Microsurgical free flaps at Kathmandu Model Hospital.

BACKGROUND: Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at Kathmandu Model Hospital in 2007 with the support from Interplast Australia and New Zealand. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal. METHODS: A retrospective cross sectional study was conducted using the clinical records of all the microsurgical free flaps performed at Kathmandu Model Hospital from April 2007 to April 2014. RESULTS: Fifty-six free flaps were performed. The commonest indication was neoplasm followed by post-burn contracture, infection and trauma. Radial artery forearm flap was the commonest flap followed by fibula, antero-lateral thigh, rectus, tensor facia lata, lattisimus dorsi, deep inferior epigastric artery perforator, and deep circumflex iliac artery flap. Radial artery forearm flaps and anterolateral thigh flaps were mostly used for burn contracture reconstructions. Twelve of the 13 (92%) fibulae were used for mandibular reconstruction for oral cancer and ameloblastoma. Rectus flaps were used mainly for covering defects over tibia. Hospital stay ranged from six to 67 days with an average of fourteen. Fifteen patients (26%) developed complications. The duration of operation ranged from six hours to 10.5 hours with an average of nine hours. The longest follow up was for four years. CONCLUSIONS: Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team.

Retrospective study on early outcome of acute burn injuries treated at Nepal Cleft and Burn Centre of Public Health Concern Trust-Nepal.

BACKGROUND: Nepal Cleft & Burn Center, Kirtipur Hospital, Kathmandu has been providing the acute burn care since 2013 with 10 ICU beds, 32 general beds and two operating rooms. This study analyses the demographics of and early outcome in the acute burn patients. METHODS: This is a descriptive retrospective study of the clinical data of acute burn patients admitted from January 1 to December 31, 2014. RESULTS: There were 78 patients from 3 months to 88 years of age with a median age of 29 years. Forty six (58.9%) were females and 32 (41.1%) were males. Most of the injuries (n=57; 73%) occurred inside the house. Flame burn was the commonest mode of injury (n= 48, 61.6%). Only eleven (14.1%) patients arrived on the same day of the injury. The time elapsed was from 1 to 67 days with a median of 5 days. Only two (2.5%) patients had poured water for more than 20 minutes. Range of total body surface area (TBSA) involved was 1% to 70% with a median of 12%. Range of hospital stay was 1 to 105 days with a median of 17 days. Sixty (76.9%) patients underwent 102 surgical operations. Twenty six (33.3%) patients needed blood transfusion. A total of 15 (19.2%) patients died. None survived a burn injury of more than 40% TBSA. CONCLUSIONS: Treatment of acute burn is very challenging with high mortality rate. A lot of effort is needed to change the present standard of care. Awareness programs on First Aid treatment of burn injuries together with the preventive programs focused on high risk population such as females and children in a large scale needs to be organized as soon as possible.

Establishing cleft malformation surgery in developing nations: a model for the new millennium.

This three-stage model outlines a safe and effective method for achieving a local cleft board in a developing region. Maintaining local culture and guaranteeing patient safety are paramount concerns. Success is rooted in the constant assessment and recognition of negative forces, including misdirection and stagnation. The key factors are the identification of an interested local host and a source of funding as the site evolves toward independence. As of June 30, 2000, 501 cases had been performed independently and free of charge by the host healthcare provider in Nepal. There had been no major morbidities or mortalities.

Renal angiomyolipoma (report of 2 cases).

Renal angiomyolipoma, a rare benign renal neoplasm constitutes less than 3 percent of all renal neoplasm. Two rare cases of renal angiomyolipoma were reported from the Department of Pathology, Dr. S.N. Medical College, Jodhpur in last fifteen years. Both were not associated with tuberous sclerosis. The relevant literature on the subject is reviewed.

Serum zinc levels in subtypes of leprosy.

Serum zinc levels were estimated in 146 patients with different types of leprosy and 40 control subjects. Tuberculoid patients were found to have normal serum zinc levels. A gradual reduction in serum zinc levels was observed from TT to LL. Serum zinc levels were not significantly higher in patients treated with dapsone for approximately 18 months. The cause of hypozincemia is not clear, but the findings suggest that there are correlations among bacillary load, immune status, and serum zinc. Zinc deficiency could be one of the factors involved in the nonspecific suppression of cell-mediated immunity in lepromatous leprosy.