Reconstructing a large cutaneous cheek defect post tumour excision poses a great challenge to the reconstructive surgeon. The surgical options are limited for a functional and aesthetically acceptable outcome. The microvascular free flap which is currently the gold standard is still not a common place in our practice in Nigeria. Cervicofacial flap, a single stage procedure, offers an excellent alternative as it can be done for patients who are not fit for prolonged anesthesia and can even be undertaken under local anesthesia.We presented two cases of patients with cheek tumors who had wide local excision after histological diagnosis of Basal Cell Carcinoma and Basaloid Squamous Cell Carcinoma. Both defects were closed with cervicofacial flap under general anesthesia. The flaps survived with no loss.Cheek defect reconstruction with cervicofacial flap is simple, reliable and with similar favourable aesthetic outcome when com- pared with free flap procedure. It should be an important part of a reconstructive surgeon armamentarium.

The elderly population is on the increase globally according to the current global demographic changes and is more vulnerable to burn injuries. Despite recent advances in burn care, the outcome of burns in the elderly has only marginally improved when compared with children and younger adults. The objective of this study was to determine the patterns and outcomes of burns in the elderly and eventually proffer prevention strategies. A retrospective review of all the elderly (65 years and older) burn patients managed at the Burn Centre of National Orthopaedic Hospital Igbobi Lagos (NOHIL) between January 2015 and December 2019 was performed. The socio-demographic data, clinical information surrounding the burn injury and management were extracted from the medical records, analyzed and presented. A total of 21 patients were included in this study, with a male to female ratio of 1:1.1. Flame burns represented the commonest cause of burns (85.7%) and the majority had pre-injury comorbidities (57.1%). All the patients with %TBSA of less than 40% were successfully managed and discharged while death occurred in all the patients with %TBSA of 40% and above, with a mortality rate of 11.1%. This study provided an epidemiological profile of elderly burn patients in Nigeria. One in five burn admissions is elderly, with flame burns being the major cause of burns. Most of the burns occurred indoors and were related to cooking activities. Prevention strategies were recommended to improve home safety and make the home a safer place for the elderly.

Abstract Background Motorcycle crash is the second most common cause of road traffic injuries in Nigeria. The study aimed to assess the prevalence of visual disorder and the knowledge of road safety measures of commercial motorcyclist. Methods A cross-sectional study was carried out among motorcyclists in all five motorcycle parks in Ibadan. A total of 439 motorcyclists were interviewed through a simple random sampling technique. An interviewer-administered questionnaire was used for data collection. Results Age of the respondents was 34.4±7.8 years. Majority were males and 15.2% (n = 67) had tertiary education. Half of respondents 228 (51.9) had good knowledge of road safety measures. Only 26 (5.9%) had ever had their vision screened before. Majority of respondents 380 (86.6%) had good right vision (visual acuity ≥6/9). Respondent with tertiary education were significantly more likely to have good knowledge of road safety measures (p = <0.001). Respondent who had ever been involved in road crash were significantly more likely to have poor vision (p = 0.028). Motorcyclists who had complete training on motorcycle riding were three times more likely to have good knowledge of safety measures (OR = 2.8; 95% CI = 1.6-5.0). Conclusions Commercial motorcyclist’s good vision, education and training contributed to good knowledge of road safety measures. There is therefore the need to encourage proper medical examination before issuance of driver’s license, conduct training and create stringent laws to guide road safety. Key messages Commercial motorcyclists, knowledge, Road safety measure, Visual acuity

Background Recurrent chronic leg ulcers and its are morbidities associated with sickle cell anaemia (SCA). Compression therapy increases the rate of healing of these ulcers and also decreases the rate of recurrence. Objective This study evaluated the haematological parameters of patients with SCA and chronic leg ulcers placed on high compression bandaging to provide data for improved ulcer management and prevention. Methods Eighteen patients with SCA and chronic leg ulcers were recruited for treatment by compression therapy in Ibadan, Nigeria, from March to June 2015. Eighteen SCA patients with no history of chronic leg ulcers were age and sex matched and recruited as controls. Blood samples, wound biopsies and swabs were collected at different time points for full blood count, microbiology, culture and antimicrobial susceptibility tests. Haemoglobin variants were quantified by high performance liquid chromatography. Fasting blood sugar was tested for leg ulcer patients to determine diabetic status. Results Ulcers ranged from 0.5 cm2 to 416 cm2 (median: 38.4 cm2). Post-intervention ulcer size ranged from 0.0 cm2 to 272 cm2 (median: 18.6 cm2, p < 0.001); four ulcers completely healed. Compared to the control group, haematological indices at commencement of treatment were more severe in leg ulcer patients (p = 0.02). No patients with chronic leg ulcer was diabetic. Microorganisms isolated from the leg ulcers include Pseudomonas aeruginosa, Staphylococcus aureus, Proteus sp., Escherichia coli and Klebsiella oxytoca. Conclusion Measures to improve haematological parameters during leg ulcer treatment in SCA patients should be taken to aid wound healing.

The Rintala flap, a versatile flap in reconstruction of the nasal dorsum, is described in an African nose where scarring is a great challenge post tumour excision. We demonstrate that the flap can provide good tissue coverage, excellent flap viability, colour match and less scarring in selected patients. The flap is single-stage, and can be achieved under local anaesthesia and with a good learning curve. The outcome was satisfactory, with acceptable scarring.

Objective/Purpose: A pilot study to assess the efficacy of compression therapy on the healing rate of chronic leg ulcers (CLUs) in patients with sickle cell anemia (SCA) in Nigeria.Materials and Methods: A cohort study of patients with SCA and CLU complication was conducted using simple random sampling method to enroll patients from communities in Ibadan, Oyo State, Nigeria. A total of 18 patients with SCA having a total of 25 chronic leg ulcers and ankle brachial pressure index >1 were treated with a high compression bandage of four layers on a weekly basis after wound assessment for a period of 3 months. Wilcoxon signed-rank test was used to compare wound area at pre- and postintervention.Results: The enrolled patients with SCA were in the age range of 19–44 years, and mean ± SD was 28.8 ± 6.5 years. The initial median ulcer size was 38.4 cm2 (range 0.5–416 cm2); 21 leg ulcers (84%) were >10 cm2 in size at the beginning of the study. These leg ulcers had been present for a median age of 7 years (range 1–22 years). The compression therapy technique achieved >50% healing rate in 16 legs (64%) with an initial ulcer size of 0.5–312 cm2. Four leg ulcers (16%) were completely healed during the study. The postintervention median ulcer size was 18.6 cm2 in all the 25 leg ulcers studied (P < 0.001).Conclusion: Compression wound therapy promotes a positive healing rate of the CLUs in patients with SCA in Nigeria.

Pharyngocutaneous fistula (PCF) is an infrequent complication of salvage total laryngectomy with associated increased morbidity. Chemoradiation for advanced laryngeal cancer is associated with increased incidence of PCF. In this case report, we present the first successful repair of a major PCF with prior chemoradiation therapy after multiple attempts at repair of the fistula in our health-care service.

To evaluate the adequacy of the use of informed consent in surgical practice from the patients’ perspective. The study was carried out in the department of Surgery, University of Calabar Teaching Hospital, Calabar, over a six-month period. A structured questionnaire was administered post operatively on patients, and parents/guardians of minors, who agreed to participate in the exercise. Data obtained included sociodemographic characteristics, description of surgery they had, whether surgical procedure was explained to them pre operatively or not, who gave the explanation, their level of understanding and their opinion on the process of obtaining the consent. Ninety one patients participated in the study. Male to female ratio was 3.8:1, with average age of 33.6 years (SD ± 13). Most of them (94.6%) had some level of formal education. Seventy nine patients (86.8%) knew the description of the surgical procedure. Pre operative explanation of the surgical procedure was given to 70.3% of the patients but 27.5% of these did not understand the explanation. A significant number of the patients (51.6%) were not satisfied with the explanation given. Even though all the patients had the consent form signed either by themselves or on their behalf by a close relative, 46.2% of them did not understand the content of the consent form and 67.1% did not understand the implication of what they had signed. The practice of informed consent for surgery is not adequate. Surgeons need to be further educated to improve their practice in this regard. The consent process needs to be simplified to enhance patients’ understanding and participation.

Dear Sir, The association of penetrating umbilical injury through an umbilical hernia is worthy of note; because though this hernia is a frequent pathology of the anterior abdominal wall in children,[1] such injury is rarely reported. Due to the inherent fascial defect in umbilical hernia, trivial injuries directed against it could lead to breach of the skin and peritoneum with evisceration of loops of intestine. These case reports emphasize the need for prophylactic repair of umbilical hernias if they fail to close spontaneously after the age of 4 years even if they remain asymptomatic and for carefully storing away of harmful objects from children. A 5-year-old boy was admitted to the Children Emergency Unit of the University of Calabar Teaching Hospital with a 24-hour history of evisceration of loops of intestine through the umbilicus. He was said to have fallen on a sharp wooden object in the home premises while playing with his peers. Suddenly loops of intestine eviscerated through his umbilicus, with associated recurrent bilious vomiting an hour later. Preceding the fall, the patient had an asymptomatic umbilical hernia with a ring diameter of about 2.0 cm. He was treated at home with bandaging for 24 hours before seeking medical treatment. On arrival at the Children Emergency Unit, the child was examined and found to be very dehydrated. The vital signs were blood pressure (BP)- 85/60 mm Hg, heart rate- 160 beats/min, respiratory rate- 46 cycles/min and temperature (rectal)- 37.0°C. There was a 2.0-cm opening in the umbilical cicatrix through which loops of non-viable small bowel eviscerated. The patient was adequately resuscitated and given anti-tetanus prophylaxis. Under a general anesthetic, a laparotomy was done, during which the gangrenous bowel was prevented from slipping back into the peritoneal cavity. About 30-cm length of the non-viable ileal segment was resected, followed by an end-to-end ileo-ileostomy. Injury to other intra-abdominal viscera was excluded by careful exploration. The abdominal wound and fascial defect were repaired with nylon suture and umbilicoplasty was done. The wound healed primarily, and he was discharged home on the eighth post-operative day. The patient was reviewed in the outpatient clinic 8 weeks after discharge, when he was found to be doing well. A 10-year-old boy presented to the Children Emergency Unit of the University of Calabar Teaching Hospital with a 24-hour history of a protrusion of a fleshy tissue through the umbilicus. He was playing at home when he fell on a piece of iron rod. He failed to tell his parents for fear of being beaten until when he developed persistent severe abdominal pain. There were no associated gastro-intestinal symptoms. Prior to the fall, the patient also had an asymptomatic umbilical hernia with a ring diameter of about 1 cm. On examination in the Children Emergency Unit, he was found to be in painful distress. The vital signs were blood pressure (BP)- 100/65 mm Hg, pulse rate- 80 beats/min, respiratory rate- 28 cycles/min and temperature (rectal) 37.2°C. There was a 1.0-cm defect in the umbilical cicatrix through which a tongue of viable omentum protruded. The abdomen was full and moderately tender. He was resuscitated and given anti-tetanus prophylaxis. Under a general anesthetic, a laparotomy was done, during which the tongue of omentum was prevented from slipping back into the peritoneal cavity. There was hemoperitoneum of about 30 mL without any visceral injury. The exteriorized omentum was ligated and excised. The abdominal wound and fascial defect were repaired with nylon suture and umbilicoplasty was done. The wound healed primarily, and he was discharged home on the seventh post-operative day. He was reviewed in the outpatient clinic 8 weeks after discharge and found to be doing well. Penetrating umbilical injury with evisceration through the umbilicus in a child has been reported,[2] but the report did not mention whether there was an associated hernia. It is however very rare that penetrating injury involves the umbilicus and leads to evisceration of loops of intestine as the intact umbilicus is not naturally a weak point in the anterior abdominal wall. The anatomy of the umbilicus is probably responsible for the rarity of penetrating injuries through it. In the normal umbilicus, there is a single layer of fused fibrous tissue consisting of the superficial fascia, the rectus sheath and linea alba, as well as the fascia transversalis with the peritoneum adherent to the deep aspect of this.[3] Therefore, though the umbilicus is actually the thinnest area of the anterior abdominal wall, it is very tough and unyielding. This is however not the case when an umbilical hernia exists irrespective of size. The herniation is through the linea alba, and the ring is formed by the fusion of all the layers of the anterior abdominal wall.[4] This leaves a defect covered only by skin, fat and peritoneum that could yield readily during abdominal injuries directed against the umbilicus. In fact, this defect is sometimes too weak to withstand the stress of raised intra-abdominal pressure associated with coughing, vomiting or difficult defecation in early life or with the presence of an overlying inflamed umbilical skin,[5] thereby leading to spontaneous rupture of infantile umbilical hernia.[6,7] Our two cases are peculiar in that both patients had untreated umbilical hernias prior to the penetrating umbilical trauma, and so the force required to breach the peritoneum when directed against the umbilical hernia was far less than that required when directed against an intact umbilicus. It is worthy of note that the objects culpable in these injuries are those found commonly in the environment in which these children grow up. Firearms are noted to cause similar injuries in developed countries.[8] Common causes of penetrating abdominal trauma in children in our environment are falls onto sharp objects, sporting injuries and, rarely, road traffic accidents and violence.[9] The gores of domestic animals like cows, goats and rams sometimes cause abdominal trauma which results in intestinal evisceration.[10] Pieces of broken glass have also been reported to cause penetrating injury with intestinal evisceration[2] and omentocele.[11] The umbilicus alone could be the site of this injury, especially when there is a co-existing hernia. The diagnosis of penetrating injury aims to establish peritonitis consequent on violation of the peritoneum and hemodynamic instability. While a limited number of diagnostic modalities may be applied, clinical examination remains the primary tool to decide which patient requires operation. The traditionally recommended management when an injury violates the peritoneum with evisceration[12,13] of the intestine or omentum is exploratory laparotomy. Currently, selective management[14] of children with such penetrating injury is adopted because of the concern about the high number of unnecessary laparotomies in adults with penetrating injuries.[15] This is so because much of the information on nonoperative management has been derived from adult experiences.[16] Because the decision as to who should have selective non-operative management is difficult, several diagnostic methods, including ultra-sound scan (USS), computerized tomography (CT), diagnostic peritoneal lavage (DPL) and diagnostic laparoscopy, may be used in some carefully selected patients.[14] This form of management requires supervision and frequent observation of the patients. Our two patients were subjected to laparotomy, though the second case could have been suitable for selective management while repairing only the umbilical hernia. With the availability of some of these diagnostic modalities in most of our health institutions now, non-operative treatment of penetrating abdominal trauma in carefully selected children should be possible and needs be considered. On the whole, these injuries are preventable. Parents should monitor and store away all potentially harmful objects from their children. Because an umbilical hernia remains a weak site for penetrating umbilical injury, any hernia that has failed to close spontaneously after 4 years of age should be prophylactically repaired even if it remains asymptomatic. Paper presented at the 6th Annual General Meeting and Scientific Conference of the Association of Paediatric Surgeons of Nigeria (APSON) in Benin City on 22nd November 2007.

Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour.Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay.Results: In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21 - 60 years (mean 42.9years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21-45 years) and 2(18.2%) HIV negative, aged 59 and 60years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/nose and penis.Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.