title: Reconstruction of Punitive Ear Amputations in Uganda: A Unique Surgical Burden of Disease.
abstract: Over the course of 12 months, a plastic surgical team from Paris, France, undertook 2 intensive ear reconstruction missions with plastic surgeons from the CoRSU Rehabilitation Hospital in Uganda. A cohort of over 30 adult women was assessed having been subjected to ear amputations by members of the Lords Resistance Army in Northern Uganda in the 1990s. The patients were identified, mobilized, and transferred to Kampala for surgery by a charitable arm of the Watoto Church, known as Living Hope. The surgical team performed 15 ear reconstruction cases during the first 1-week mission and 16 ear reconstruction cases during the second 1-week mission. All cases were reconstructed successfully using the 2-stage autologous auricular reconstruction method advocated by the senior author (FF). Local skin was used to cover the costal cartilage framework in the first stage without need for temporo-parietal fascial flaps. Technical challenges included the older age of patients and ossified costal cartilage, high prevalence of HIV positivity, bilateral amputation, and difficulty of surgical follow-up. The main modifications to standard practice were routine pre-op testing of the costal cartilage, pre-op viral load and CD4 count screening in HIV-positive patients, simultaneous bilateral first-stage ear reconstruction, prolonged hospital stay, and implementation of routine surgical counting procedures.
authors.affiliation: *Royal Australasian College of Surgeons, Sydney, Australia †CoRSU Rehabilitation Hospital, Kampala, Uganda ‡Yale University School of Medicine, New York, NY §Hôpital Européen Georges Pompidou ||Clinique Bizet, Paris, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Dusseldorp
authors.forename: Andrew
authors.initials: A
authors.lastname: Hodges
authors.forename: Anup
authors.initials: A
authors.lastname: Patel
authors.forename: Alexandre
authors.initials: A
authors.lastname: Marchac
authors.forename: Françoise
authors.initials: F
authors.lastname: Firmin
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D066186:Costal Cartilage / Q000637:transplantation*; D004425:Ear Cartilage / Q000293:injuries / Q000601:surgery*; D004431:Ear, External / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D014454:Uganda; D055815:Young Adult