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Highlights • Local/regional flaps able to cover majority of abdominal wall defects. • Associated with good surgical ocomes and are easier to perform compared to free flaps. • Most commonly used are anterior lateral thigh flap, tensor fascia lata and paraumbilical flaps., Introduction Extensive abdominal wall defects requiring reconstruction with flaps are best done with free flaps. However, free flaps are not readily available in many countries. Free flaps are associated with long operative hours, technically demanding and are prone to complications. However, local or regional flaps are a better option in managing such defects especially in resource-limited settings. Objective This was a prospective study to determine the outcome of patients with extensive abdominal defects managed with local or regional flaps. Results A total of fifteen patients with extensive abdominal wall defects were reconstructed with local/regional flaps. Ten of these patients were managed with pedicle anterior lateral thigh flaps with two tensor fascia lata flap and three para-umbilical abdominal flaps. The defect ranged from 90 to 300 cm2 in size. All the flaps were successful, with only one patient experiencing flap dehiscence in a wound that had sepsis. Donor site wounds in one patient had partial skin graft failure necessitating regular dressing and repeat grafting later. Conclusion Local/regional flaps are reliable, good options for the management of majority of the anterior abdominal wall defects, as they are less demanding, do not require long operative hours and are easy to monitor post operatively. They should be considered in most reconstructive needs of the abdominal wall.

Background: Examination methods change over time, and audits are useful for quality assurance and improvement. Objective: Comparison of traditional clinical test and objective structured clinical examination (OSCE) in a department of surgery. Methods: Examination records of results of the fifth year MBChB examinations for 2012–2013 (traditional) and 2014–2015 (OSCE) were analyzed. Using 50% as the pre-agreed pass mark, the pass rate for the clinical examinations in each year was calculated and these figures were subjected to t-test to determine any significant differences in each year and in type of clinical test. P value of

Highlights • Management of intra- abdominal sepsis requires a multi-disciplinary approach for success to be achieved. • Patient will undergo multiple surgeries and an open abdomen approach allows for planned re- laparotomies., Introduction Peptic ulcer perforation is a common surgical emergency that is a complication of 9% of patients with peptic ulcer disease (Kjetil et al., 2015 [1]). Despite advances in the management of peptic ulcer disease, the number of acute complications have remained constant. Intra-abdominal sepsis is defined as inflammation of the peritoneum caused by pathogenic micro-organisms and their products (Pavlidis, 2003). Case presentation We present a case report on intra-abdominal sepsis in a 20 yr old patient admitted in the intensive care unit at our institution following a perforated duodenal ulcer that was repaired by modified Graham patch method but leaked and he had multiple surgeries thereafter necessitating the open abdomen. Discussion The open abdomen remains an option to the surgeon as the patient may have severe peritonitis or be in septic shock. Hence the need of damage control laparotomy due to severe physiological derangement or a planned second look laparotomy if there is failed source control. Conclusion Intra-abdominal sepsis management of patient in an intensive care unit set-up with adequate surgery, open abdomen treatment and antibiotics given based on blood culture and sensitivity results enables successful management of difficult surgical abdomens.

Background: Breast cancer survival is linked to early detection, and timely and appropriate treatment. Survival depends on the stage and biological behaviour of the tumour. It is unclear how different molecular subtypes impact on axillary node involvement. Objective: This study sought to determine the correlation between hormonal receptor status with axillary nodal status in breast carcinoma. Methodology: A cross sectional study was carried out at Kenyatta National Hospital surgical wards and histopathology laboratory. Patients with a histological diagnosis of breast cancer, scheduled to undergo a modified radical mastectomy, were recruited. Data collected included age at diagnosis, parity, menopausal status, clinical examination findings, stage of the disease clinically and pathologically, and hormonal receptor status. Data were analyzed using SPSS version 21.0. Results: We enrolled 79 women with invasive breast carcinoma. Mean age was 48 (SD=14.5) years. Most (48.1%) presented with stage III tumour. Most tumours (58.2%) were luminal A. Correlation between molecular type and nodal involvement was not significant. Luminal B was significantly present in those above 50 years (p=0.011). Conclusion: The most common molecular type of breast cancer was luminal A, but luminal B disease which was prevalent in women more than 50 years old was the only molecular subtype that had a positive correlation with axillary nodal status. Keywords: Breast cancer, Axillary lymph nodes, Molecular subtypes, Hormonal receptor status, HER-2 status