title: Microsurgical free flaps at Kathmandu Model Hospital.
abstract: BACKGROUND
  Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at Kathmandu Model Hospital in 2007 with the support from Interplast Australia and New Zealand. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal.
  
  
  METHODS
  A retrospective cross sectional study was conducted using the clinical records of all the microsurgical free flaps performed at Kathmandu Model Hospital from April 2007 to April 2014.
  
  
  RESULTS
  Fifty-six free flaps were performed. The commonest indication was neoplasm followed by post-burn contracture, infection and trauma. Radial artery forearm flap was the commonest flap followed by fibula, antero-lateral thigh, rectus, tensor facia lata, lattisimus dorsi, deep inferior epigastric artery perforator, and deep circumflex iliac artery flap. Radial artery forearm flaps and anterolateral thigh flaps were mostly used for burn contracture reconstructions. Twelve of the 13 (92%) fibulae were used for mandibular reconstruction for oral cancer and ameloblastoma. Rectus flaps were used mainly for covering defects over tibia. Hospital stay ranged from six to 67 days with an average of fourteen. Fifteen patients (26%) developed complications. The duration of operation ranged from six hours to 10.5 hours with an average of nine hours. The longest follow up was for four years.
  
  
  CONCLUSIONS
  Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team.
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: S M
authors.initials: SM
authors.lastname: Rai
authors.affiliation: Royal Melbourne and St. Vincents Hospitals, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Grinsell
authors.affiliation: Coastal Plastic Surgery Center, Melbourne, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Hunter-Smith
authors.affiliation: University of Melbourne, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Corlett
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: K
authors.initials: K
authors.lastname: Nakarmi
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: S J
authors.initials: SJ
authors.lastname: Basnet
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: P
authors.initials: P
authors.lastname: Shakya
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: K
authors.initials: K
authors.lastname: Nagarkoti
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Ghartimagar
authors.affiliation: Department of Burns, Plastic and Reconstructive Surgery, Kathmandu Model Hospital, Exhibition Road, Kathmandu, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Karki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000601:surgery; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005360:Fibula; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D009390:Nepal / Q000453:epidemiology; D061646:Operative Time; D017534:Radial Artery; D012189:Retrospective Studies; D013848:Thigh; D055815:Young Adult