Abdulrasheed Ibrahim

Post-burn axillary contractures in pediatric patients: A retrospective survey of management and outcome

Over a 5-year period, 63 children aged 15 years and less had surgical correction of 74 axillary contractures in our center. They were grouped into three severity categories based on the Kurtzman and Sterns classification. Accordingly, 56 were type I, 11 were type II and 7 were type III axillary contractures. While local flaps sufficed in all the type I contractures, skin grafts and fasciocutaneous flaps were required in types II and III. The principal movements at the shoulder joint were assessed at 2 years after, and functional outcome classified into three outcome categories. Excellent result (A) was obtained in all the type I contractures, 82% of the type II contractures and 28% of the type III contractures. Good result (B) was obtained in 18% of the type II and 57% of the type III contractures and poor result (C) was obtained in 14% of the type III contractures.

An overview of diabetic foot disease

The incidence of diabetes globally is reaching an epidemic proportion and with it carries the risk of complications and diabetic foot disease inclusive. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischaemia and abnormal foot structure and biomechanics. Early recognition of the aetiology of these lesions is important for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection and revascularisation of ischaemic limbs are the mainstays of treatment. Even with proper management, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents and negative pressure wound therapy. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google scholar and hand searching of bibliographies of published articles using the keywords: Diabetes, diabetic foot, neuropathy, peripheral arterial disease and ulceration. The enormity of the challenges associated with the management of this important complication of diabetes, coupled with the various progresses being made in this area, and the need to streamline the principles of management, especially in our environment prompted us to review this subject matter.

Vascular surgeries in West Africa: Challenges and prospects

Background The field of vascular surgery is evolving in sub-Saharan Africa but the practice is bedeviled by lack of expertise and infrastructure challenges. The consequences are a low volume of operations and a dearth of data. Available data are not representative of the wider picture, therefore, this study was undertaken to evaluate the practice of vascular surgery in a tertiary institution, in the light of the prevailing challenges. Methods Data from all patients with vascular-related pathologies managed in our surgical outpatient clinic and accident and emergency wards were obtained from the clinic and in-patient records from January 2008 to December 2012. Age, sex, diagnosis, treatment, and complications were noted. There were 73 patients comprising 45 (61.6%) males and 28 (38.4%) females. The age range was 1–90 years (mean 43.5 years). Results The pathologies managed included end-stage renal disease (n = 36, 49.3%), nontraumatic and posttraumatic aneurysms (n = 13, 17.8%), vascular trauma (n = 12, 16.4%), peripheral vascular disease (n = 5, 6.9%), congenital vascular malformations (n = 4, 5.5%), and thrombotic diseases (n = 3, 4.1%). Fifty-four (74.0%) surgeries were performed, with a complication rate of 5.5% and 2.7% mortality. Conclusions The practice of vascular surgery in Zaria, Nigeria, is fraught with challenges. The gap created by the dearth of skilled vascular surgeons is filled by competent cardiothoracic surgeons. Infrastructure decay and lack of prostheses limit the number and variety of operable cases. These challenges result in preventable morbidity and mortality.

Single Stage Reconstruction of Type IIA Defect of the Ear Lobule: The Limberg flap Technique Revisited

The ear lobule is an important reference point for symmetry of the face and its loss causes an obvious aesthetic abnormality. Type II A defects are characterized by loss of the ear lobule without presence of a nubbin of tissue attached to the cheek. Such defects are typically seen in individuals having an unattached ear lobule. The goal of surgery should be an aesthetically pleasing reconstruction that maintains symmetry with the opposite ear lobule. The Limberg-flap technique using a doubled-over skin flap allows a one stage reconstruction of the ear lobule. It is technically simple and may be performed under local anesthesia. The aesthetic results are generally well acceptable and there is a good color match between the neolobule and the surrounding skin.

Burn prevention and first aid knowledge: A focus on adolescents in Zaria

Background: Burns in developing countries accounts for significant morbidity and mortality. Despite the impressive advances in the science of injury-control and prevention, burns have remained the neglected disease of modern society and are still regarded by many as an act of fate and bad luck. The aim of this study was to determine the knowledge of burn prevention and first aid treatment in adolescents as baseline information to develop an effective burn prevention program. Materials and Methods: A survey to ascertain the knowledge of burns prevention and first aid was conducted in 10 junior secondary schools in Zaria. It was divided into three sections; demographic, knowledge of burn prevention practices and first aid treatment at home and a self-report of radio and television viewing habits. Descriptive frequencies were used to describe the student′s knowledge of burn prevention and first aid treatment. Chi-square analyses were conducted to identify any significant differences between students who had previous knowledge of burn prevention and those who did not. Results: A total of 335 students from 10 schools took part in the survey. Their age ranged from 10 to 17 years with a mean age of 14.8 years. There were 192 males (57%) and 143 females (43%). Seventy three students (21.5%) had previous knowledge of burn prevention and first aid, compared with 262 (77.3%) who had no previous knowledge of burn prevention. Those who had previous knowledge of burn prevention and first aid for burns were more likely to select the appropriate answers to burn prevention practices and first aid treatment at home (P < 0.0001). Majority of the students indicated that information on television (94.3%) or radio (90.7%) will be helpful in preventing burn injuries. Conclusion: Knowledge deficits exist in burn prevention and first aid knowledge among adolescents in Zaria. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.

Clinical competence with central venous lines by resident doctors in a Nigerian teaching hospital

Introduction: Central venous catheterization has become not only common but a very useful clinical procedure in all well-established tertiary hospitals world over. This study aims to assess the competence of resident doctors with central venous lines in a tertiary institution in the subregion. Materials and Methods: A structured proforma was used to assess the information from resident doctors in four departments of the training institution. The result was analyzed with SPSS version 15.0 software program (SPSS 2006, Inc., Chicago, IL, USA). Results: A total of 40 residents were assessed, 30 (75%) males and 10 (25%) females with a mean age of 35.08 ± 4.999 years. Twelve (30%) and 28 (70%) had spent <2 years and >2 years in residency, respectively. Nineteen (47.5%) ticked that a line in the subclavian vein is a central line while 1 (2.5%) ticked same for femoral vein. Fifteen (37.5%) ticked correctly types of central line. Nineteen (47.5%) had observed the procedure in their institution and 7 (17.5%) elsewhere. Eleven (27.5%) knew that any experienced doctor could insert a central. Only 1 (2.5%) resident had inserted a central line. Ten (25%) knew that central line is inserted by ‘’SELDINGER’S’’ technique. Fourteen (35%), 4 (10%), and 20 (50%) said central line can be inserted only in the theatre, by the bedside, and both respectively. Thirty (75%) ticked correctly the uses of central line. Only 3 (7.5%) knew correctly a combination of central line complications. Twenty-five (62.5%) knew that chest X-ray is required after central line insertion. Conclusion: Based on knowledge assessment, the resident doctors in this institution are clinically incompetent in central venous line and efforts must be made to reverse the situation.

Reaching Our Successors: Millennial Generation Medical Students and Plastic Surgery as a Career Choice

Background: Research shows that career choices are made as a result of preconceived ideas and exposure to a specialty. If plastic surgery is to continue to attract the best, factors that may dissuade the millennial generation medical students from pursuing plastic surgery as a career must be identified and addressed. We explored the determinants of interest in plastic surgery as a career choice amongst millennial generation medical students. Materials and Methods: A survey regarding factors considered important in choosing plastic surgery was conducted amongst final year medical students in September 2011. Participants were asked to rate their agreement or disagreement with 18 statements on a four-point Likert scale (1 = very unimportant; 4 = very important). Statistical analyses were performed using Chi-square test to compare categorical variables between male and female medical students. Values of P < 0.05 were considered significant. Results: The most important factors influencing the decision of medical students to choose plastic surgery as a career include; plastic surgeons appear happy in their work 93 (85%), Plastic surgeons have rewarding careers 78 (71%), and plastic surgeons provide good role models for medical students 96 (87%). An overall score of > 3.0 was seen in all the subscales except in gender equity and life style concerns. There were statistically significant differences between male and female students in opinions of a spouse, a significant other, or family members in choosing plastic surgery P < 0.5 and my choice of plastic surgery will be influenced by my decision to have a family P < 0.5. Conclusion: Factors influencing the decision of medical students to choose plastic surgery were related to the perceived quality of life as a plastic surgeon and the ability of plastic surgeons to provide good role models for medical students. Female medical students were more concerned with gender equity and work-life balance in selecting plastic surgery compared to male medical students.

University students and cosmetic surgery in Nigeria: A survey of perception, attitudes, and experiences

Introduction: A global trend to improve appearance has been observed with the advent of technological civilization and contemporary culture. This is related to social customs that places high premium on appearance, and the increased accessibility of cosmetic surgery. This article explores the perception of cosmetic surgery among university students in Nigeria. Materials and Methods: Self-administered questionnaires were used to collect data. It was divided into four sections; demographic, knowledge, attitude, and experience with cosmetic surgery. The association between knowledge, attitude, practice, and sociodemographic characteristics was sought using Chi-square statistical test. Statistical significance was set at P ≤ 0.05. Results: The respondents perceptions of what cosmetic surgery means include surgery for beauty 673 (52%), surgery on the face 84 (7%), use of chemicals for beautification 35 (3%), correction of deformity 37 (2.8%), and 116 (9%) were not sure. A significant association was found in attitude in the 15-25 age group, when asked about willingness to undergo cosmetic surgery. (P = 0.014) and recommending cosmetic surgery (P = 0.024). There was no statistically significant difference in gender when comparing the knowledge, attitude, and practice of cosmetic surgery. There was a significant difference in knowledge of cosmetic surgery among 3 rd and 4 th year students related to having heard about cosmetic surgery (P = 0.048) and knowledge of difference between cosmetic surgery and plastic surgery (P = 0.001). Participants that were single were more aware of cosmetic surgery (P = 0.013) and knew someone who had cosmetic surgery (P = 0.000). Conclusion: Attitudes toward cosmetic surgery are positively related to age, level of study, and marital status. However, there was no statistically significant difference based on gender. Our study also suggests that respondents are aware of the existence of cosmetic procedures, but they do not know what it actually means.

Perceived role of therapeutic footwear in the prevention of diabetic foot ulcers: A survey of patients with diabetes mellitus in Kaduna State

Background: There is a paucity of literature about the status of therapeutic footwear and their role in prevention of diabetic foot ulcers in Nigeria. The purpose of this study is thus 2-fold. (1) To determine the perceived role of therapeutic footwear in the prevention of foot ulcers among patients with diabetes mellitus, (2) to establish strategies that will encourage the use of therapeutic footwear in the prevention of diabetic foot ulcers. Materials and Methods: This cross-sectional study was carried out among patients with diabetes mellitus in Kaduna state, between December 2012 and March 2013. All the participants in this study had a history of foot ulceration. Exclusion criteria were patients with amputations and non-ambulatory status. Pre-tested questionnaires were used to collect data. The questionnaire was divided into four sections. The first section illustrates the demographics of the respondents. The second section explores the anatomic location of diabetic foot ulcers. The third section evaluates the type of regular footwear worn and experience of participants. The fourth section explores the awareness of respondents regarding therapeutic footwear features. Simple descriptive statistics were used; frequency with percentage distribution for categorised variables. Results: The anatomic subunit in the plantar surface with the highest number of ulcer was the phalanges 23% in males and 26% in females. In the dorsolateral surface, the phalanges 22% and 17% were the most common location in males and females, respectively. Slippers were regularly worn by 71% of respondents, whereas only 1% of respondents were reported to wear therapeutic footwear. More than 75% of respondents were willing to use footwear, as well as buy therapeutic footwear. Conclusion: Majority of the patients are reported to have foot ulcers located on the phalanges and these are related to the wearing of inappropriate footwear. However, they are willing to use therapeutic footwear if recommended by a physician.

Sub-specialization in plastic surgery in sub-Saharan Africa: capacities, gaps and opportunities.

The skill set of a plastic surgeon, which addresses a broad range of soft tissue conditions that are prevalent in sub-Saharan Africa, remains relevant in the unmet need for surgical care. Recently, there has being a major paradigm shift from discipline-based to disease-based care, resulting in an emerging component of patient-centered care; adequate access to subspecialty care in plastic and reconstructive surgery. Given the need for an evolution in sub-specialization, this article focuses on the benefits and future role of differentiation of plastic surgeons into sub-specialty training pathways in sub-Saharan Africa.