Is reimplantation surgery an option in resource constrained countries?

Abstract

Re-implantation of a severed body part is a demanding procedure that requires consolidated surgical efforts. Many factors influence the outcome, amongst them being availability of re-implantation team and necessary support structure. There is paucity of data on the management and outcome of the severed extremities in many resource constrained settings especially in Africa. To determine clinical presentation and outcomes of patients offered re-implantation after cut extremities. We carried out a prospective cohort study of patients presenting with cut extremities managed by re-implantation in our center between January2018 and December 2019. Variables determined included anatomical locations, ischemic time, length of surgery, grafts utilized and outcome. A total of 11 patients with 12 cut extremities requiring re-implantation were managed at Kenyatta National Hospital during the period of our study. The age range was six to forty five years. Majority were male [11] with only one female. Most injuries involved the upper limb (11 patients) with one the lower limb. The mean ischemia time was 13.3 h. Ten patients required venous or arterial grafts during the surgery. The overall success rate was 71% for the re-implantations. The functional recovery varied from fair to good in all the patients whose limbs were saved. Re-implantation surgery is a viable option in many countries with limited resources. Determinants of success rate include multidisciplinary team approach as well as motivation and necessary experience in microsurgery. Post-operative follow up is critical for functional outcome. • Male patients more affected that female. • Mean ischemic time of more than 12 h. • More than 80% required vascular grafts. • Overall reimplantations success of greater than 70%. • -multidisciplinary approach with plastic and orthopaedic surgeons is critical.