Rhodes Isaiah J, Arbuiso Sophia, Alston Chase C, Zhang Ashley, Medina Samuel J, Liao Matthew, Chesang Patricia, Hayden Giles, Batdorf Niles J, Rhodes William R, Otterburn David M
From the Division of Plastic Surgery, NewYork-Presbyterian, Weill Cornell Medical Center, New York, NY.
Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya.
Plast Reconstr Surg Glob Open. 2024 Dec 20;12(12):e6390. doi: 10.1097/GOX.0000000000006390. eCollection 2024 Dec.
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.
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.
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.
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.
在许多低收入和中等收入国家，显微外科技术仍难以普及。学术文献中很少有关于在非洲大陆建立显微外科实践的报道，而且几乎没有关于撒哈拉以南非洲当地人员组成的团队进行游离皮瓣手术财务方面的描述。卡普索瓦尔医院是肯尼亚农村的一家医院，有两名获得美国整形外科委员会认证的整形外科和重建外科医生，最近扩大了临床实践，将显微外科手术纳入其中。
对2022年至2023年在卡普索瓦尔医院接受游离皮瓣手术的患者进行回顾性病历审查。记录的参数包括年龄、性别、相关病史、伤口病因、所做皮瓣、手术时间、并发症、手术修正以及住院时间。对所有接受游离皮瓣手术的国内患者的计费信息进行了审核，并计算了伤残调整生命年。
对17名患者进行了19例游离皮瓣手术。最常进行的皮瓣是股前外侧皮瓣（n = 11）。皮瓣存活率为94.7%。进行股前外侧皮瓣手术的成本为548美元±35美元。其他游离皮瓣手术的总成本为863美元±269美元。避免每一个伤残调整生命年的成本为121美元，这表明该手术具有很高的成本效益。
尽管存在障碍，但在资源有限的非洲地区仍可安全地建立显微外科实践。由当地团队进行游离皮瓣手术时，可以提高成本效益。外科医疗援助任务应强调教育内容，并最终将护理工作移交给当地外科医生。
