Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience.

Autor:	Rhodes IJ; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Arbuiso S; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Alston CC; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Zhang A; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Medina SJ; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Liao M; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY., Chesang P; Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya., Hayden G; Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya., Batdorf NJ; Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya., Rhodes WR; Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya., Otterburn DM; From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery. Global open [Plast Reconstr Surg Glob Open] 2024 Dec 20; Vol. 12 (12), pp. e6390. Date of Electronic Publication: 2024 Dec 20 (Print Publication: 2024).
DOI:	10.1097/GOX.0000000000006390
Abstrakt:	Background: Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures. Methods: A retrospective chart review was conducted on patients who received a free flap at the Kapsowar Hospital in 2022-2023. Captured parameters included age, sex, relevant medical history, etiology of wound, flap performed, intraoperative time, complications, surgical revisions, and length of stay. Billing information for all domestic patients who received free flaps were audited, and disability-adjusted life years was calculated. Results: Nineteen free flaps were performed on 17 patients. The most common flap performed was the anterolateral thigh flap (n = 11). Flap survival rate was 94.7%. The surgical cost associated with performing an anterolateral thigh flap was $548 ± $35. The total cost associated with other free flap performances was $863 ± $269. The cost per disability-adjusted life years averted was $121, indicating that the procedure was very cost-effective. Conclusions: Despite obstacles, microsurgical practices can be safely established in limited-resource African settings. Free flaps can be performed with greater cost-efficiency when performed by local teams. Surgical mission trips should emphasize educational components and ultimately transition care to local surgeons. Competing Interests: The authors have no financial interest to declare in relation to the content of this article. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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