Gossypiboma though uncommon is under-reported. It is an infrequent but avoidable surgical error. The retained sponge induces two types of reactions, fibrinous response resulting in granuloma formation and exudative response leading to abscess formation. This serious medical condition may result in significant morbidity and mortality with serious medico legal implications. We present two cases of retained guaze(gossypiboma) seen in a busy surgical unit within three months. The pathogenesis is due to gauze induced adhesions that may cause intestinal obstruction and abscess formation resulting in peritonitis . The plain abdominal radiograph was very valuable in the first line investigation of these patients. It is possible that gossypiboma is underreported and standard protocols are not common except for routine concern for detail while doing laparotomy.

Depressed forehead scars are not frequently reported in the literature in the West African sub-region. Although they are not commonly reported, few cases were managed and are to be documented. We had seen a case of depressed forehead scar which was due to post frontal avulsion injury of the forehead with an intact posterior table of the frontal bone. He complained of aesthetic and psychological problems of the scar on presentation. The scar revision was done with polymethylmethacrylate bone cement with simple wound closure based on patient’s choice after counseling. The treatment outcome was satisfactory. We intend to highlight the use of polymethylmethacrylate bone cement and simple wound closure as an option in the revision of depressed forehead scars as well as add a report to the volume of literature from the sub-region.

Amputations of the upper limb, in particular, have a major impact on patients’ lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.

Injuries to the fingertip are common in our Accident and Emergency Department. The goal of treatment is restoration of a painless, functional digit with protective sensation. In other words, it involves the provision of sensate and durable fingertip and bone support for nail growth. When selecting a treatment option the amount of soft-tissue loss, the integrity of the nail bed, the age and physical demands of the patient should be considered. The study seeks to evaluate the mechanisms and management of fingertip amputations including the treatment modalities used and its impact on patient outcomes. This is a prospective study of 37 patients with 43 cases of fingertip amputations. Patient ages ranged from 5 to 56 years. Data was collected from January, 2016 to December, 2017. Various reconstructive options were considered for the fingertip amputations such as skin grafting, cross finger flap, thenar flap, hypothenar flap, louvers flap and groin flap in multiple digital injuries. The total duration of treatment varied from two to seven weeks with follow-up of two to eight months. The results showed preservation of finger length and contour, retention of sensation and healing minimal complication. About 40% of the patients had well formed fingertip pulps which were aesthetically acceptable. In conclusion, fingertip amputation is a common injury. Treatment depends on how much skin, soft tissue, bone and nail were damaged and how much of the finger or thumb was cut off. A good knowledge of the mechanism of injury, type of injury, occupation of patient and hand dominance would help in deciding the surgical technique to use. A satisfactory reconstruction is ascertained if the patient has durable, sensate, fingertip length preservation and a fairly formed pulp.

Introduction: Pseudoepitheliomatous hyperplasia is a benign condition characterized by hyperplasia of the epidermis and adnexal epithelium commonly occurring in reaction to several conditions including chronic burn wound. Case Report: An 18 month old male patient presented with scald burns to the scalp and face with chronicity and infection of the burn wound as consent for skin grafting was not given by the parents. Initial histology of incision biopsy specimen revealed a well-differentiated squamous cell carcinoma in a chronic burn wound on the scalp. This did not correlate with the clinical picture of the wound necessitating a second histologic review of the biopsy specimen, which this time was confirmed as pseudoepitheliomatous hyperplasia. Patient further declined excision and grafting with the wound eventually healing with scarring after 10 months. Conclusion: A very high index of suspicion is required in making the diagnosis of PEH. Public enlightenment is needed to educate people on wounds and their management if optimal results must be obtained.