Background
We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020.
Methods
Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software.
Results
We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15–90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050–4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1–278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001.
Conclusions
Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and relative complications.
male students giving a sex ratio of 2.55. 54.52% chose surgery but the proportion decreases with the years of study. So, we go from 65% in the third year to 36% in sixth year. The choice depends neither on students' sex nor on the number of completed surgical trainings. The favorite specialty was traumatology. As the year of study increases, fewer students choose surgery. The main motivation is the intellectual challenge. Non-availability of certain surgical specialties and lifestyle are discouraging factors. Conclusion: this study revealed a lack of interest in medical' students for specialization in surgery during their training. Solutions must be found to increase the number of surgeons long-term.
Background
We analysed the clinical and therapeutic profile of the patients who underwent a surgical lower extremity amputation (LEA) in Togo.
Methods
Retrospective study based on clinical files of the adult patients who underwent a LEA at a single centre (Sylvanus Olympio Teaching Hospital, SOTH) from 1st January 2010 to 31st December 2020. We analysed files with 95% of the studied parameters and excluded those with less than 5%. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software.
Results
We included 245 cases. The mean age was 59.62 years (15.22SD) (range 15 to 90 years), the sex ratio, 1.99. The medical history of diabetes mellitus was found in 143/222 (64.41%). Gangrene was diagnosed in 212/245 (86.53%) patients; crush syndrome in 23/245 (9.39%); bone tumour in 5/245 (2.04%); osteomyelitis in 2/245 (0.82%); chronic ulcer in 2/245 (0.82%); necrosis fasciitis in 1/245 (0.40%). A Doppler-ultrasound of the lower limbs was performed in 91/245 (37.14%) cases. The anatomical site of LEA found in 241/245 (98.37%) files was leg in 133/241 (55.19%), knee in 14/241 (5.81%), thigh in 83/241 (34.44%), and foot in 11/241 (4.56%) patients. The mean delay from the indication of amputation to surgery retrieved in 239/245 (97.55%) files was 6.75 (1–78) days (11.59 SD). The immediate postoperative complications have been reported in 242/245 (98.78%) files, and no complication in 234/242 (96.69%). There were early complications in 56/238 (23.53%) patients. The mortality rate after LEA was 17/238 (7.14%). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20SD).
Conclusion
Most patients admitted to SOTH (Lomé, Togo) who underwent LEA had diabetes mellitus at the late presentation, which led to challenging complications. This result entails essential information campaigns to prevent diabetes mellitus and cardiovascular diseases.
Background
Report cases of vesico-peritoneal and vesico-cutaneous fistulas suspected to Doppler ultrasound confirmed by CT scan/conventional cystography and successfully treated.
Case presentation
Two male patients of 35- and 36-year-old, without any medical past history, had presented anuria and absence of miction respectively after a road traffic accident and a piece of wood penetrating the left thigh. The physical examination revealed lower limbs hematoma and severe abdominal pain in the man of 35 years and a sutured wound of the left thigh of 4 cm with a bright liquid flowing from it with the characteristic smell of urine in the man of 36 years. A Doppler ultrasound was made. The Doppler had shown normal ureteral jets but with a third abnormal flux which went from interior to exterior of the urinary bladder for the first patient and from the bladder to the left inguinal cutaneous tissue for the second patient. The treatment was a Foley’s catheter into the bladder with antibiotics in the two cases after excision and separate suture of the peritoneum and bladder during umbilical laparotomy in the first case. The suites were simples.
Conclusions
The diagnostic contribution of CT/conventional cystography is well known and undisputed, but for Doppler ultrasound, it is anecdotal like in these cases we report. Nevertheless, there is a need to evaluate the semiological value of Doppler ultrasound contribution on a greater sample.
Hexadactyly of the foot, an abnormal congenital condition presenting as eight toes, is a rare malformation. We report the case of a ten-year-old girl, admitted to our orthopedic and reconstructive surgery department for a preaxial hexadactyly. The girl was abandoned by her parents at birth and stopped school early due to stigmatization. The goals of the surgical procedure were: social reintegration, gait improvement, ability to wear shoes comfortably, and improved appearance of the foot. The surgery was a medial resection of the supernumerary toes.
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