Background: Split skin grafts are frequently employed to provide biological cover for extensive wounds. The clinical outcome of skin grafts depends on a variety of factors of which infection is one of the most important. The intent of this study was to define the micro-organisms causing skin graft infections and failures at the National Reconstructive Plastic Surgery and Burns Centre (NRPSBC) at the Korle Bu Teaching Hospital (KBTH). Aim: The study assessed the extent to which bacterial infection of grafted wounds resulted in graft failure and subsequent re- grafting.Materials and Methods: The study was a longitudinal study conducted on the wards of the NRPSBC at the KBTH on patients with wounds who received split skin grafts. Wound swabs of discharging grafted wounds were inoculated into a Stuarts’ transport medium to prevent desiccation and transported immediately to the microbiology laboratory for further processing.Results: Fifteen (20.8%) of the grafts failed to take. The incidence of infected grafted wounds was 79.2% (57). Infected grafted wounds that resulted in graft failure were 14 out of 57 infected wounds (24.6%). Pseudomonas aeruginosa and Other Pseudomonas Species were identified as the bacteria frequently involved in graft failure at the NRPSBC.Conclusion: In this study, we found a graft failure rate of 20.8%. This was influenced by the bacterial load present in the graft bed.Â
Introduction: The vacuum-assisted closure (VAC) has proved to be very promising in the management of difficult to heal wounds. However, the first reports about the use of negative pressure wound device came from Argenta and Morykwas in the year 1997. Though there are various commercially prepared and manufactured vacuum assisted closure dressing materials, these are often unavailable or unaffordable to patients in third world countries. Our “homemade” vacuum dressing has been found to be, affordable for our patients and most importantly effective in wound management. Materials and methods : The homemade Vacuum Assisted closure dressing was used for the management of some wounds which presented at our centre. These wounds were irrigated and thoroughly debrided. Our homemade vacuum assisted closure dressings were subsequently applied. Results: The wounds healed well with good granulation tissue. Subsequent split thickness skin graft (SSG) done had very good take. The VAC dressing often resulted in good wound contraction with no need for SSG. Conclusion: In our practice our “home made” vacuum which was affordable and customized proved to be effective in wound management.
Introduction: Several Local flaps can be used for the reconstruction of digital soft tissue defects with exposure of tendons and/or phalanges. The homodigital flap is a versatile option. This article discusses the use of the homodigital reverse vascular island flap-a regional, axial-patterned skin flap in the reconstruction of distal digital defects.Methods: 6patients with a soft-tissue defect at the distal part of the finger were treated by homodigital island flaps for reconstruction. We evaluated the active range of motion of the involved finger, and the patient's satisfaction with the appearance of the finger after reconstruction.Results: All patients admitted to a good functional outcome. The donor site morbidity was minimal. The take of the split-thickness skin graft to the flap donor site was generally good. However one patient complained of numbness of the finger over the donor site. Conclusion:The Homodigital flap is a handy multipurpose flap that can be used. Notwithstanding its limitation, it is easy to raise and it can be used to a variety of defects.
Introduction. One of the most challenging regions of the body to cover is the lower part of the leg, the ankle, and the foot, especially with the exposure of bones or tendons. Many options for covering soft tissue defects in this area have been proposed. This article describes the lateral supramalleolar flap, which is used for the reconstruction of defects of the lower leg, ankle, heel, and foot. This flap is a surgical technique to salvage the lower extremity due to its large skin paddle and a wide rotation arc. In this case series, patients with lower leg and ankle defects requiring flaps had the lateral supramalleolar flaps performed. This article discusses the overview, technique, and outcomes.Methods. These flaps were performed under spinal anesthesia and tourniquet control. The upper limit of the flap was about 8 cm from the popliteal crease, and the lower border was 5 cm from the axis of the ankle joint. The lateral extent of the flap was up to the fibula, contrary to mid-calf. The flap was harvested in the sub-facial plane, and the donor site was grafted.Results. The Flap was generally easy to raise and secure in place at the donor site. Partial necrosis of the flap was reported in one case. The overall donor site morbidity was minimal.Conclusion. The lateral supramalleolar flap is a reliable and useful flap for coverage of the lower third of the leg, ankle, and dorsal foot defects. It is a viable option available to the reconstructive surgeon, especially with the exposure of bones or tendons.Â
Background: There are often situations that require the correction of facial defects. Local fasciocutaneous flaps provide a reasonable option for reconstruction of facial defects with good colour and texture match and good success rate. Among the various options of local flaps is the use of a rotation flap. Aim: The aim of this work is to demonstrate the reliability of the rotation flap in the correction of facial defects and its ability to achieve a good aesthetic outcome by applying the knowledge of facial aesthetic units. Case Presentation: This is a case report of a 28-year-old woman who suffered an avulsion injury to the face with loss of facial tissue resulting in exposure of the left zygomatic bone. The defect measured 5 cm × 6 cm. A rotation flap was used to cover the defect after the wound had been previously irrigated and debrided. Her wounds healed well. She suffered no facial nerve injury. The rotation flap resulted in a good colour match with no disruption of facial contour. Conclusion: The Rotation flap provides a reasonable option for reconstruction of facial defects with good colour and texture match.
Background: Pedicled abdominal and groin flaps have since the 70s and80s continued to provide reliable solutions for upper limb injuries that require flap cover. In recent times reconstructive surgeons have found the use of free flaps a better alternative. However, in centres where microsurgery facilities are not available or where the patient cannot afford such services, the pedicle flaps continue to have an important role. Interestingly, some literature states that the long term outcomes of successful pedicled flaps are equal or even better than free flaps. Abdominal flaps together with the groin flaps continue to be the workhorse flaps in the developing world as well as at our centre for major hand injuries with tissue loss. Aim:The aim of this work is to point out the reliability of the abdominal flap leading to a good clinical outcome.Case presentation: This is a case report of an 8-year-old boy, who sustained a closed fracture to the left forearm. He was taken to a traditional bone setter who wrapped the arm up with herbs. However, after about 2 weeks it was noticed the arm had deteriorated significantly. He presented to our centre 3 weeks after the injury., On arrival at the 37 Military Hospital, it was noticed that the bones of the forearm were exposed, with extensive ulceration and necrotizing of tissue of the lateral extensor and whole flexor surfaces of the left forearm. The wound was generally septic. The wound was debrided and an Abdominal flap cover was done to salvage his upper limb. Conclusion:The abdominal flap provides a reliable option for reconstruction and salvage of the upper limb with good colour and texture match. Together with the Groin Flaps, Abdominal Flaps continue to be dependable additions in the quiver of the reconstructive surgeon in the developing world.
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