Paediatric Post Burn Flexion Contracture Release: Early Outcomes Using Two Bloodless Techniques

Post burn flexion contracture of the hand in children constitutes a significant proportion of post burn complications. We compared the early clinical outcomes of reconstruction of pediatric post burn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomised study of pediatric patients requiring contracture release and wound resurfacing with full thickness skin graft between September 2020 and August 2021. Patients were randomised into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t-test, and Chi-squared test were performed. Twenty-two (22) patients were randomised into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade three (3) flexion contracture was the most common (72.1%). Ninety four (94) digits and one hundred and seventy eight (178) joints were operated on with the proximal interphalangeal joint (PIPJ) being the most common (48.9%). The mean surface area of graft take on post operative day ten (10) was significantly higher for the tumescent group than the tourniquet group, p =0.001. The total active motion across the joints at six (6) and nine (9) weeks post operative showed a strong correlation between the total active motion across joints and the technique of release, p=0.004 and 0,001 respectively. Tumescent technique is a feasible alternative to the tourniquet method for post burn flexion contracture release of the digits in the pediatric burned hand.

The Impact of Covid-19 Pandemic on Acute Burn Admissions at the University College Hospital, Ibadan, Nigeria

The coronavirus disease and the subsequent pandemic that followed drastically changed human civilization with disruptive effects on health and overall wellbeing of mankind. This disruptive effect has been shown to include changes in epidemiology of burn injuries. This study therefore aimed to determine the impact of covid-19 on acute burn presentation at the University College Hospital (UCH), Ibadan. This was a retrospective study carried out between April 1, 2019 and March 31, 2021. The period was divided into two: April 1, 2019 to March 31, 2020 and April 1, 2020 to March 31, 2021. Data obtained from the burn unit registry were analyzed using the Scientific Package For Social Sciences version 25. The only statistically significant finding from this study was the marked reduction in burn ICU admission during the pandemic (P < 0.001). A total of 144 patients presented to the burn intensive care unit at UCH, Ibadan during the period under review with 92 patients in the prepandemic year, and 52 patients in the pandemic year. Patient group from 0- to 9-year-olds representing 42% in prepandemic, and 30.8% in the pandemic period was the most affected age group. Scald was predominantly among the pediatric age group in both groups. Males were more likely to suffer flame burn in both study periods with a near gender equilibration during the pandemic. Burn injury during the pandemic resulted in more total body surface area burned. The lockdown effect of the pandemic resulted in a significant reduction in acute burn admissions at the UCH, Ibadan.

Thermographic Mapping of Arterial Perforators in the Leg

Background

Preoperative localisation of perforators aids in easy intraoperative dissection. Infrared thermography is a simple, safe, and effective tool with a short learning curve that is useful in identifying perforators. It has been found to have a high concordance rate when compared with computed tomography angiography and is useful in identifying arterial perforators in the leg.

Objectives

To create a thermographic map of arterial perforators in the leg and to determine the correlation between the number of perforators identified and the length of the leg.

Materials and Methods

This was a cross-sectional study. The length of the leg was measured and the location of perforators corresponding to the distribution of the anterior tibial, posterior tibial, and peroneal arteries was identified using thermography. The mean number of perforators corresponding to the different surfaces of the leg was noted, this was then correlated with the length of the leg using the Pearson correlation coefficient.

Results

Using thermography, perforators were identified along a line drawn from the medial malleolus to the medial tibia plateau and from the lateral malleolus to the head of the fibula and within 2 cm of these lines. More perforators were found in the middle third of the leg and there was no significant correlation between the number of perforators and the length of the leg.

Conclusion

A useful surface marking to aid the identification of perforators in the leg using infrared thermography was found. There was no significant correlation between the length of the leg and the number of perforators.

Presentation, Clinical Outcome, and Quality of Life of Patients Treated for Head and Neck Skin Cancer at the University College Hospital, Ibadan

Introduction

Patients with head and neck skin cancer experience adverse functional, psychosocial, and financial impacts as a result of the disease and/or its treatment. This study aimed at evaluating the pattern of presentation, clinical outcomes, and quality of life of patients with head and neck skin cancer.

Materials and Methods

A retrospective cross-sectional study of patients with head and neck skin cancer presenting to the Department of Plastic, Reconstructive & Aesthetic Surgery of the University College Hospital, Ibadan, from January 2017 to December 2021. Data obtained from the clinical records included sociodemographic characteristics, clinical and surgical details, as well as clinical outcomes. Quality of life was assessed using EORTC QLQ-C30 questionnaires. Data were summarized using descriptive statistics.

Results

Nineteen patients were reviewed with a median age of 38 years (ranging from 18 to 85 years) and a male-to-female ratio of 1:1.4. Eight (42.1%) of the patients were albinos. Squamous cell carcinoma was the predominant histologic type (63.2%), while the scalp was the commonest location (42.1%). Only one patient (5.3%) presented with metastatic disease. A greater percentage of treated patients, eight (61.5%), had surgery as the only treatment modality. After a mean follow-up period of 33 months, a recurrence rate of 10.5% (two patients) and a mortality rate of 15.8% (three patients) were recorded. Quality of life assessment revealed an adverse financial impact of the disease on our patients.

Conclusion

Although albinism is a recognized risk factor for skin cancers, head and neck skin cancers can occur in the dark-skinned.

Cosmetic surgery procedures accessed by Nigerian women at a single private cosmetic surgery practice: A retrospective review

Background

Little is known about the cosmetic surgery procedures sought by Nigerian women. Aim: We sought to report the proportion of cosmetic surgery procedures accessed by Nigerian women and determine any associations between the demographics and cosmetic procedures accessed.

Patients and Methods

A retrospective review was conducted between January 2020 and July 2021 of all cosmetic surgery procedures at a single private cosmetic surgery practice. Data were analyzed using means, Mann-Whitney U-test, chi square test, and Fisher's exact test as appropriate. The statistical significance was set at P ≤ 0.05.

Results

Of the 392 consultations for cosmetic procedures, 245 (62.5%) patients accessed cosmetic surgery. Most were women (239 (97.6%)) and single (178 (72.7%)). The median age of the patients at surgery was 29.0 years (IQR 26-33), the median weight was 78.8 kg (IQR 71.4-88.8), and the median body mass index (BMI) was 28.1 (IQR 25.7-32.3). Liposuction was the procedure accessed by nearly all the patients (224 (91.4%)). Next to this was bilateral buttock augmentation (199 (81.2%)). Other cosmetic procedures such as tummy tuck, facial cosmetic surgery, umbilicoplasty, and labiaplasty each constituted less than three percent of the patients. The abdomen (224 (91.4%)), back (219 (89.4%)), and arms (79 (32.2%)) were the most common regions of the body sought for liposuction, while the calves (2 (0.8%)) were the least. Liposuction of the arms was associated with the BMI (p < 0.003).

Conclusion

Liposuction and bilateral buttock augmentation are the most common cosmetic surgery procedures accessed by this cohort of Nigerian women.

The cleft Q as an outcome measure after palatoplasty

The Cleft Q, a patient-reported outcome measure, has been adopted by the International Consortium for Health Outcome measurement as a valid tool for the measurement of outcomes following intervention on a patient with a cleft. It is scarcely used in sub-Saharan Africa. We report our first experience with the Cleft Q in measuring the outcomes following palatoplasty in an African adult female with a Veau type II defect. The Cleft Q was able to demonstrate improved scores across all domains measured. There is however a need for further validation of the Cleft Q in our setting.

Experience with Liposuction for the Treatment of Subcutaneous Lipoma: A Case Series from a Tertiary Health Institution in Nigeria

Background

Lipomas are the commonest benign tumours in the body. Treatment is often by excision biopsy. Liposuction has traditionally been used for body sculpturing, but recently, it was introduced for the operative management of lipomas. The aim of this study was to present our experience with liposuction lipectomy-assisted lipoma aspiration in terms of its efficacy, complications, risk of recurrence, and patient satisfaction.

Materials and Methods

A retrospective review of 16 patients with solitary or multiple lipomas managed with liposuction over a 5-year period was done. All the patients had a prior fine needle aspiration cytology, which was reported as benign. Informed consent was obtained, and the procedures were performed as a day case under tumescent anaesthesia. Lipo-aspiration was done with manual liposuction device. The patients were discharged on oral analgesics and antibiotics.

Results

Sixteen patients (10 females and six males) with 21 lesions were managed. The median age was 43 years (23-66 years). All the patients had satisfactory outcomes. The procedure was converted to open-excisional surgery in one patient, and the histology was reported as fibro lipoma. Friction burn at the cannula site occurred in one patient, which subsequently healed with scars. No recurrence was reported in any of the patients.

Conclusion

In well-selected patients, liposuction-assisted lipectomy may have an advantage over the classical open technique. All patients should have a minimum investigation of fine needle aspiration cytology because of the risk of atypical lipomas or liposarcoma, which might have similar features as subcutaneous lipoma.

OUP accepted manuscript

Infrared thermography is a useful adjunct for the clinical monitoring of infantile hemangioma (IH) activity with or without treatment. There is a dearth or reporting on the ideal tissue for standardizing temperature readings from IH. This case illustrates the use of mean medial canthal temperatures and the differential hemangioma temperatures for monitoring of facial IH.

Concentric mastopexy for pubertal gynaecomastia in an African child

Gynaecomastia refers to the enlargement of the male breast. It can be psychologically disturbing for children and adolescents as well as adults. While in children watchful waiting is advised as the gynaecomastia could resolve, surgical intervention becomes necessary where there is significant psychosocial disturbance. We present a case of an African child whose quality of life improved after correcting the gynaecomastia. We highlight the concentric mastopexy method in the surgical management of gynaecomastia.

Time to return to school in child and adolescent burn patients from a sub-Saharan tertiary hospital

BACKGROUND

Africa, with the largest number of paediatric burns needs to focus more attention on paediatric burn survivors. Burn injury truncates schooling in child and adolescent burn patients. The aim of this study was to determine the time to return to school and factors influencing this in child and adolescent burn patients.

METHODOLOGY

A cross-sectional study of child and adolescent patients aged one to nineteen years that had been managed for bun injuries. Demographic variables were obtained from archived computerized data. Phone interviews were conducted to obtain time to return to school variables using a questionnaire. Descriptive statistics, students t test, fishers exact test and Chi square test were uses as appropriate for analysis on data on SPSS version 23. A p value <0.05 was considered statistically significant.

RESULTS

Thirty-one patients were recruited for the study. There was a female preponderance, 19 (61.3%). The mean age of the patients was 7.2 (±5.3) years. Scald injuries were the commonest [N = 14 (45.2%)] cause of burn. The mean Total Burn Surface Area (TBSA) was 14.1 (±12.0)%. The mean length of hospital stay was 30 (±59) days. The mean time to return to school after discharge from the hospital was 8.4 (±8.7) weeks. The occurrence of burns on the trunk was significantly (p = 0.048) associated with an earlier time to return to school.

CONCLUSION

Time to return to school from burn injury and from discharge in child and adolescent burn survivors in this study are at least three times longer than previous studies. The burn care team needs to consider school re-entry programs for these children.

Pediatric keloids: A 6-year retrospective review

BACKGROUND/OBJECTIVES

Keloids are reportedly rare at the extremes of life. We sought to describe the epidemiology of pediatric keloids seen at the plastic surgery outpatient department of the University College Hospital, Ibadan.

METHODS

We retrospectively reviewed all children younger than 19 years who presented with nonburn keloids between 2008 and 2014. Data were obtained on age; duration, size, and location of the keloid; family history; mode of treatment; and outcome. Outcome variables were recurrence and wound complications. Data were analyzed using the Pearson chi-square test for discreet variables and the independent-sample t test for continuous variables. P < .05 was taken as statistically significant.

RESULTS

Within the review period, 304 patients presented with keloids, of whom 40 (13.1%) were younger than 19 years. There was a female preponderance (n = 23, 57.5%). The mean age at onset of the keloid was 9.3 years (range 3 months-18 years). Thirty (75%) patients had keloids in the head and neck region. Keloids were sporadic in 31 (77.5%) patients. Nineteen (47.5%) patients had multimodal treatment for keloid. The recurrence rate was 20%. Recurrence was significantly associated with the size of the lesion (P = .003).

CONCLUSION

Keloids during childhood are not rare. More attention should be paid to the management of keloids in this age group.

Methylated spirit burns following traditional hair dressing practice

Methylated spirit burns have been reported following domestic uses such as igniting fondues. It has also been used as an accelerant for self-immolation. We report the first documented case of severe methylated spirit burns sustained during traditional hair dressing. Increased awareness on the dangers of methylated spirit as well as making it less readily available for domestic use is warranted.

Propeller Flap for Complex Distal Leg Reconstruction: A Versatile Alternative when Reverse Sural Artery Flap is Not Feasible

Reverse sural artery fasciocutaneous flap has become a workhorse for the reconstruction of distal leg soft tissue defects. When its use is not feasible, perforator-based propeller flap offers a better, easier, faster, and cheaper alternative to free flap. We present our experience with two men both aged 34 years who sustained Gustilo 3B injuries from gunshot. The donor area for reversed sural artery flap was involved in the injuries. They had early debridement, external fixation, and wound coverage with perforator-based propeller flaps. The donor sites were covered with skin graft. All flaps survived. There were minor wound edge ulcers due to the pressure of positioning that did not affect flap survival and the ulcers healed with conservative management. Perforator-based propeller flap is a versatile armamentarium for reconstruction of soft tissue defects of the distal leg in resource-constrained settings, especially when the donor area for a reverse flow sural flap artery is involved in the injury.

Demographic characteristics and prognostic indicators of childhood burn in a developing country

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.

Partial characterization of a fibroblast-stimulating factor produced by cloned murine T lymphocytes

T cells may regulate tissue fibrosis through the elaboration of soluble factors that stimulate fibroblast growth. The authors previously identified a factor produced by cloned Schistosoma mansoni antigen-specific T cells which served as a competence factor for murine fibroblasts. In the present report, they further characterize this fibroblast-stimulating factor (FsF) and differentiate it from a number of other T-cell-derived lymphokine activities. Crude supernatants from concanavalin-activated cloned T cells were fractionated by gel filtration, ion exchange, or reversed-phase high-pressure liquid chromatography. FsF has an apparent molecular weight of 17,000 and could be differentiated from colony-stimulating factor (CSF), interleukin-3 (IL-3), and interferon (IFN) on the basis of chromatographic characteristics. Highly purified or recombinant IL-2, IL-3, CSF, and IFN had no significant effect on fibroblast proliferation. Furthermore, a monoclonal anti-B-cell-stimulating factor-1 antibody only partially blocked the fibroblast proliferation induced by T-cell supernatants.

In vitro and in vivo evidence that autoimmune reactivity to collagen develops spontaneously in Schistosoma mansoni-infected mice

Egg-induced granuloma formation in murine schistosomiasis mansoni results from vigorous anti-parasite reaction by activated T cells, macrophages, eosinophils, and fibroblasts. The present study suggests that strain-specific, autoimmune T-cell reactivity directed against host matrix proteins might also contribute to granulomatous hypersensitivity. T cells from infected C57B1/6, but not from CBA or BALB/c mice, proliferative in vitro in response to denatured collagen. T cells from uninfected mice, previously immunized with soluble egg antigen (SEA), did not respond in vitro to collagen. Spleen cells from acutely infected mice, but not chronically infected or uninfected animals, formed granulomas around collagen-coupled polyacrylamide beads in vitro. This response was blocked by anti-collagen antibodies that had no inhibitory effect on in vitro granuloma formation around SEA-coupled beads. In related in vivo studies, granuloma formation was quantitated after iv injection of SEA-, collagen-, or uncoated beads into normal or infected recipients. The mean diameter of lung granulomas induced by collagen-coupled beads in infected mice was significantly greater than the diameter of granulomas around either collagen beads in uninfected mice or uncoated beads in infected mice. these observations indicate that anti-collagen responses develop spontaneously in Schistosoma-infected mice and suggest that such reactivity might play a secondary role in granuloma formation and the pathogenesis of hepatic fibrosis.

In vitro granuloma formation using defined antigenic nidi

The in vitro granuloma model provides an excellent tool to study granulomatous hypersensitivity. In our studies of granuloma formation in schistosomiasis, we have demonstrated the utility of the model with respect to analysis of human PBL responses, cloned T cells, purified antigens of the parasite, and regulatory mechanisms. We have also presented data which demonstrate the applicability of this model to other antigenic systems. While the suggestion that this model may be suitable for the study of sarcoidosis may be premature, we would propose that the system may be adapted to screen potentially causative antigens. Furthermore, with the identification of the critical antigen(s), the in vitro granuloma model will facilitate studies at the clinical level.

Production of a fibroblast-stimulating factor by Schistosoma mansoni antigen-reactive T cell clones

Fibrosis in schistosomiasis is the terminal event of a complex pathophysiologic cascade involving interactions between fibroblasts and both host and parasite products. In the present study, the effect of lymphokines produced by cloned Schistosoma mansoni antigen-reactive T cells on the proliferation of murine fibroblasts was investigated. These T cells previously have been shown to proliferate, produce lymphokines, mediate delayed-type hypersensitivity responses, and generate in vitro granulomas in response to soluble egg antigen (SEA). T cells, co-cultured with irradiated antigen-presenting cells and pulsed with SEA, produced levels of fibroblast-stimulating factor (FSF) comparable to equivalent numbers of dispersed hepatic granuloma cells isolated from infected mice. Supernatants of cloned T cells pulsed with Con A (in the absence of macrophages) contained no detectable interleukin 1 activity, but did stimulate fibroblast activation and growth. T cell FSF activity was trypsin-sensitive, was stable at 56 degrees C but not to boiling, and was retained by Con A Sepharose. Activity was associated with HPLC fractions corresponding to an m.w. of 10,000 to 40,000. Neither recombinant interferon-gamma nor affinity-purified interleukin 2 was capable of stimulating fibroblast proliferation. In functional studies, the degree of fibroblast proliferation was related to the length of exposure to the factor. In addition, quiescent fibroblasts were maximally stimulated by T cell FSF only if a second co-factor such as insulin or epidermal growth factor was present. The synergism between T cell FSF and known progression factors suggests that FSF-T may provide a competence signal to fibroblasts. The present results suggest that a direct molecular link may exist between T cells and fibroblasts in schistosomiasis.

Production of a fibroblast-stimulating factor by Schistosoma mansoni antigen-reactive T cell clones

Fibrosis in schistosomiasis is the terminal event of a complex pathophysiologic cascade involving interactions between fibroblasts and both host and parasite products. In the present study, the effect of lymphokines produced by cloned Schistosoma mansoni antigen-reactive T cells on the proliferation of murine fibroblasts was investigated. These T cells previously have been shown to proliferate, produce lymphokines, mediate delayed-type hypersensitivity responses, and generate in vitro granulomas in response to soluble egg antigen (SEA). T cells, co-cultured with irradiated antigen-presenting cells and pulsed with SEA, produced levels of fibroblast-stimulating factor (FSF) comparable to equivalent numbers of dispersed hepatic granuloma cells isolated from infected mice. Supernatants of cloned T cells pulsed with Con A (in the absence of macrophages) contained no detectable interleukin 1 activity, but did stimulate fibroblast activation and growth. T cell FSF activity was trypsin-sensitive, was stable at 56 degrees C but not to boiling, and was retained by Con A Sepharose. Activity was associated with HPLC fractions corresponding to an m.w. of 10,000 to 40,000. Neither recombinant interferon-gamma nor affinity-purified interleukin 2 was capable of stimulating fibroblast proliferation. In functional studies, the degree of fibroblast proliferation was related to the length of exposure to the factor. In addition, quiescent fibroblasts were maximally stimulated by T cell FSF only if a second co-factor such as insulin or epidermal growth factor was present. The synergism between T cell FSF and known progression factors suggests that FSF-T may provide a competence signal to fibroblasts. The present results suggest that a direct molecular link may exist between T cells and fibroblasts in schistosomiasis.

Golgi apparatus and acid phosphatase in mammary gland and kidney cells under the influence of diethylstilbestrol (DES)

It is commonly accepted that hormonal disturbances in experimental animals produce pathological changes in several organs namely in mammary glands and kidney. Taking into consideration the close relationship between acid phosphatase and Golgi apparatus, the present study was undertaken, to study the relationship in kidney and mammary gland cells under the influence of DES. The observation indicate, that acid phosphatase and Golgi apparatus were localized in the cytoplasm of mammary gland and kidney cells. It has also been found a parallel change in the activity of acid phosphatase and the degree of development of Golgi apparatus after DES administration.

Schistosoma haematobium infection in the white mouse--histopathological and histochemical studies

Mice were infected with 1000 Schistosoma haematobium cercariae (Egyptian strain). Histopathological and histochemical studies were performed on the different organs, during the first four weeks after infection and on the fourth week after oviposition. Pathological changes during early prepatency matched with those in S. mansoni infection. Eggs were laid in aggregates in the colon and liver. They initiated the development of typical granulomatous lesions. Abundant bilharzial pigment and areas of sclerosis were present in both liver and spleen. The heart, kidneys and urinary bladder were pathologically free. Disturbed succinic dehydrogenase and acid phosphatase enzyme levels were detected which point to a derangement in the functions of the cell organelles.

Indirect immunoperoxidase tests in the diagnosis of schistosomiasis

An enzymatic technique, immunoperoxidase histochemistry, was applied in the diagnosis of human schistosomiasis. Sera of patients with S. haematobium, S. mansoni and mixed infection, together with control sera, were studied. The test proved easily applicable and gave reliable results particularly with S. mansoni and double infection. The depth of the colour reaction, was then compared with ELISA readings, but there was no relation in the results of the individual cases.

Granuloma size in the liver of mice with Schistosoma haematobium infection and Schistosoma mansoni challenge

Swiss albino mice have been infected with S. haematobium and challenged with S. mansoni. S. haematobium infection in the mouse runs a course more or less parallel to that of S. mansoni infection. Granuloma has reached a maximal size at 135 days post infection and has regressed thereafter. Suppression of S. mansoni granuloma was observed in mice previously infected with S. haematobium. This manifests the presence of cross immunization.