I was selected as the American Society for Reconstructive Microsurgery (ASRM) MicroSurgery Visiting Educator through ReSurge to Kirtipur Hospital, Kathmandu, Nepal. The local team requested a surgeon to help with surgeries for patients with brachial plexus and peripheral nerve injuries. My role will be to educate and mentor local surgeons to serve the community.
The local population does not have access to a surgeon who can perform complex brachial plexus and peripheral nerve reconstruction.
Impact should be seen throughout Kathmandu and Nepal. The aim is to educate the local physicians. ReSurge has a standing collaboration with Kirtipur Hospital
Surgical cases performed were complex and interesting. Good discussion was performed with the hosts about treatment options for brachial plexus injury and complex hand pathology. The local trainees and visiting surgeons found the discussion useful and asked many questions. No issues encountered with education and clinical care.
There were many successes from this trip. Complex surgeries were performed. Highlights included the following:
1) Brachial plexus exploration/ median nerve grafting/ bipolar latissimus flap for reconstruction of elbow flexion/ open reduction and internal fixation of humerus fracture
This was a complex multi-team procedure performed for reconstruction of a mangling injury of the upper extremity. We anticipate hopefully recovery of some wrist of finger flexion through the median nerve graft and elbow flexion through the bipolar latissimus flap.
2) Free functional reverse gracilis myocutaneous flap for reconstruction of elbow flexion.
This was a free functional muscle flap for reconstruction of elbow flexion in a patient with chronic brachial plexus injury after a previous failed pedicled bipolar latissimus dorsi flap for attempted reconstruction of elbow flexion. A recurrent complex flap of this sort would be a challenging endeavor even in a well-equipped tertiary center in the USA. The case went well and we anticipate recovery of elbow flexion in this patient.
3) Free superthin anterolateral thigh (ALT) flap for reconstruction of burn wound contractures in the hand.
Most centers in the USA do not perform superthin flaps, which allow a better like for like contour in reconstruction of extremity wounds. We were able to perform this complex free flap successfully in this patient, with additional attention to providing a good aesthetic outcome.
