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South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie

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https://www.readbyqxmd.com/read/28272859/coverage-of-extensive-tibial-bone-exposure-in-burn-patients-with-three-local-flaps
#1
N Lahouel, P Mokwatlo, E Ndobe
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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272858/coverage-of-extensive-tibial-bone-exposure-in-burn-patients-with-three-local-flaps
#2
N Lahouel, P Mokwatlo, E Ndobe
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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272857/management-of-acute-complex-traumatic-wound-with-a-dermal-regeneration-template-case-report
#3
R R V Patel, M Giaquinto-Cillers, J Kotze, R S Hartnick, L W van der Merwe, E B Holford
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. METHOD: 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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272856/macromastia-and-gigantomastia-efficacy-of-the-superomedial-pedicle-pattern-for-breast-reduction-surgery
#4
V Chetty, E Ndobe
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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272855/a-fifteen-year-experience-of-total-thyroidectomy-for-the-management-of-simple-multinodular-goitres-in-a-low-medium-income-country
#5
A O Afolabi, O O Ayandipo, O O Afuwape, O A Ogundoyin
INTRODUCTION: Total thyroidectomy as a treatment for simple multinodular goitre is not well recognised in most centres in low middle income countries. METHOD: 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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272854/comparative-study-of-extralevator-vs-conventional-abdominoperineal-excision-in-a-single-centre-in-the-developing-world
#6
M Oostenbroek, E Coetzee, A Boutall, R Baigrie, P Goldberg
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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272853/acute-extradural-haematomas-in-children-a-single-neurosurgery-unit-s-12-year-experience
#7
B Enicker, H Louw, T Madiba
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. METHOD: 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...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272852/trauma-unit-attendance-is-there-a-relationship-with-weather-sporting-events-and-week-month-end-times-an-audit-at-an-urban-tertiary-trauma-unit-in-cape-town
#8
K L Milford, P H Navsaria, A J Nicol, S Edu
BACKGROUND: The Groote Schuur Hospital Trauma Unit is a high-volume referral center where patient volumes may be related to temporal and environmental factors. OBJECTIVE: This audit aimed to determine if numbers of patients presenting after motor vehicle collisions (MVCs) and interpersonal violence (IPV) were related to temporal factors, weather variables and important soccer matches. METHOD: Numbers of patients presenting to the unit per shift over 17 months were obtained from unit logs...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272851/the-effect-of-emergency-medical-services-response-on-outcome-of-trauma-laparotomy-at-a-level-1-trauma-centre-in-south-africa
#9
S Chowdhury, P H Navsaria, S Edu, A J Nicol
BACKGROUND: Due to resource constrained pre-hospital emergency medical services (EMSs) there is a significant delay in injured patients arriving at Groote Schuur Hospital Trauma Centre (GSHTC). The aim of the study was to examine the effectiveness of EMSs in transferring trauma patients to GSHTC. The effect of any delay to laparotomy from injury was noted. METHOD: A prospective audit of patients presented directly from the scene to GSHTC following abdominal trauma over a four-month period was performed...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272850/computerised-tomographic-angiography-cta-in-extremity-trauma-a-level-one-hospital-experience
#10
P Jordaan, S Roche, S Maqungo
INTRODUCTION: The aim of this study was to audit the use of Computerised Tomographic Angiography (CTA) in assessing extremity vascular injuries at our institution and to compare it to international standards. The primary aim was to assess the number of CTAs performed and the indications for doing them. The secondary aim was to look at CTA results and clinical findings and to correlate the two. METHOD: This is a retrospective review of all patients aged 13 years and older who had CTA performed for suspected extremity vascular injuries due to blunt trauma or gunshot injuries, who presented from January 2012 to December 2012...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272849/enhanced-recovery-after-surgery-eras-in-penetrating-abdominal-trauma-a-prospective-single-center-pilot-study
#11
M R Moydien, R Oodit, S Chowdhury, S Edu, A J Nicol, P H Navsaria
BACKGROUND: Enhanced recovery after surgery (ERAS) programmes employed in elective surgery have provided strong evidence for decreased lengths of hospital stay without increase in postoperative complications. The aim of this study was to explore the role and benefits of ERAS implemented in patients undergoing emergency laparotomy for penetrating abdominal trauma. METHOD: Institutional University of Cape Town Human Research Ethics Committee (UCT-HREC) approved study...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272848/sixty-five-is-the-time
#12
D A Thomson
In state service in South Africa, retirement is mandatory for doctors at 65 years while in private practice retirement age is not regulated. Is this an issue? Professor Michael DeBakey famously continued to operate until he was 90. Surely a lifetime of experience offsets the inevitable decline in motor and cognitive function that comes with age? There is however a growing body of evidence that physician experience and age is linked to worse patient outcomes. In one meta-analysis, 74% of studies showed a negative association between physician age and recognized standards of therapeutic care...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272847/when-should-surgeons-retire
#13
I Buccimazza
Everyone ages, and so do surgeons. No one seemed to mind that Professor Michael DeBakey was 88 years old and still performing open heart surgery when he operated on the Russian President Boris Yeltsin.1 But is there a point beyond which the surgeon's age becomes a risk factor?
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28272846/do-surgeons-have-a-sell-by-date
#14
D M Dent
When should surgeons retire? Do they have a defined shelf life and a sell-by date? At what point should they chuck in the scalpel and hang up their gloves? The answer to these questions for young and old surgeons is found by them merely looking around themselves: the young to make continuous mental notes about what to do (and not to do) when they get older; older surgeons to do so as a reality or insight check. The first gaze is at the theory and understanding that underpins surgery - academic surgery if you will - and the second gaze is at the craft of cutting, for surgeons are really just journeymencraftsmen, the better ones with well-developed cognitive and manipulative skills...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240471/self-expanding-metal-stent-sems-insertion-fluoroscopy-versus-pure-endoscopic-technique-a-cost-comparison
#15
M Govender, C Aldous, D L Clarke
Oesophageal cancer is a disease with significant morbidity and mortality, and in South Africa most patients present with advanced disease.1 Self-expanding metal stents (SEMS) are now widely used in the palliation of oesophageal cancer, and in most institutions SEMS are deployed under fluoroscopic guidance. In our institution, we use an exclusive endoscopic deployment technique which is comparable to the traditional fluoroscopic technique in terms of safety and efficacy.2-4 We undertook a study to compare the two techniques with respect to their time- and cost-effectiveness...
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240470/perforated-appendicitis-presenting-as-a-thigh-abscess-a-lethal-combination
#16
S Naidoo, R Du Toit, A Bhyat
Typical cases of acute appendicitis have excellent treatment outcomes, if managed appropriately.1 We discuss an unusual case of perforated retrocaecal appendicitis that presented as a right thigh abscess without prominent abdominal symptoms, which highlights the lethal nature of advanced appendicitis even when appropriate surgical therapy is instituted.
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240469/intestinal-volvulus-after-conservative-management-of-incidental-midgut-malrotation-discovered-at-laparoscopic-appendectomy-in-a-teenager
#17
S Naidoo, F Kimmie, A Bhyat
Midgut malrotation (MMR) is the abnormal rotation of the foetal midgut around the axis of the superior mesenteric artery which in symptomatic neonates requires a Ladd's procedure. We present a rare case of midgut volvulus occurring in a teenager 3 days after observational management of incidentally discovered MMR during laparoscopic appendectomy. A Ladd's procedure was performed and the patient is well at one-year follow up. We suggest prophylactic Ladd's procedure remains the treatment of choice for MMR even when discovered incidentally...
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240468/primary-seromucinous-cystadenocarcinoma-of-the-mesentery
#18
S Sobnach, J C Kloppers, S Burmeister, M Locketz, L Roodt, S R Thomson, J E J Krige
A 72-year-old woman presented with a slow growing mass on the left side of the abdomen, which was found to originate from the mesentery of the descending colon. Histopathology revealed a seromucinous cystadenocarcinoma of the mesentery, a rare clinical entity occurring most often in females. There are only 20 cases reported in the literature. It is postulated that these tumours develop as a result of serous or mucinous metaplasia of pre-existing coelomic mesothelium. Surgical excision remains the mainstay of successful management...
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240467/perforated-caecal-duplication-cyst-presenting-as-an-appendicular-abscess
#19
J Sookram, N Naidoo, S Cheddie
A duplication cyst of the caecum is a very rare congenital malformation, representing 0.4% of all gastrointestinal duplications. We present a case of cystic duplication of the caecum in a 12-year-old child who presented with a right iliac fossa mass and peritonitis. An ischaemic, perforated caecal duplication cyst was found on emergency laparotomy, mandating a right hemicolectomy.
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28240466/liberal-transfusion-strategies-still-the-trend-in-burn-surgery
#20
N L Allorto, M D T Smith, D L Clarke
OBJECTIVE: Blood is a limited resource in middle-income countries such as South Africa. Transfusion is associated with complications and expense. We aimed to understand our transfusion practices in burn surgery as well as ascertain the opinion of a broader group of surgeons and anaesthetists regarding transfusion triggers in order to understand the rationale and bias that drives current transfusion practice in our setting. METHOD: Firstly, we investigated the current blood practices at our regional burn service through an audit of perioperative notes for all patients receiving packed cell transfusions in a 24-month period...
September 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
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