Objective: To determine the presentation and management of patients with pressure ulcers. Design: A prospective study. Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital (NSIH). Subjects: One hundred and thirteen patients were evaluated. Ninety six patients from KNH and seventeen from NSIH. Patients admitted at Kenyatta National Hospital and National Spinal Injury Hospital with pressure ulcers during the study period. Results: Of the 113 patients, 77 (68.1%) were male and 36 (31.9%) were female. Mean age of the patients studied was 38.1 years while the range was between 12 and 74 years. Paraplegia was the main associated medical condition accounting for 35.4%, followed by HIV/AIDS with 27.4%. The most common anatomical site for pressure ulcers was tronchanteric region with 43% of the ulcers. Pressure ulcers of grade III and IV accounted for 66.4% of the ulcers. Two hourly turning was the most common method of pressure dispersion used. Gauze dressing was the most common method used in wound care while 67.3% of the patients had their wounds cleaned with povidoneiodine. Fasciocutaneous flaps were the most common surgical procedure performed (81.7%) for closure of pressure ulcers. Overall, 59.3% of surgical procedures had been successful at one month. This was, however, reduced to 48.1% at three months. Conclusion: Majority of patients with pressure ulcers were in a relatively young age group with a mean age of 38 years. Most of the ulcers were located along bony prominence points of the pelvic girdle and the proximal femur. Most of the ulcers in this study were treated conservatively, with only a few ulcers subjected to surgical interventions. For the ulcers treated with surgical interventions the early outcome was good, however studies need to be done to determine long term outcomes.

Degloving injuries to anterior abdominal wall are rare due to the mechanism of injury. Pedicled tensor fascia lata is known to be a versatile flap with ability to reach the lower anterior abdomen. A 34-year-old man who was involved in a road traffic accident presented with degloving injury and defect at the left inguinal region, sigmoid colon injury, and scrotal bruises. At investigation, he was found to have pelvic fracture. The management consisted of colostomy and tensor fascia lata to cover the defect at reversal. Though he developed burst abdomen on fifth postoperative day, the flap healed with no complications.

This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series.

Extensive scalp defect with exposed bone is best reconstructed with flaps. Majority of these wounds are now routinely reconstructed with free flaps in many centers. Free flaps however require lengthy operative time and may not be available to all patients, where possible less extensive options should thus be encouraged. A sixty-eight-year-old patient presented to us with a Marjolin's ulcer on the vertex of the scalp. After wide local excision a defect of about 17 cm and 12 cm was left. The defect was successfully covered with a combination of an ipsilateral pedicle temporalis fascial flap and an axial supraorbital scalp flap with good outcome. In conclusion wide defects of the scalp can be fully covered with a combination of local flaps. The axial scalp flap and the pedicle temporalis fascial flap where applicable provide an easy and less demanding option in covering such wounds. These flaps are reliable with good blood supply and have got less donor side morbidity.

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