Malachy Eneye Asuku

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.

Knowledge and Cultural Beliefs About the Etiology and Management of Orofacial Clefts in Nigeria's Major Ethnic Groups

Objective To determine the knowledge and cultural beliefs about the etiology and management of orofacial clefts in Nigerias major ethnic groups. Design Questionnaires designed to elicit respondents’ knowledge and cultural beliefs about the etiology and management of orofacial clefts. Setting Northern and southern Nigerian communities where the major ethnic groups reside. Participants Consenting, randomly selected individuals. Results There were 650 respondents (350 women and 300 men) from 34 of Nigerias 36 states; 65.5% were aged 21 to 40 years and 52.5% were married. There were Yoruba (33.7%), Igbo/Bini/Urhobo (40.5%), and Hausa/Fulani (25.8%), with most having attained primary and secondary education. Of those responding, 75% had seen an individual with an orofacial cleft. A significant level of ignorance about the cultural beliefs was found. The Hausa/Fulani considered it mostly an act of God; whereas, the Igbo/Bini/Urhobo and Yoruba groups displayed a greater variety of cultural beliefs. The latter groups implicated witchcraft, evil spirit or devil, the mother, and occasionally the child. Of respondents, 40% knew that surgery was a possible solution, and 22% would recommend a visit to the hospital. Respondents with higher educational attainment produced significantly more scientifically related etiologic factors and accurate treatment options. Conclusion Of respondents, 75% were aware of the existence of orofacial clefts, and a fair knowledge of treatment of orofacial clefts was elicited. Diverse cultural beliefs often may present an obstacle to treatment. Improved awareness about the etiology and management of orofacial clefts is required.

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.

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.

Experience with a two-stage nasal reconstruction with the paramedian forehead flap

The unique anatomy of the nose combined with its aesthetic and functional importance makes its reconstruction a challenging but rewarding undertaking. The authors of this study present their experience in a two-stage nasal reconstruction with a paramedian forehead flap. The patient underwent reconstruction with a narrow pedicle to resurface the dorsum, and its distal wings covered the alae. He had a significant amount of residual intranasal lining and this was used for a pedicle flap. The reconstructed dorsum and nasal tip appeared bulky, and the soft triangle needed better definition after the second stage. The patient underwent two revisions with improvement in the projection, outline, and contour of the nose.

Inventory of potential reconstructive needs in patients with post-burn contractures

Background: The inventory of potential reconstructive needs records the specific reconstructive needs of the patient with burns and allows systematic planning for future reconstruction and rehabilitation. It also assists patients to evaluate and prioritize reconstructive options with the guidance of the plastic surgeon, as well as facilitating the adoption of realistic expectations on the part of the patient and family. Materials and Method: A survey of the potential reconstructive needs was carried out using the inventory of reconstructive needs form. The form is applicable to all body regions and is divided into three sections. Each section is subdivided into anatomic units: head and neck (anatomic units 1-5); upper extremity (anatomic units 6-9); and trunk and lower extremity (anatomic units 10-13). The results are presented in tabular form and analyzed using simple frequency distribution. Results: The anatomic region with the highest number of reconstructive needs was the head and neck in adults 25 (42%).The trunk and lower extremity accounted for the least reconstructive needs in adults 12 (20%). When the reconstructive needs were stratified by anatomic units in the head and neck, the upper eyelids 8 (32%) and the neck 6 (24%) had the highest frequency of reconstructive needs in adults. The upper extremity had the highest reconstructive needs in children 51 (52%). The upper eyelid, mouth and neck accounted for 13 (76%) of the reconstructive needs in children. Seventy-eight (50%) of the 157 patients had at least two contractures. Conclusion: There were more reconstructive needs in children than adults. The anatomic region with the highest number of reconstructive needs was the head and neck in adults and the upper extremity in children. This study underscores the importance of positioning and intensive therapy intervention in the prevention of post-burn contractures.

Burns of the face in epilepsy: Risk factors and an opportunity for prevention

Burns are devastating injuries that may occur during altered levels of consciousness in an epileptic seizure. There is a paucity of literature on the profile of epileptic patients with severe burns of the face. This article reports the avoidable risk factors in burn injuries of the face in patients with epilepsy. A review of the medical records for all burn admissions in patients with epilepsy was undertaken from January 2010 to December 2013. Demographic and clinical data of the patients were collected and analyzed. Grading of facial appearance was based on the classification of facial soft-tissue deformities in post-burn patients by Zan et al. All the patients were female and the mean age was 27 years. Age range was 18 - 35 years. Carbamazepine was the commonest antiepileptic drug utilized. Three patients reported the use of herbal medications in addition to antiepileptic drugs while one patient admitted to the use of only herbal medications. Three of these patients presented with full thickness burns of the face and had Type IV post burn facial deformity. There are trends that accord to female gender, low socioeconomic status and poor adherence to antiepileptic drugs in this study. The use of the electronic media (television and radio) is suggested as an effective strategy to increase awareness.

Bilateral oral commissurotomy and buccal mucosa advancement flaps in the reconstruction of post-burns microstomia

Microstomia following burns of the face remains a significant challenge. This article describes the experience in the reconstruction of post-burns microstomia with bilateral oral commissurotomy and buccal mucosa flaps. Four patients aged from 15 to 29 years had commisurotomy and buccal mucosa advancement flaps. All the patients were operated under local anesthesia with sedation. The procedure was bilateral in three patients. There were three females and one male. The most common cause of microstomia was flame burns in three patients while one patient sustained burns to the face following assault with acid. Pre-operative mean mouth opening was 20 mm and post-operative mean mouth opening was 35 mm in the four patients. Median follow-up was 57 days (range 12-472 days). Late follow-up visits revealed that the improvement in mouth opening remained satisfactory. The technique remains useful in restoration of the oral aperture. The operation is easily performed and it is recommended for immediate and delayed reconstruction of the commissure. The functional and aesthetic results are generally well-acceptable.