South African Journal of SurgeryDownload
The SAJS is a quarterly general surgical journal. It carries research articles and letters, editorials, clinical practice and other surgical articles and personal opinion, South African health-related news, obituaries, general correspondence, and classified advertisements.
|Coverage||Vol 42 Issue 1 Feb 2004 - current|
Covering tibial bone exposure from third degree burns to the lower limbs is a challenging task for the plastic surgeon. We present our experience of covering tibial exposure from burns in three different patients, where four limbs were involved and three muscular flaps were used in conjunction with one another; i.e. the tibialis anterior flap, the medial gastrocnemius flap and the hemisoleus flap. Through the use of this technique, tibial bone exposure, ranging from 15–30 cm, was successfully covered. This technique constitutes a good solution for surgically challenging wounds.
Background: Acute complex traumatic wounds of the lower limbs are usually managed by a combination of multiple debridements, dressing changes, and specialized surgical procedures which may include tissue transfers for the reconstruction of the soft tissue injury. The recovery is lengthy, and the outcome dependent on the initial injury, the surgical procedures undertaken and rehabilitation programs with a multidisciplinary team.
Methods: A nine-year-old male patient presented to Kimberly Hospital with an extensive soft tissue injury of the leg associated with a tibia fracture caused by a high velocity pedestrian vehicle accident.
Results: A combination of proper wound care, “homemade” negative pressure wound therapy dressings, reduction of fracture and use of a dermal regeneration template over the fracture site, followed by skin grafting was used to manage the wound.
Conclusion: The final functional and cosmetic results obtained with the case suggest that the dermal regeneration template may provide a potential alternative for coverage of complex wounds, which might include an open fracture, without the need for complex tissue transfer interventions.
Macromastia and gigantomastia : efficacy of the superomedial pedicle pattern for breast reduction surgery
Background: Reduction mammoplasty procedures in patients with macromastia and gigantomastia can prove a major challenge to the plastic surgeon. Although several techniques have been described to reduce very large breasts, they can often result in vascular compromise to the nipple-areola complex (NAC) and skin flaps, decrease in NAC sensation and inability to breast-feed. The superomedial pedicle (SMP) procedure is often used in patients with moderate to large breast reductions. For extremely large breast reductions, macromastia and gigantomastia breast amputation with a free nipple graft is often recommended. For large resections and long suprasternal notch-nipple (N-N) distances there is no consensus in terms of approach.
Objective: To evaluate the efficacy and complication rate of the SMP reduction mammoplasty technique for extremely large, macromastia and gigantomastic breasts at two institutions in Johannesburg.
Methods: Retrospective review of patient records with macromastia and gigantomastia who had undergone the SMP technique reduction mammoplasty between 2008 and 2012. Complications were assessed at 1 week, 3 weeks, 6 months and a mean of one year postoperatively.
Results: There was a total of 31 patients, 62 breasts, with macromastia and gigantomastia who had an SMP pattern of reduction. The mean age was 30.1 years, mean BMI was 28.1 and average resection weight from each breast was 1835 g. The mean N-N was 44.13 cm. The majority, 90% of patients had a good aesthetic outcome with less than 20% having any long-term complications, which were all relatively minor.
Conclusion: The SMP reduction mammoplasty efficiently reduces extremely large breasts while preserving the vascular integrity and sensation of the NAC, while simultaneously providing a well-shaped, projecting breast in macromastia and gigantomastia patients.
A fifteen year experience of total thyroidectomy for the management of simple multinodular goitres in a low medium income country
Introduction: Total thyroidectomy as a treatment for simple multinodular goitre is not well recognised in most centres in low middle income countries.
Methods: This paper is a retrospective review of outcomes of total thyroidectomy for simple multinodular goitres in the last fifteen years in a tertiary hospital in Nigeria.
Results: A total of 652 thyroidectomies were done from January 2001 to December 2015. Simple multinodular goitres were indication for a total thyroidectomy in 447 patients (68.6%) with a male to female ratio of 1:6. Postoperative complications were hypocalcaemia in 22 (4.9%), unilateral recurrent laryngeal nerve palsy in 13 (2.8%) and haemorrhage in 2 patients. Others were seroma and cellulitis. Tracheostomy was required in 35 (5.8%) patients but none was permanent.
Conclusion: Total thyroidectomy is a relatively safe treatment option for patients who have simple multinodular goitre. It provides a permanent cure with a low postoperative morbidity risk. The burden of replacement l-thyroxine needs to be discussed with the patients.
Comparative study of extralevator vs. conventional abdominoperineal excision in a single centre in the developing world
Abstract: Abdominoperineal excision (APE) is used to resect cancers in the distal rectum and anus where sphincterpreserving surgery is not possible. It is associated with increased local recurrence rates compared to anterior resection. The extralevator abdominoperineal excision (ELAPE) was developed to reduce local recurrence and was widely adopted without sound evidence.
Aim: To compare the short-term (2 years) outcomes of patients managed with ELAPE to those with conventional APE in a single institution in a developing country.
Methods: A prospective database on all patients treated with prone ELAPE from 2010 to 2014 was compared to patients treated with conventional APE. Patient demographics, tumour characteristics, intra-operative tumour perforation, involvement of the circumferential resection margin (CRM), surgical complications and mortality are reported.
Results: Fifty-six patients were treated with APE of which 29 were male. Median age was 56. Thirty underwent conventional APE (16 male; 14 female) and 26 underwent ELAPE (15 male; 11 female). The groups were similar in age, tumour histology, height above anal verge clinical staging and response to neoadjuvant treatment. Perineal closure techniques in both cohorts were similar. There was no difference in intra-operative tumour perforation, involvement of the CRM, perineal wound complications or 30-day mortality in the 2 groups.
Conclusion: There is no difference in the important short-term outcomes of conventional APE when compared to ELAPE.
Background: Acute extradural haematomas (AEDHs) occur infrequently in children. This study was undertaken to review our experience with management and outcomes of this condition in children treated in the Neurosurgery Unit at Inkosi Albert Luthuli Central Hospital.
Methods: A retrospective review of medical records of all children (age less than or equal to (≤) 12 years) with a diagnosis of AEDH admitted from January 2003 to December 2014 was performed. Records were analyzed for demographics, mechanisms of injury, clinical presentation, neuroradiology findings, management and outcomes at discharge.
Results: A total of 150 children with AEDHs were admitted during this period. The mean age was 6.6 ± 3.8 years with a peak incidence in the 7-9 year age group. There were 84 (56%) males, (M: F= 1.3:1). Sixty AEDHs resulted from road traffic crashes (40%). On admission 104 (69.3%) children were Glasgow coma scale (GCS) 13-15, 26 (17.3%) GCS 9-12 and 20 (13.4%) GCS 3-8. Haemoglobin was less than (<) 8 g/dl in 56% of infants (p < 0.001). Skull fractures were identified in 78% of cases. Surgical management was undertaken in 83% of children and the mean hospital stay was 6.9 ± 6.1 days. Four children (2.7%) died during in-hospital stay period. One hundred and forty one (94%) children had a favourable Glasgow outcome scale (GOS) at discharge.
Conclusion: AEDHs in children carry a good prognosis, but can be potentially fatal. A vigilant approach is required when assessing these children, as early diagnosis and treatment yields gratifying results.