Challenges in global microsurgery: A six year review of outcomes at an East African hospital

Citron, Isabelle; Galiwango, George; Hodges, Andrew

doi:10.1016/j.bjps.2015.10.016

Cited by 20 publications

(25 citation statements)

References 10 publications

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“…It states that surgical expertise, late and complex presentations, limited resources, and postoperative care challenges are all important contributing factors to outcomes in our institution. This review also evaluated the learning curve associated with these procedures in our setting and found a significant improvement in outcomes over time (Citron et al, 2016).…”

Section: Complicationsmentioning

confidence: 99%

“…Successful microvascular reconstruction rates are recognized to be lower in chronic wounds (Rasool, 2011;Organek et al, 2006;Vail and Urbaniak, 1996;Daoud and Saighi-Bouaouina, 1989) and in low-resource settings, even if performed by experienced teams (Huijing et al, 2011;Marck et al, 2010). A review of postoperative outcomes and challenges associated with free flaps in our institution was published by Citron et al (2016). Although this review is not limited to VFF, it analyses free flap procedures carried out by the same plastic surgeons as in this case series.…”

Section: Complicationsmentioning

confidence: 99%

“…Donor site morbidity following the harvest of the fibula is well documented (Verma et al, 2016;Agarwal et al, 2012;Babovic et al, 2000;Shpitzer et al, 1997;Coghlan and Townsend, 1993). A systematic review revealed that up to 10 % of the patients may subsequently develop ankle pain, instability and/or valgus deformity, chronic leg pain, cold intolerance, and motor weakness (Ling and Peng, 2012).…”

Section: Complicationsmentioning

confidence: 99%

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Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

Loro¹,

Hodges²,

Galiwango³

et al. 2021

J. Bone Joint Infect.

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Abstract. Background: Hematogenous osteomyelitis is commonly observed in the pediatric population across sub-Saharan Africa. This retrospective case series was designed to evaluate the complications and outcomes of treatment using a vascularized fibula flap (VFF) to fill segmental bone defects secondary to osteomyelitis in children in a low-resource setting in CoRSU Rehabilitation Hospital, Uganda. Methods: Clinical notes and radiographs of children with a diagnosis of osteomyelitis that subsequently underwent a VFF procedure between October 2013 and December 2017 were reviewed. All patients were clinically and radiographically evaluated in 2019. Results: Forty-four children, with an average bone defect of 10.5 cm, were included. Eighty-four percent of children had successful VFF limb reconstruction. Integration of the graft was radiologically sound in 20.8 weeks on average. The postoperative phase was uneventful in 29 % of patients. Complications were observed in the remaining patients, including flap failure (6), donor leg neurapraxia (3), cutaneous paddle necrosis (11), graft fracture (2), skin graft loss (6), fixator failure (1) and non-union (2). Functional outcomes were rated as excellent in 13 patients, good in 14, fair in 9 and poor in 8. There was no recurrence of the bone infection in any of the enrolled children. Conclusion: Despite being a complex and demanding procedure, VFF is a good option for reconstructing post-osteomyelitis bone defects, particularly when associated with loss of soft tissue envelope. Considering the more than satisfactory functional and clinical outcomes, this procedure should be kept in mind for these complex pediatric cases of bone and soft tissue loss, even in a low-resource setting.

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Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

Loro¹,

Hodges²,

Galiwango³

et al. 2021

J. Bone Joint Infect.

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“…The first occurs when foreign surgeons visit from developed countries, such as the experience of Giessler et al demonstrated in detail for the treatment of Noma [5,6] or the vast project that Dr. Mustardè and Dr. Webster have been developing in Ghana and Sierra Leone since 1992 [7]. The second, instead, is when a local team manages to create a suitable, albeit resource-limited setting in which to perform microsurgery [4,8]. In both cases, there are several challenges to overcome in achieving safe and effective microsurgery, in particular in the ECSA regions.…”

Section: Introductionmentioning

confidence: 99%

Achieving microsurgery missions in Kenya—a 6-year experience of a non-governmental organization

et al. 2021

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Background Microsurgery has enormously expanded the possibilities of reconstructive plastic surgery in the modern era. However, there is a vast difference in its spreading and utilization between developed and developing countries. Microsurgery missions can play a significant role in the evolution of reconstructive microsurgery in developing countries. We present our 6-year experience in a rural hospital in Kenya. Methods The humanitarian missions consisted of 19 consecutive visits to North Kinangop Catholic Hospital (Kenya) between 2014 and 2020. Every mission team consisted of a plastic surgery specialist with more than 10 years of experience and a final-year plastic surgery resident. All missions were organized and coordinated by a nonprofit organization alongside the Clinic of Plastic and Reconstructive Surgery of the University of Padova, Italy. Results During all missions, our plastic surgery teams evaluated a total of 749 patients, performed a total of 595 outpatient visits, and gave a total of 83 inpatient consultations. Among all surgical procedures performed, 17 were microsurgeries: six free flaps, one hand replantation, and ten propeller flaps. We experienced few complications and a success rate of 82%. Conclusions Our 6-year experience demonstrates that it is possible to safely carry out microsurgery procedures with local staff help and coordination. We believe that our missions are a real practical example of how foreign expertise can make local surgery evolve to perform safe microsurgery, even in a low-experience setting such as that of most developing countries. The education of local staff is crucial for the outcome of such missions. Level of Evidence: Level IV, risk / prognostic study Keywords Microsurgery • Free tissue flaps • Medical mission • Nonprofit organization • Eastern Africa

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“…Thus, there are only a few published outcomes on free tissue transfer, and the reported success rates are low. [2][3][4][5][6][7] The literature suggests that some basic issues should be considered to provide precise and comfortable working conditions while performing microsurgery. Although the surgeon's operative experience is recognized to be the most important factor in achieving free flap success, 7,8 microsurgery is a resource-dependent surgical procedure, and thus, standardization of the setup and operating room conditions is highly recommended.…”

mentioning

confidence: 99%

Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment

Datlı

Karasoy

Genc

et al. 2020

J Reconstr Microsurg

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Background Microsurgical lower extremity reconstruction remains challenging, especially when resources are limited such as lack of proper equipment, human resources, administrative support, and located in a remote area far from tertiary care. Nevertheless, reconstructive solutions are required, especially when in urgent trauma situations. In this article, we evaluate ways of overcoming challenges and issues that should be considered in a newly established unit by sharing our initial lower extremity reconstruction experience. Methods We report a local hospital's initial lower extremity reconstruction experience in February 2017 to January 2018. Through a total of seven patients, we tried to enhance the environment, instruments, nurses' contribution, and perspective of the peers and community in terms of factors related to the surgeon, hardware, environment, supporting faculty, reimbursement, and patients. Results Four patients underwent reconstruction with a freestyle propeller flap and three with an anterolateral thigh flap; in one case, a superficial circumflex iliac artery perforator flap was chosen to salvage partial flap necrosis. Increased experience of the surgeon, new equipment, continuing nurse/patient education, and collaborating with other departments allowed us to choose more challenging flaps and be more meticulous while decreasing the operation time and hospital stay. Conclusion To start a lower extremity reconstruction practice in a resource-poor environment, the surgeon needs to evaluate the relevant factors; moreover, he or she should continuously improve them until a working methodology is achieved. Despite all the challenges, the adaptations learned at this center can be applied to other local hospitals around the world to set up a lower extremity reconstruction practice and improve its outcomes.

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Challenges in global microsurgery: A six year review of outcomes at an East African hospital

Cited by 20 publications

References 10 publications

Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

Achieving microsurgery missions in Kenya—a 6-year experience of a non-governmental organization

Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment

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