Browsing by Author "Devkota, Manish"
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Publication Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal(Institute of Medicine, 2021) Niraula, Himalaya; Rajbhandari, Bikesh; Devkota, Manish; Sharma, Samit; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Lower limb defects are caused by trauma, chronic ulcers or oncological resection. Being a large and varied area of the body, lower limb reconstruction is challenging. This study analyzed clinical presentation of such defects, surgical management and outcomes in Nepalese context. Methods: Single-center retrospective study of flap reconstruction of lower limb defects conducted in Tribhuvan University Teaching Hospital, Kathmandu over a two years period (April 2019-March 2021). Demographics, clinical presentation, comorbidities, treatment and complications were recorded and analyzed. Results: A total of 53 flaps were performed on 47 patients with 50 defects (35 males and 12 females). Road traffic accidents (38.3%) and pressure ulcers (17.02%) were common causes. Ankle-foot was the most affected site (48%), followed by leg and thigh (18% each). Defect size ranged from 3 cm2 to 396 cm2. Surgery consisted of 46 pedicled and seven free flaps. Reverse sural artery flap was the commonest flap performed (30.2%). All free flaps were performed on defects larger than 100cm2. Overall complication rate was 30.2%, partial flap loss being the commonest (15.1%). Total flap loss occurred in one pedicled and one free flap. Eleven pressure ulcers were operated on, with 36.4% complication rate. Average hospital stay was 33.5±26.88 days. Conclusion: Multiple surgeries, comorbidities and high complication rates with hospital stay of more than a month reflect the difficulties encountered in lower limb reconstruction. Despite these challenges, majority of our patients were discharged with stable wound coverage. Keywords: Lower limb reconstruction, pressure ulcers, reverse sural artery flapPublication Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal(Institute of Medicine, 2020) Devkota, Manish; Sharma, Samit; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, IshwarABSTRACT Introduction: Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal. Methods: This is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018. Results: Out of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%. Conclusion: Adult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries. Keywords: Acute burn, burn injury, burn outcome, epidemiology