parts of the world except for the Inframammary fold to nipple distance which is longer than values in studies on white subjects. This study establishes preliminary morphometric breast reference data for Nigerian females.
Introduction: Perineal burn contractures remain under reported in our region. We have set out to study the pattern of presentation, describe the formation of these contractures and identify any recurring patterns that will form a basis for a classification that will be useful in planning their management. Methods: A retrospective study of the patients seen over a three year period (2009–2011) at the National Orthopaedic hospital Dala is presented. Information was retrieved from case notes in the medical records department. The bio-data, type of care received post injury associated percentage burns, formation of contractures, were all noted. Results: All the seven patients seen were children of which five were females. Flame burn was the main type of burn. All burns occurred at home. Four major types of contractures were identified as transverse bands, hooding, fusion and obliteration. An equal number of patients presented following home versus hospital care. Conclusion: The relative rarity of post burn perineal contractures leaves little experience for the young surgeon to take advantage of when in training. A classification system will help to make it easier to identify what structures are involved and make planning easier. In the absence of specialized care it is doubtful that there is any statistical difference in the likelihood of perineal contracture development of patients managed at home by traditional healers versus those presenting in peripheral centers lacking formal burn management protocols. Most childhood burns still occur at home. There is a need to continually educate the public on the need to make the home a safe place for children.
Background: Parotidectomy has been traditionally done with general endotracheal anaesthesia mostly in tertiary institutions where there is adequate anaesthetic manpower. A lot of patients with parotid masses presents to other cheaper healthcare providers including medical outreaches where there is paucity of both anaesthetic manpower and gadgets. Aim: To share our experience in parotidectomy using local anaesthetics in medical outreaches where there is inadequate support of anaesthetic personnel and gadgets. Method: Patients counseled for parotidectomy had local anesthetic infiltration and nerve block with 1% ligdocaine in 1:100,000 adrenaline. Lazy-S incision was used starting pre-tragally down to the angle of the mandible. Branches of the facial nerve were gently separated from the mass which is delivered to the wound and shelled out. Wounds were closed in layers without drain. Conclusion: Parotidectomy with local anaesthetic agents is a safe option especially in settings of medical outreaches in resource poor countries with limited anaesthetic manpower and gadgets. The safety of surgery on day case basis and avoidance of use of hardly available nerve stimulator all the more make it an appealing alternative.
To report the case of a four year old girl with Tessier 4 right-sided orofacial cleft deformity, type I left cleft foot and hypoplastic right thumb. The patient presented with right-sided congenital orofacial defect, left foot defect and abnormally small right thumb noticed at birth. The pregnancy, labor and delivery periods were uneventful. She subsequently had repair of the orofacial cleft and the cleft foot defects. The post-operative period was uneventful. The patient is currently being followed up in the clinic. Tessier 4 cleft, though a rare orofacial cleft deformity may occasionally be associated with other congenital anomalies as it is found in the index case.
Aplasia cutis type VI, commonly referred to as Bart’s syndrome, is a rare genetic disorder characterized by congenital localized absence of skin commonly in the lower limbs, epidermolysis bullosa, and sometimes dystrophic nails. We present a 2-hour-old male infant who presented with congenital absence of skin over both lower limbs at birth. He developed blisters in keeping with epidermolysis bullosa 24 hours after birth. Examination and investigations revealed no systemic involvement. An assessment of aplasia cutis type VI (Bart’s syndrome) was made. He was managed conservatively and wounds showed progressive re-epithelialization.
The usage of fresh and glycerolized preserved human skin allograft in burn care is a challenge in a developing countries despites it’s benefits in improving morbidity and mortalities in burn patients. We present two case reports to demonstrates it’s usage. In our first case report, the skin harvested allograft was from a consented patient who was undergoing abdominoplasty. It was harvested as a full thickness skin graft from the panniculus. The harvested skin allograft underwent process of glycerolisation and was stored in 85% glycerol in a fridge at 4°C. The skin allografts were used on the donor site of a patient with 51 percent burns undergoing burn wound excision and skin grafting. The skin was secured with sutures and adherence of the skin allograft on the donor site was noted on the wound review on the third day. Evidence of rejection of some parts of the skin allograft (sloughing off of the skin) was noted by the 7th day post-surgery. The second case report, a two-year-old girl who presented with 37% total burn surface area predominantly deep dermal flame burn injury with suspected inhalation injury. She had tangential wound excision and split thickness skin grafting with both autograft and living donor allograft (donor was the mother). The donor was screened for human immunodeficiency virus (HIV) I and II, hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV). The autografts were meshed 6:1. Allografts were previously harvested from the thigh of the mother on the same day using a power dermatome and meshed 3:1. By the 12th day, there was a 60% loss of the allograft on the left thigh while there was 5% graft loss for the autograft. On the right thigh, there was a 50% graft loss for the allograft while there was a 2% graft loss for the autograft. Human Skin allograft can be used as an option for wound coverage in patients who have sustained burns.
Context: Scar following facial trauma is an important problem affecting aesthetics and function. Aim: The aim of the study is to compare the usefulness of topical silicone gel versus coconut oil in facial scar modulation. Design: Prospective randomized comparative study was done between January and December 2016. Subjects and Methods: Seventy-four post-traumatic facial scar patients were randomized into three groups − Group A topical silicone gel only, Group B coconut oil only, and Group C both. Observational data were collected and photographs were taken at 2 weeks, 1 month, 3 months, and 6 months. Vancouver scar score and visual analog scale score were done for observational data. Photographs were analyzed by two independent blind observers at the end of the study. Results: Topical silicone gel gave superior results in reducing vascularity and pliability at 1 month and hyperpigmentation at 3 months. Coconut oil has better antipruritic effects at 1 month as compared topical silicone gel. Conclusions: Topical silicone gel is a superior product for initial management of facial scars compared to coconut oil.
The current century is an era of microsurgical reconstruction. However, there are situations when free tissue reconstruction is not possible due to extremes of age, their associated co morbidities and dearth of microsurgical expertise and equipment. The significance of local and regional flaps in such reconstructive scenario is paramount. These flaps are well vascularised, easy to master, quick to perform and can be used in both primary as well as salvage reconstruction. The Lateral forehead flap (LFF) is one such useful option. The LFF is an axial myocutaneous flap spanning the entire forehead aesthetic subunit. Herein we describe the operative technique of LFF elevation, advantages and disadvantages of the use of this flap in the reconstruction of facial and intra oral defects reconstruction, both in primary and salvage settings. We describe our experience in the use of this handy flap for various facial reconstructions in our institute. This versatile “forgotten” flap which is easy to master can be handy to all general plastic surgeons who indulge in such reconstructions.
Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) is a congenital malformation resulting in the absent or small uterus and variable degrees of vaginal hypoplasia of its upper portion. One of the treatment goals for these patients is the creation of an artificial vagina either conservatively or surgically. Use of long-term prosthetic vaginal stents prevents the possible contraction of the reconstructed vagina, maintain vaginal width and depth and avoid vaginal stenosis. Prefabricated stents of standard sizes have widely been utilized to assist surgical creation of a neovagina. However, a customized stent has the evident advantage of the possibility of adjusting the size as per individual patient requirements. In the present clinical report, an early adolescent female patient with MRKH syndrome was surgically managed with insertion of a customized vaginal stent that offers the versatility of design configuration to suit the various clinical situations.
Background: Scars are inevitable sequelae of any surgical procedure. Wound closure method has been shown to affect the post-operative scar outcome. This study compared the post-operative scar of two wound closure techniques in paediatric groin surgeries. Methods: This was a prospective comparative analytical study involving 60 paediatric surgical patients randomized into two groups. After a groin procedure in patients who met the inclusion criteria, patients in Group A had only the skin layer closed whereas both skin and subcutaneous tissue were closed in Group B. Scar assessment was done using the Patient and Observer Scar Assessment Scale (POSAS) at 1 week, 3 weeks and 6 weeks after surgery. Results: The mean POSAS score was 108.44 ± 20.32 and 113.91 ± 26.18 for groups A & B respectively (P = 0.379) while the overall opinion score for groups A & B were 19 (IQR = 4) and 21(IQR = 10) (P = 0.392) respectively. The average duration of surgery was 35 minutes in each group. There was equal distribution of seroma formation among the two wound closure groups. Among the patients that developed wound dehiscence, 25% were in group A, while 75% were in group B. Ninety-five percent of the wounds healed with fine linear scar. Conclusion: Majority of paediatric groin wounds heal with fine linear scars. Although no statistically significant association exists between wound closure technique and scar assessment scores, patients who had two-layer wound closure recorded worse scar assessment scores compared to those who had one-layer closure.
Vaginal atresia can be congenital or acquired. The tissue is virgin in primary vaginal atresia or agenesis, so various methods have been used with successful outcomes. On the other hand, one can expect a lot of fibrosed tissue in secondary atresia. There is no elaborate literature on secondary vaginal atresia. There is also no standard treatment for both the types of vaginal atresia. The use of amnion graft and surgicel in vaginoplasty for secondary atresia is one of our experiences with best results. We report a case of a 22-year-old primipara who presented with dyspareunia and cyclical lower abdominal pain for the past 4 months. She had a history of traumatic vaginal delivery 3 months prior to presentation. On examination, she was diagnosed with secondary vaginal atresia. We managed her by vaginoplasty with amnion grafting and surgicel, followed by regular dilatation with soft vaginal mould for the next 6 weeks. Our patient is doing well with normal coital function on follow-up.
Background and Objectives: Fournier’s gangrene is rapidly progressive fulminating gangrene of the genitals and the perineum. The resulting skin loss can be covered by various techniques. Split thickness skin grafting (STSG) is a surgical technique which gives good functional and cosmetic outcome and is relatively easier to perform. We intend to study the results of split-thickness skin grafting in patients with scrotal defect following Fournier’s gangrene. Materials and Methods: Split-thickness skin graft was performed in seven patients with Fournier’s gangrene. The patients were selected consecutively from December 2016 to April 2018. All patients were followed for 3 to 6 months postoperatively. Results: All patients had good uptake of graft with no complications except two patients, one had infection at the graft site and in the other one there was a gap devoid of skin at the junction of perineum and base of scrotum. The first patient was managed conservatively with antibiotics and the gap in second patient was repaired by suturing. The donor site in all patients had healed well without any complications. Conclusion and Interpretations: STSG is safe, simple technique for scrotal reconstruction which is both cosmetically and physiologically compliant to the patient.
Context: Perforator flaps is now a very versatile tool for the reconstruction of challenging tissue defects. The beauty of the tool lies in the minimization of morbidity in comparison to conventional pedicled flaps surgery. Also the inherent property of ease of rotation through 180° gives it excellent versatility in repair of defects that would have been difficult with conventional pedicled flaps. Aims: This article discusses our experience and encourages more plastic surgeons to develop the skill and use it in solving complex reconstructive challenges. Methods and Material: This a case series involving 16 cases of complex wounds (chronic and acute) that presented at our unit. Results: A total of 16 cases were selected for surgical treatment. It involved 12 males and four females. The average age of the patients was 42.4 years. The most common site of reconstruction was in the lower limb with the left being more frequent. Posterior tibia artery was the most common axial vessel that the perforators were based. The most common complication in our series was superficial epidermolysis. There was no flap loss. Conclusions: Perforator flaps are indispensable tools in managing complex defects. This is the next available option to free flap transfer as long a perforator vessel can be identified in a skin tissue just large enough to cover a defect. Due to poor development of free flap surgery, we are encouraging surgeons − old and new − to pick up the skill. We have opened opportunities for training in our institution.
Introduction: Gynaecomastia is the commonest aesthetic problem in men. Treatment in our environment is mainly by open surgical excision. The practice of liposuction is still developing in our region. We present our experience in the use of liposuction in the management of bilateral gynaecomastia in Alex Ekwueme Federal University Teaching Hospital Abakaliki with a satisfactory outcome. Method: We report a case of 33-year old male with idiopathic bilateral gynaecomastia (Simon grade IIb) and resultant aesthetic concern. Treatment was by suction-assisted liposuction with satisfactory outcome. Results: The lipoaspirate from the left breast was 900 mls and 600 mls from the right breast. Male chest contour was regained several weeks post-surgery with good patient satisfaction. Conclusion: Liposuction alone offered a satisfactory outcome in the management in this case.
In Togo, reconstructive management has been based on local and regional flaps. In some severe cases and in cases of failure, only a cross leg flap (if possible) or an amputation would save the patient. It has become vital to move forward in the reconstructive ladder in our setting. We report our first case of free gracilis muscle flap for the reconstruction of a foot defect in a 21-year-old male patient who was presented with a foot laceration due to a road traffic accident. The plastic surgeon had training in microsurgery. For other members of the operative team, this was the first microsurgery procedure. The gracilis muscle was harvested from the contralateral thigh and inset in the defect by microsurgical vascular anastomosis. The flap’s monitoring was done clinically. The post-operative course was uneventful. The muscle flap was resurfaced on day 5 using a split thickness skin graft. The patient was discharged on day 12. Total healing was seen on day 21. The patient was very satisfied with the procedure. The success of this first case represents an optimal motivation to build up a microsurgery team and the debut of microsurgery procedures for patients with difficult defects in Togo.
Objective: As the country becomes increasingly ethnically and racially diverse, it is important for surgeons with an interest in eyelid anatomy to have an appreciation and understanding of eyelash and eye width variations that exist in order to plan for and execute ethnically congruent procedures. The eyelash and eye width analysis is an important aspect of patient assessment for plastic surgeons to identify variations from the normal anatomy. The aim of this study is to inform on anatomical variations that exist between selected ethnic groups as a guide for describing the status of the eyelash and eye width. Enlightenment on these variations will help instruct on important cultural aesthetics, which can be used to plan for blepharoplasty [A1] in a diverse patient population. Materials and Methods: Morphometry of eyelashes and eye width was conducted on 389 healthy volunteers comprising of 193 males and 196 females with no eyelash abnormalities and no eyelash extension participated in the study. The Yoruba tribe consisted of 274, the Igbo tribe were 78 and the Hausa tribe were 37 volunteers respectively. Result: The result showed that the Hausa tribe had the longest lashes with mean values in millimeters of 7.80±1.03, 9.35±1.13 and 8.29±1.19 followed by the Yoruba tribe with mean values of 7.40±3.14, 8.58±1.16 and 7.67±1.12 and then the Igbo tribe with mean values of 7.24±0.93, 8.65±0.89 and 7.72±0.83 on the medial, middle and lateral regions respectively. Further analysis also revealed that males had longer upper eyelid eyelashes in the three regions compared to females. With respect to age, volunteers between the ages of 0–19 years had longer eyelashes than those that were between the ages 20–39 years. The ratio of their mean eye width compared to the mean upper eyelash length was at least 5:1 or more across the three tribes. Conclusion: Morphometric analysis of the eyelashes and eye width provides baseline anatomic data relevant in the performance of cultural background sensitive procedures.
Background: Lactational breast abscess, if not promptly and appropriately treated, can become complicated with associated destruction of breast skin and tissue that may necessitate breast resurfacing or reconstruction. The study is aimed at highlighting management challenges of patients who presented with complicated lactational breast abscess to a tertiary health facility in a resource-constrained environment. Patients and Method: A retrospective review of patients who presented with complicated lactational breast abscess to a tertiary health facility in northwest Nigeria from April 2015 to March 2017 was carried out. Patients were identified using the hospital admission records and appropriate data were retrieved from their case notes and analyzed. Results: A total of 17 patients were included in the study and 10 (58.8%) were in the age range 21 to 30 years. Nine (52.9%) patients presented in the puerperal period and 10 (58.8%) patients were multiparous. Left breast was predominantly affected accounting for 10 (58.8%) cases whereas there was bilateral breast involvement in four (23.5%) patients. Sixteen (94.1%) patients presented after the symptoms have started for more than a week. Four (23.5%) of the patients had necrotizing infection. Six (35.3%) patients had surgical intervention for breast resurfacing or breast reconstruction whereas 11 (64.7%) patients declined surgery due to financial constraint. Conclusion: Complicated breast abscess is not uncommon among lactating women in our environment due to late presentation resulting from illiteracy, poverty, and cultural practice of seeking alternative medical practice and its management is challenging to the surgeon partly due to financial constraint for patients’ treatment.
