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BACKGROUND: Multiple trichoepitheliomas are rare benign adnexal tumours that present a unique challenge both to the patient and the managing physician. The multiple nature of the lesion and face being a common location often causes cosmetic concern and psychosocial challenges. Physicians on the other hand face the challenge of providing an ideal treatment with a satisfactory outcome. Dermabrasion and laser therapy have been used to treat this lesion successfully, though they require multiple sessions, and recurrence is common. These options are however either not available or unaffordable in low-resource countries such as Nigeria. Surgical excision though an option, has rarely been advocated due to scarring, leading some experts to offer no treatment at all in developing nations. We report a challenging case of sporadic multiple trichoepitheliomas successfully treated with surgical excision and full-thickness skin graft. METHOD: Following diagnosis, the patient was counselled on the procedure, the risks and benefits. She had en-bloc excision of the lesion, and full-thickness skin graft harvested from the right groin was transplanted and anchored with Monocryl 5-0. All wounds were dressed, and the graft site was reviewed on day 10. She was discharged for outpatient follow-up. RESULT: Graft take was 95%. Epidermolysis which was seen on postoperative day 10 resolved. Hypertrophic scar on the ala nasi is softening on scar massage, and the patient is very satisfied with the outcome. CONCLUSION: Surgical excision can be a valuable tool in low-resource settings for the management of multiple trichoepitheliomas.

CONTEXTE: Les trichoépithéliomes multiples sont des tumeurs annexielles bénignes rares qui présentent un défi unique à la fois pour le patient et le médecin traitant. La nature multiple de la lésion et le visage étant un site commun entraînent souvent des préoccupations esthétiques et des défis psychosociaux. Les médecins, de leur côté, sont confrontés au défi de fournir un traitement idéal avec un résultat satisfaisant. La dermabrasion et la thérapie au laser ont été utilisées avec succès pour traiter cette lésion, bien qu'elles nécessitent plusieurs séances et que la récidive soit fréquente. Ces options ne sont cependant pas disponibles ou abordables dans les pays à faibles ressources tel que le Nigeria. L'exérèse chirurgicale, bien qu'une option, a rarement été préconisée en raison des cicatrices, conduisant certains experts à ne proposer aucun traitement du tout dans les pays en dével oppement . Nous rappor tons un cas difficile de trichoépithéliomes multiples sporadiques traités avec succès par exérèse chirurgicale et greffe de peau totale. MÉTHODE: Après le diagnostic, la patiente a été informée de la procédure, des risques et des avantages. Elle a subi une exérèse en bloc de la lésion, et une greffe de peau totale prélevée dans l'aine droite a été transplantée et fixée avec du Monocryl 5-0. Toutes les plaies ont été habillées, et le site de la greffe a été examiné le 10e jour. Elle a été renvoyée pour un suivi en consultation externe. RÉSULTAT: La prise de greffe était de 95 %. L'épidermolyse observée le 10e jour postopératoire a disparu. La cicatrice hypertrophique sur l'aile du nez s'assouplit avec le massage de la cicatrice, et la patiente est très satisfaite du résultat. CONCLUSION: L'exérèse chirurgicale peut être un outil précieux dans les contextes à faibles ressources pour la prise en charge des trichoépithéliomes multiples. MOTS-CLÉS: Trichoépithéliomes multiples, Thérapie au laser, Électrocautérisation, Exérèse chirurgicale, Greffe de peau totale.

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Introduction: Soft tissue masses are commonly encountered in surgical and general medical practice. The graduating medical student should therefore be competent in the physical examination of a lump. Paucity of real patients makes it paramount that models be used for teaching and evaluation. This study purposed to describe the perception of graduating medical students to the use of a low-cost lump model for Objective Structured Clinical Examination (OSCE). Methods: This was a cross-sectional survey of final year medical students who participated in a surgery OSCE utilizing an innovative low-cost lump model. Results: One hundred and sixty students undertook the OSCE examination while 130 (81.3%) students completed the survey questionnaire. One hundred and forty students (87.5%) passed (score 3 5) the skills assessment using the lump model. The median age of the students who completed the questionnaire was 25 (range 24-27) years. There were more males N=84 (65.6%) than females N= 44 (34.4%). Two thirds (67.2%; n=84) of the students said the model simulated a true lump. Nearly all the students agreed that the signs of site (97.6%; n=127), size (97.6%; n=127), shape (95.4%; n=124) and transillumination (95.4%; n=124) were clearly demonstrable with the model. A lower proportion of agreements were seen with signs such as tenderness (64.6%; n=82), attachment (77.7%; n=80) and warmth (58.6%; n=75) while more students disagreed with pulsatility (51.5%; n=67). Conclusion: The medical students had a positive perception to the use of the model. However, further refinements would be needed for more signs to be demonstrable.

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BACKGROUND: In the growing need of microvascular surgery in modern-day plastic surgery, financial burden on surgeon or institution can discourage acquisition of skill particularly in the initial phase of laboratory simulation. This article describes the construction of a cheap, easy-to-make blood vessel model. MATERIALS AND METHOD: The model was made using infusion giving set, latex glove, scissors, tape measure and Swan glue CD 308. A cut sheet from the latex glove was rolled twice over two glue-painted segment of the infusion giving set stent. The stents were gently pulled out, turning the sheet into a conduit. The blood vessel model was then allowed to dry. DISCUSSION: The use of latex glove for initial training in microvascular anastomosis has been for long. Previously described productions into a conduit are cumbersome. This model is easy to construct and is useful in an office or dry laboratory setting. CONCLUSION: The latex glove blood vessel model described in this article is a useful material in the training of budding microsurgeons. Residents in our institution have reported a very good learning experience with its use.

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BACKGROUND: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. OBJECTIVE: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. METHODS: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. RESULTS: Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA's) in Oyo state. Patients were seen from LGA's in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA's. CONCLUSION: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.

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Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.

Les greffes de peau mince font partie des opérations les plus fréquemment réalisées dans tout service de chirurgie plastique. La qualité de cicatrisation du site donneur dépend de plusieurs facteurs, dont le type de pansement utilisé. Le but de cette étude est d'enquêter sur la pratique des chirurgiens plasticiens en Afrique de l'Ouest, vis-à-vis de la gestion du site donneur de peau mince et de vérifier si elle est en accord avec les standards internationaux. Des questionnaires structurés sur les différents aspects du prélèvement cutané de peau mince ont été remis aux chirurgiens plasticiens pendant la 53e Conférence annuelle des chirurgiens du Collège des Chirurgiens de l'Afrique de l'Ouest(WACS) à Lomé, Togo en Mars 2013. Les données ont été analysées à l'aide de statistiques descriptives. Ont été recueillies 47 réponses sur 55 chirurgiens plastiques de 4 régions de l'Afrique de l'Ouest, soit 85 8,4 % des participants inscrits à la section chirurgie plastique de la Conférence. Toutes les réponses émanaient de chirurgiens pratiquant des greffes de peau mince de façon régulière et la cuisse était la zone la plus communément utilisée. Différents types de pansements à la paraffine étaient le plus souvent utilisés en première intention. Seulement 17 % des réponses signalaient l'utilisation d'un topique anesthésiant local sur le site donneur. Le choix de pansement du site donneur dépendait principalement de sa disponibilité. Des efforts concertés doivent être faits pour avoir accès aux nouveaux produits cicatrisants, afin d'obtenir une meilleure prise en charge de ce type d'intervention couramment pratiquée.

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BACKGROUND: With the severity of machine hand injuries in our environment, the need to determine the normal values for key pinch strength with which to compare restorative surgeries was justified. METHOD: A cross sectional survey of participants who had no previous hand injuries limiting hand function. Data obtained included age, gender, body mass index, hand dominance and hand span. The Baseline Hydraulic Pinch Gauge was used to obtain key pinch strength. The influence of the above variables on measured pinch strength was analyzed using independent sample t-tests and Pearson's correlation. RESULTS: Of the 242 recruited participants, age range between 20 and 80 years, 163(67.4%) were male and 79 (32.6%) were female. Males had higher pinch strength (right-8.3±2.7kg, left-7.6±2.5kg) than females (right-6.3±1.5kg, left- 5.8±1.5kg). Pinch strength varied with age peaking in the fifth decade in males and females. Interestingly, the left handed dominant female had higher right pinch strength than her right handed counterpart (p<0.009). Height, and hand span correlated with pinch strength in females. CONCLUSION: Normal values for key pinch strength in this Nigerian population are lower than that of Caucasians.

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Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.

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INTRODUCTION: This study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes. METHODS: A cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined. RESULTS: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p<0.001, p=0.004, p=0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. CONCLUSION: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.

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Burn injury constitutes a major cause of trauma related morbidity and mortality. Improvements in care have resulted in reduced mortality in the burn patient significantly. The aim of this study was to determine the outcome and management of burns in children. This was a prospective study of children aged 0-13 years, managed in the burns unit of University College Hospital, Ibadan, Nigeria, between January 2001 and September 2003. There were 62 patients, 42 (67.7%) were females and 20 (32.3%) were males (Male: Female= 1:2. Their ages ranged between 1month and 13 years (mean = 4.8 ± 3.8 years). Majority of the patients (56.5%) were below 4 years of age. Burn was caused predominantly by flame (57%), followed by inhalation injury in 43.5% of the patients. The percentage total burn surface area (%TBSA) ranged between 1%and 95%(mean 29.7%± 22.8%), and 41.4% of the patients sustained amajor burn (TBSA= 30%). Infective complications were present in 37% of patients. The overall mortality was 33.9%, and occurred in those patients with %TBSA of 14 95% (mean = 48.8%). Mortality rate was 62.9% among those that had inhalation injury compared with 11.4% in those without inhalation injury. There was no mortality in those patients whose %TBSAranged between 1 and 32%(mean = 17.5%). Percentage of the total body surface area burnt and the presence of inhalation injury were important predictors ofmortality in childhood burns injury

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The case of a 24-year-old female Nigerian with features of Goldenhar syndrome is presented and the challenges of management especially with reference to reconstructive facial surgery and general anaesthesia are discussed.

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