scholarly journals No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

2021 ◽  
Author(s):  
F. Wichlas ◽  
V. Hofmann ◽  
M. Moursy ◽  
G. Strada ◽  
C. Deininger
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Sierra Leone ◽  
Low Income ◽  
Soft Tissue Defect ◽  
Low Income Countries ◽  
Pelvic Surgery ◽  
Closed Fractures ◽  
Trauma Triage ◽  
Tissue Defects

Abstract Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

COVERAGE CONSIDERATIONS AND OUTCOME ANALYSIS OF RECONSTRUCTION OF POST TRAUMATIC SOFT TISSUE DEFECTS AROUND THE ELBOW

2020 ◽  
pp. 70-72
Author(s):  
Vishwamitra B Dayal ◽  
M. Senthil Kumaran ◽  
S Raja Sabapathy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Defect ◽  
Defect Size ◽  
Outcome Analysis ◽  
Soft Tissue Reconstruction ◽  
Soft Tissue Defects ◽  
Comparison Results ◽  
Average Defect ◽  
A Prospective Study ◽  
Tissue Defects

Introduction: Major crush injury of elbow joint following trauma with extensive injury to skin & soft tissue, bone, tendon, nerves and vessels remains a challenge to the reconstructive surgeon. Purpose of this study is to nd out whether the size of the defect, type of ap used and the location of the soft tissue defect inuence the outcome of soft tissue reconstruction. Material and methods: A prospective study was performed in all patients with soft tissue defects around the elbow in need of ap cover at Ganga Medical Centre Coimbatore, Tamilnadu India from April 2014 to December 2015.Patients demographics, defect size, location, type of ap used, complications and long – term outcomes analysed. Patients Mayo elbow performance score and Likert scale score were recorded for analysis of functional and aesthetic outcome respectively. The Kruskal wallis test was used for statistical comparison. Results: Forty three aps were performed primarily for coverage in forty patients. Three patients required two primary aps for reconstruction. The aps used in our study included 14 local fasciocutaneous aps (32.5%); 20 pedicled aps both locoregional and distant (46.5%) and 9 2 2 Anterolateral thigh free aps (20.9%) The average defect size was 151 cm . For local fasciocutaneous ap the average defect size was 44.7cm , 2 2 2 2 2 (range, 4-120 cm ), distant pedicled ap was181 cm (range 24- 600 cm ) and for the ALT free ap was 252.2 cm (range 80-450 cm ). Conclusion: The defect size is the main determinant of the type of ap used and their outcomes.

scholarly journals Results of Microvascular Free Flap for Reconstruction of Soft Tissue Defects: Our Early Experience

2014 ◽  
Vol 3 (2) ◽  
pp. 33-37
Author(s):  
Debashis Biswas ◽  
Md Abul Kalam ◽  
Tanveer Ahmed ◽  
Md Rabiul Karim Khan
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Tissue Defect ◽  
Radial Forearm ◽  
After Cancer ◽  
Microvascular Free Flap ◽  
Tissue Defects

Extensive soft tissue defects following trauma, burn or after cancer surgery need coverage by flaps. Sometimes surrounding tissues are not healthy enough or quantity is not favorable to provide adequate pedicle flaps. Microvascular free flap can provide healthy tissue of adequate amount from distant area for those difficult situations.15 microvascular free flaps were performed from October 2011 to February 2013. Radial forearm free flap was done in 8 and Latissimusdorsi (LD) flap in 7 cases. 10 flaps done in foot, ankle & lower leg region (radial forearm-5, LD-5) and 5 flaps were done in face and scalp region (radial forearm-4, LD-1).12 flaps healed uneventfully with good coverage of the defect. Average ischemia time was 135 min (range 100-240 min) and average anastomosis time was 75 min (average 60-100 min). 2 flaps failed. There was necrosis of the tip of 2 LD and cumbersome swelling of the flap was found in 2 cases of LD flaps.Large soft tissue defect of body where local or regional flaps are not feasible; can be easily covered with free flaps. Its capacity to cover huge soft tissue defect has neutralizes its technical demand. Though complications are still high in our hands; can be reduced performing more number of cases. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18242 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 33-37

scholarly journals Organization of stage rehabilitation of servicemen with gunshot defects of soft tissues at the levels of medical care

2021 ◽  
Vol 26 (4) ◽  
pp. 188-195
Author(s):  
K.D. Babov ◽  
I.P. Khomenko ◽  
S.V. Tertyshnyi ◽  
Babova I.K. Babova I.K. ◽  
R.S. Vastianov
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Lower Extremities ◽  
Gunshot Wounds ◽  
Care Quality ◽  
Rehabilitation Service ◽  
Soft Tissue Defects ◽  
Tissue Defects

Building a modern system of rehabilitation of servicemen in Ukraine is an integral part of providing medical care in armed conflict. Rehabilitation of servicemen after gunshot wounds with soft tissue defects of the lower extremities is a common but difficult problem for surgical and rehabilitation teams. The process of rehabilitation requires the implementation of certain methodological provisions. At present, medical care for servicemen is a four-levels’ one. Rehabilitation service is provided at the third and fourth levels of medical care. The aim of the study was to improve the quality of medical care for servicemen after gunshot wounds with soft tissue defects of the lower extremities by introducing a system of staged rehabilitation. Organizational and methodological bases of the system of staged rehabilitation of wounded servicemen with soft tissue defects at different levels of medical care have been developed. Two models of rehabilitation depending on the severity of the injury and the tactics of surgical treatment are proposed. The division of the stage of early sanatorium rehabilitation for the wounded with severe soft tissue injuries depending on the stage of surgical treatment and the formation of a "skin patch" is justified. The introduction of the proposed models of rehabilitation of wounded with soft tissue defects in the practice of early sanatorium rehabilitation will provide increasing of medical care quality.

scholarly journals Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Siti Handayani ◽  
Shelly Madona Djaprie
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Wide Range ◽  
Reconstructive Microsurgery ◽  
One Year ◽  
Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

Study on Chitosan-Based Nanocomposite Hydrogel in Soft Tissue Defect of Hand

2020 ◽  
Vol 12 (9) ◽  
pp. 1120-1126
Author(s):  
Jian Zhang ◽  
Zhaoyu Gao ◽  
Yao Zhang ◽  
Jinghai Tian
Keyword(s):  
Soft Tissue ◽  
Blood Compatibility ◽  
Rabbit Model ◽  
Soft Tissue Defect ◽  
Common Disease ◽  
Nanocomposite Hydrogel ◽  
Soft Tissue Defects ◽  
Clinical Role ◽  
Tissue Defects

Hand soft tissue defects are a common disease in surgical emergency, which seriously affects the limb function of patients and significantly reduces their quality of life. To effectively repair hand soft tissue defects, a difficult problem posed to surgeons, we report here the use of a chitosan-based nanocomposite hydrogel (CS-GEL-PDRN). In vitro experiments showed that the nanocomposite hydrogel could promote the proliferation of human embryonic fibroblasts M-22 and human vascular endothelial cells EC-304. In addition, the hydrogel had excellent blood compatibility. In the rabbit model of soft tissue defects, CS-GEL-PDRN effectively coordinated cytokine responses, accelerated wound healing and promoted tissue repair. Based on this, CS-GEL-PDRN is expected to play a clinical role in the repair of hand and other soft tissue defects in the future.

Case Report: Severe Dental Abscess Complications in Rural Sierra Leone

2021 ◽  
Author(s):  
Rosa Roemers ◽  
Aminata I. Sesay ◽  
Musa G. Sesay ◽  
Jan Henk Dubbink ◽  
Heleen M. Koudijs ◽  
...  
Keyword(s):  
Case Report ◽  
Mortality Rate ◽  
Sierra Leone ◽  
Low Income ◽  
Case Series ◽  
Low Income Countries ◽  
Prevalence Data ◽  
Dental Abscess ◽  
Dental Infections

Prevalence data on severe dental infections is scarce, particularly for low-income countries. Patients with dental abscess complications who presented from September 2020 until December 2020 in two hospitals in Tonkolili District, Sierra Leone, were included into this case series. We report on a total of 20 patients, median age 28 years, with severe complications of dental abscesses, with a mortality rate of 45%. This case series illustrates the severity of the dire consequences of the absence of access to basic dental and oral healthcare.

scholarly journals Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

2017 ◽  
Vol 45 (3) ◽  
pp. 1074-1089 ◽  
Author(s):  
Lifeng Shen ◽  
Yiyang Liu ◽  
Chun Zhang ◽  
Qiaofeng Guo ◽  
Wenhua Huang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Lower Leg ◽  
Soft Tissue Defect ◽  
Venous Congestion ◽  
Peroneal Artery ◽  
Soft Tissue Defects ◽  
Propeller Flap ◽  
Perforator Vessel ◽  
Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

scholarly journals Ten technical considerations revisited in tissue expansion

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Luke Geoghegan ◽  
Dariush Nikkhah
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expansion ◽  
Soft Tissue Defect ◽  
Illustrative Case ◽  
Soft Tissue Defects ◽  
Case Presentation ◽  
Versatile Tool ◽  
Technical Factors ◽  
Tissue Defects

Abstract Tissue expansion is a versatile tool in resurfacing soft tissue defects of the breast, extremity, head and neck that involves the placement of a temporary implant adjacent to a soft tissue defect. Incremental expansion exploits the viscoelastic properties of skin to generate a skin flap that can be used to resurface defects and provide cover over permanent protheses. Infection, implant extrusion and skin necrosis are recognized complications of tissue expansion. This article presents a revised framework of 10 technical factors to reduce the risk of complications and optimize outcomes with tissue expansion using an illustrative case presentation.

scholarly journals Adipofascial perforator flaps: Its role in reconstruction of soft-tissue defects of lower leg and ankle

2018 ◽  
Vol 51 (02) ◽  
pp. 216-221 ◽  
Author(s):  
Deepak Nanda ◽  
Shamendra Anand Sahu ◽  
Durga Karki ◽  
Sanjay Kumar ◽  
Amrita Mandal
Keyword(s):  
Soft Tissue ◽  
Lower Limb ◽  
Donor Site ◽  
Soft Tissue Defect ◽  
Soft Tissue Defects ◽  
Adipofascial Flap ◽  
Tibial Artery ◽  
Split Skin ◽  
Tissue Defects

ABSTRACT Background: Despite advances in surgical skills, adipofascial flaps are still less preferred option for coverage of leg defect. We evaluate the use of perforator-based adipofascial flap in small-to-medium-sized soft-tissue defects in the lower limb. Patients and Methods: After localisation of perforators along the major axial vessels in the lower limb using handheld Doppler, adipofascial flap based on the nearest best perforator of anterior tibial artery, posterior tibial artery and peroneal artery was raised to cover soft-tissue defect in 21 patients. The flap was transposed over the defect and covered by split-skin graft. Donor site was primarily closed. Flap complications, functional and aesthetic outcomes are noted in follow-up. Results: There was partial loss of flap in five patients. After debridement and dressings, split-skin grafting was done for four patients and one patient was managed with local flap. Scar over the flap was stable with no reports of recurrent ulceration or breakdown of wound in 6-month follow-up. Four of five patients reported adequate healing of the fractured bone. Average visual analogue score was 8.24/10 for appearance of donor site as evaluated by the patient. Conclusions: Perforator-based adipofascial flap is a good alternative for coverage of small-to-medium-sized soft-tissue defect of the leg, particularly over the malleolus and lower part of the leg. Use of adipofascial tissue and primary closure of the donor site causes minimal donor-site morbidity. Adipofascial perforator flap provides aesthetically superior recipient-site scar with satisfactory functional outcome.

scholarly journals Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038520
Author(s):  
Maria Lisa Odland ◽  
Tahir Bockarie ◽  
Haja Wurie ◽  
Rashid Ansumana ◽  
Joseph Lamin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Access To Care ◽  
Sierra Leone ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Health System Strengthening ◽  
Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

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