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BACKGROUND: Exogenous factors occurring in the antenatal period could be contributory to the formation of orofacial cleft. This study sought to determine the antenatal events in mothers that may have contributed to orofacial cleft deformity of their children. METHODOLOGY: It was a prospective observational cross sectional study of consenting mothers of babies with orofacial cleft who met the inclusion criteria. The study instrument was a questionnaire. RESULTS: Seventy-two mothers participated in the study. Most of these mothers were below 35 years of age and more than half, 43 (59.7%) were of the low-intermediate socioeconomic status. Although majority, 70 (97.2) of the mothers had antenatal care, the mean gestational age at commencement of antenatal care was 4 months. Almost all, 69 (95.8%) mothers had ultrasound scans however the detection of the orofacial cleft was in only 2 (2.8%) mothers. The commonest medication taken was haematinics, 26 (36.1%). Herbal medication, 15 (20.8%) and antimalarial, 12 (16.7%) were the other drugs more frequently taken. The mean age of pregnancy at commencement of these medications was 3.6 months. CONCLUSION: Although uptake of antenatal service was common practice among mothers of babies with orofacial clefts in this study, no antenatal predisposing factors were identified.

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Clefts of the primary and secondary palate represent one of the commonest congenital anomaly for which surgical correction is required. The perioperative care of the patients varies widely across centers and among surgeons and range from preoperative swab of palatal clefts for microbiological studies to prophylactic and or therapeutic antibiotic care. These practices have economic implications especially in the Low and Middle Income Countries (LMIC) where the cost of care are borne directly by the parents. The clinical implications of indiscriminate antibiotic use may also include development of resistant strains and hypersensitivity reactions which may be life threatening. Surgical site infections and its possible sequelae of dehiscence and fistulae is another concern for the surgeon and the patient. This review examines the microbiological pathogens, surgeon's perspectives as well as the current evidences for the use of perioperative antibiotic therapy in orofacial cleft surgery and concludes with a need for a large multicenter randomized clinical trial to answer critical aspects of the subject.

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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: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. OBJECTIVES: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. RESULTS: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. CONCLUSION: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.

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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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Various types of wound care products abound for the treatment of burn injuries. Most of these products are rather expensive and beyond the means of many patients in poorer countries. This poses a challenge to burn care workers in these environments and calls for the adoption of practical solutions with the use of less expensive and readily available alternatives. The aim of this study is to review the outcome of our burn patients managed with topical silver sulphadiazine dressing in terms of time to wound healing and length of hospital stay. Consecutive burn patients admitted over a four year period were included in the study. The patients were resuscitated along standard protocols and their wounds were dressed daily with dermazin. The demographic and clinical characteristics of the patients were retrieved and analyzed using the SPSS version 16. The primary outcome measure for the study was the time to complete re-epithelialization of the wounds and discharge of the patients. 144 patients with a M: F ratio of 2.3: 1 were managed during the period. The age range was 4 months to 81.9 years with a median age of 26 years. The TBSA range was 1 to 99% with a median of 28.5%. The mean duration from time of injury to wound healing was 21.5 days with a median of 17 days. Open burn wound dressing with silver sulphadiazine offers a satisfactory outcome and should be considered for burn dressing in low resource settings.

Des produits différents de soins pour le traitement des brûlures des plaies abondent. La plupart de ces produits sont assez coûteux et au-delà des moyens de beaucoup de patients dans les pays pauvres. Cela pose un défi pour les agents de santé qui s'occupent des victimes des brûlures dans ces environnements. Pour cette raison il faut adopter des solutions pratiques, moins coûteuses et facilement disponibles. Le but de cette étude est d'examiner les résultats de nos patients brûlés gérés avec des pansements topique à la crème de sulphadiazine d'argent en termes de temps de la cicatrisation et de la durée du séjour à l'hôpital. Patients brûlés consécutifs admis sur une période de quatre ans ont été inclus dans l'étude. Les patients ont été réanimés selon des protocoles standards et les pansements avec dermazin étaient changés quotidiennement. Les caractéristiques démographiques et cliniques des patients ont été récupérées et analysées en utilisant la version 16 de SPSS. Le critère d'évaluation primaire de l'étude était le temps pour la réépithélialisation totale des plaies et le congé des patients. 144 patients avec un sex-ratio de M 2,3: F 1 ont été gérés au cours de la période. La tranche d'âge était de 4 mois à 81,9 ans, avec un âge médian de 26 ans. La gamme de la surface corporelle totale brûlée était de 1 à 99% avec une médiane de 28,5%. La durée moyenne de temps pour la guérison des plaies était de 21,5 jours, avec une médiane de 17 jours. Les pansements avec sulphadiazine d'argent sur les plaies de brûlures ouvertes donnent des résultats satisfaisants et devraient être considerés pour traiter des brûlures dans les milieux à faibles ressources.

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BACKGROUND: Olabisi Onabanjo University Teaching Hospital is located in Sagamu, a suburban town with a population of 50,000 (1992 census). The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence. OBJECTIVE: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital. METHOD: A retrospective study of subjects who had appendectomy for the clinical diagnosis of acute appendicitis between January 2002 and December 2004 was done. RESULT: 113 subjects consisting of 52 females (46%), and 61 males (54%) were studied. The mean age was 24.1 years, 71 subjects (62.9%) were in the 10-30 years range. 57.5% of the subjects were students and 71 subjects (62.8) resided in urban area. All the subjects, had generalized in 23.9%). The mean duration of symptoms was 3.53 days with standard deviation of 3.69 days. Only 3 subjects presented on the day of onset of symptoms. Only 15 subjects (13.3%) had surgery on the day of admission. 69subjects (61.1%) had uncomplicated inflamed appendix at surgery and 2 subjects (1.8%) had clinically normal appendix. The mean duration of hospital stay was 10.6 days with standard deviation of 7.4. The commonest postoperative complication was pyrexia in 16 subjects (14.2%), followed by wound infection in 12 subjects (10.6%). One subject died (0.9%). CONCLUSION: The outcome reflects the late presentation and delay in surgical treatment.

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Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure

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