Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency, current clinical pattern, and anatomic distribution of KS in Calabar, south-eastern Nigeria and compare this with total malignant skin tumour. Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. Results: In our study, there were 11 patients (7 males and 4 females), with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38%) followed by squamous cell carcinoma (SCC) (34.5%) and the age ranged from 21 -60 years (mean 42.9years). Nine patients (81.8%) were HIV positive including the 4 females (age ranged from 21 -45 years) and 2(18.2%) HIV negative, aged 59 and 60years. The lower limb was the commonest site (50%). Atypical lesions involved the eyelids/ nose and penis. Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour.
To evaluate the adequacy of the use of informed consent in surgical practice from the patients' perspective. The study was carried out in the department of Surgery, University of Calabar Teaching Hospital, Calabar, over a six-month period. A structured questionnaire was administered post operatively on patients, and parents/guardians of minors, who agreed to participate in the exercise. Data obtained included sociodemographic characteristics, description of surgery they had, whether surgical procedure was explained to them pre operatively or not, who gave the explanation, their level of understanding and their opinion on the process of obtaining the consent. Ninety one patients participated in the study. Male to female ratio was 3.8:1, with average age of 33.6 years (SD ± 13). Most of them (94.6%) had some level of formal education. Seventy nine patients (86.8%) knew the description of the surgical procedure. Pre operative explanation of the surgical procedure was given to 70.3% of the patients but 27.5% of these did not understand the explanation. A significant number of the patients (51.6%) were not satisfied with the explanation given. Even though all the patients had the consent form signed either by themselves or on their behalf by a close relative, 46.2% of them did not understand the content of the consent form and 67.1% did not understand the implication of what they had signed. The practice of informed consent for surgery is not adequate. Surgeons need to be further educated to improve their practice in this regard. The consent process needs to be simplified to enhance patients' understanding and participation.
Reconstructing a large cutaneous cheek defect post tumour excision poses a great challenge to the reconstructive surgeon. The surgical options are limited for a functional and aesthetically acceptable outcome. The microvascular free flap which is currently the gold standard is still not a common place in our practice in Nigeria. Cervicofacial flap, a single stage procedure, offers an excellent alternative as it can be done for patients who are not fit for prolonged anesthesia and can even be undertaken under local anesthesia.We presented two cases of patients with cheek tumors who had wide local excision after histological diagnosis of Basal Cell Carcinoma and Basaloid Squamous Cell Carcinoma. Both defects were closed with cervicofacial flap under general anesthesia. The flaps survived with no loss.Cheek defect reconstruction with cervicofacial flap is simple, reliable and with similar favourable aesthetic outcome when compared with free flap procedure. It should be an important part of a reconstructive surgeon armamentarium.
Keywords: Cheek defect; cervicofacial flap; basal cell carcinoma; squamous cell carcinoma; wide local excision.
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