Tubularized incised plate urethroplasty (Snodgrass procedure) for distal penile hypospadias: A regional center experience Aditya P Singh, Arvind K Shukla, Pramila Sharma, Dinesh K Barolia Nigerian Journal of Plastic Surgery 2019 15(1):1-8 Objective: Tubularized incised plate (TIP) urethroplasty has rapidly become the procedure of choice for repair of distal penile hypospadias (DPH) at most of the centers throughout the world. We did some modifications in the original technique to improve the outcome. In this article, the technique of TIP urethroplasty is discussed and literature is reviewed. Materials and Methods: TIP urethroplasty was performed in 250 new cases of DPH from January 2005 to December 2015 in our institute. We included only primary DPH with typical characteristics including stenotic meatus, deep glandular groove, wide urethral plate distally and in middle, and adequate size penis. We did some modification in the original Snodgrass repair to improve our outcome. Neourethra was covered with vascularized pedicled dartos flap from the inner prepuce. Patients were followed up for a mean of 12 months. Results: Age range of the patients varied between 3 and 11 years with majority of them [235 (94%)] below 9 years; 50 (20%) patients had mild-to-moderate chordee, which was corrected by degloving of the penis. We did not require tunica albuginea plication to correct chordee because it was only skin chordee. The mean age of children was 6 years. Mean duration of surgery was 50 min (45–60 min). Postoperative hospital stay was 10 days. Overall complication rate, requiring specific intervention, was 13.2%. Major complications occurred in 30 (13.2%), urethrocutaneous fistula in 15 (6%), meatal stenosis in five (2%), complete dehiscence in three (1.2%), glanular dehiscence in five (2%), and proximal stricture in five (2%) patients. Functional results as judged by the urinary stream were good in 225 (90%) patients. An excellent cosmetic result was seen in 215 (86%) patients. Conclusion: TIP urethroplasty with dartos flap cover is a simple, single-stage procedure for DPH with excellent cosmetic and functional results and is associated with minimal complications. Finally, some of our modifications in the original technique can improve the outcome.

Split-thickness skin grafting: A modest technique for scrotal reconstruction in patients of Fournier’s gangrene Imran Ahmad, Rajesh K Maurya, Mohammed F Khurram, Brajesh Pathak, Ali A Mahmud, Sudheer K Maurya Nigerian Journal of Plastic Surgery 2019 15(1):9-13 Background and Objectives: Fournier’s gangrene is rapidly progressive fulminating gangrene of the genitals and the perineum. The resulting skin loss can be covered by various techniques. Split thickness skin grafting (STSG) is a surgical technique which gives good functional and cosmetic outcome and is relatively easier to perform. We intend to study the results of split-thickness skin grafting in patients with scrotal defect following Fournier’s gangrene. Materials and Methods: Split-thickness skin graft was performed in seven patients with Fournier’s gangrene. The patients were selected consecutively from December 2016 to April 2018. All patients were followed for 3 to 6 months postoperatively. Results: All patients had good uptake of graft with no complications except two patients, one had infection at the graft site and in the other one there was a gap devoid of skin at the junction of perineum and base of scrotum. The first patient was managed conservatively with antibiotics and the gap in second patient was repaired by suturing. The donor site in all patients had healed well without any complications. Conclusion and Interpretations: STSG is safe, simple technique for scrotal reconstruction which is both cosmetically and physiologically compliant to the patient.

Building capacity for aesthetic surgery in Nigeria: perspectives from the cosmetic surgery fellowship at the Ivo Pitanguy Institute Rio de Janeiro, Brazil Olayinka A Olawoye Nigerian Journal of Plastic Surgery 2019 15(1):14-19 Very little of cosmetic surgery procedures were done hitherto in most of the plastic surgery training institutions in Nigeria. The reasons for this are many. The practice and training is tilted significantly in favor of reconstructive surgery compared to aesthetic surgery with a ratio as high as 9:1 in the major teaching and training institutions in the country. As a result, experience is limited in cosmetic surgery and the trainees rarely participate in significant number of cosmetic procedures throughout their training. With the progressive increase in demand for cosmetic surgery locally, concerted efforts must be made to build the capacity of plastic surgeons to meet this growing demand. This article documents the experience of the author during a cosmetic surgery fellowship at the Ivo Pitanguy Institute, Rio de Janeiro, Brazil, and drew perspectives from the experience for the building of capacity for cosmetic surgery in Nigeria.

Management challenges of complicated lactational breast abscess in a tertiary health facility in a resource-constrained environment Muhammad Habib Ibrahim, Eguono Erhinyaye Omoyibo Nigerian Journal of Plastic Surgery 2019 15(1):20-23 Background: Lactational breast abscess, if not promptly and appropriately treated, can become complicated with associated destruction of breast skin and tissue that may necessitate breast resurfacing or reconstruction. The study is aimed at highlighting management challenges of patients who presented with complicated lactational breast abscess to a tertiary health facility in a resource-constrained environment. Patients and Method: A retrospective review of patients who presented with complicated lactational breast abscess to a tertiary health facility in northwest Nigeria from April 2015 to March 2017 was carried out. Patients were identified using the hospital admission records and appropriate data were retrieved from their case notes and analyzed. Results: A total of 17 patients were included in the study and 10 (58.8%) were in the age range 21 to 30 years. Nine (52.9%) patients presented in the puerperal period and 10 (58.8%) patients were multiparous. Left breast was predominantly affected accounting for 10 (58.8%) cases whereas there was bilateral breast involvement in four (23.5%) patients. Sixteen (94.1%) patients presented after the symptoms have started for more than a week. Four (23.5%) of the patients had necrotizing infection. Six (35.3%) patients had surgical intervention for breast resurfacing or breast reconstruction whereas 11 (64.7%) patients declined surgery due to financial constraint. Conclusion: Complicated breast abscess is not uncommon among lactating women in our environment due to late presentation resulting from illiteracy, poverty, and cultural practice of seeking alternative medical practice and its management is challenging to the surgeon partly due to financial constraint for patients’ treatment.

Use of amnion graft and surgicel in vaginoplasty for secondary vaginal atresia: A case report Rajlaxmi Pardeshi, Kusumlata Meena, Krishna Gurjar Nigerian Journal of Plastic Surgery 2019 15(1):24-26 Vaginal atresia can be congenital or acquired. The tissue is virgin in primary vaginal atresia or agenesis, so various methods have been used with successful outcomes. On the other hand, one can expect a lot of fibrosed tissue in secondary atresia. There is no elaborate literature on secondary vaginal atresia. There is also no standard treatment for both the types of vaginal atresia. The use of amnion graft and surgicel in vaginoplasty for secondary atresia is one of our experiences with best results. We report a case of a 22-year-old primipara who presented with dyspareunia and cyclical lower abdominal pain for the past 4 months. She had a history of traumatic vaginal delivery 3 months prior to presentation. On examination, she was diagnosed with secondary vaginal atresia. We managed her by vaginoplasty with amnion grafting and surgicel, followed by regular dilatation with soft vaginal mould for the next 6 weeks. Our patient is doing well with normal coital function on follow-up.

Management of lower extremity soft-tissue sarcoma in a sub-Saharan African teaching hospital: Case reports Omobolaji O Ayandipo, Samuel A Ademola, Oludolapo O Afuwape, Afieharo I Michael, Peter O Elemile, Naomi S Udonsak Nigerian Journal of Plastic Surgery 2019 15(1):27-33 Background: Soft-tissue sarcomas are relatively rare tumors and can occur in many parts of the body. When they affect the body extremities, their management can be challenging, often leading to limb amputation. Recent advances in surgery, adjuvant therapy, and better collaboration among different surgical specialists, medical and radiation oncologists, coupled with management in specialized centers have led to an upsurge in limb preservation. However, this is not obtainable in many centers in the developing countries. We report cases of soft-tissue sarcoma of the lower limb in two patients managed in a tertiary center in sub-Saharan Africa and the challenges encountered in their management. Case Reports: Two patients presented to our hospital with progressive painless masses on the lower third of their legs. Evaluation suggested that the masses were malignant. They both had wide local excision. The first patient had reconstruction with island sural artery fasciocutaneous flap, whereas the second had reconstruction with freestyle propeller flap. The postoperative periods were uneventful, and timely adjuvant therapy was commenced. Limb function was preserved in the two patients. Conclusion: Treatment of soft-tissue sarcomas of the limbs could be tasking, but multispecialty surgical intervention and adequate adjuvant therapy could give favorable result and a functional limb postoperatively.