ARTICLES

THE NEED OF PLASTIC SURGERY HOSPITAL IN NEPAL

Plastic and Reconstructive Surgery is known very little to the Nepalese People as well as to the Nepalese Medical community although there is a tremendous need of this service in the country. The people who can be benefit from this type of surgery are very poor and these people can’t reach to the limited service available in the country till now. There is a vital need of the burn and plastic surgery centre which can serve the people.

People are dying of simple Burn. The poor people from the rural villages are affected much more due to Open Fire. Open fire is used in the villages for cooking as well as heating the house during winter. Small Children suffer much due to the negligence. Children are left alone by the mother while cooking and likely to get burn. Even in developing cities inside the country there is an emerging problem of acute burn due to urbanization with the wide use of kerosene and cooking gas. There is not any centre to care for those victims till now in Nepal. Acute burns need a special care and treatment with the team of professionals in a well set up centre.

Similarly disfigurement due to Post Burn is giving much psychological trauma to both the patients and their family. To treat such conditions by the family means extra financial burden for which the patient might be left alone without treatment.  Post Burn Contractures are major problems to those who survive severe burn. There is a great impairment of the function as well. Release of such contractures can help them to live their lives with a great function.

Defective Wounds also pose a great challenge to the medical personnel. There are multiple factors for the cause of the wounds. The defective wounds can be acute due to trauma which may be from the road traffic accident or from fall injuries. It may be chronic most commonly due to infections. It varies from simple cut wounds to big Bed Sore Defects. Many people are suffering from huge bed sores either due to paraplegia with spinal injury or due to chronic bedridden from various medical problems in the hospital. Closure of the bed sore is not possible with the simple means. It can only be closed with the construction of various flaps. The patients with bed sores are both neglected from their family and from the society. There is a great need of such centre to take care of them-to treat their surgical problems and to rehabilitate them so that they can be back to their normal wheel chair life. The next step to uplift their lives is to get them involve in the jobs.

Cleft Lip and Cleft Palate fall into another big heading in Plastic Surgery.  Many people are born with the cleft lip and cleft palate in Nepal. There are various organizations working in the management of these patients which are still not enough. The closure of the lip and palate is not only enough but a long term follow up for their proper function is very essential. For example, speech therapy after the closure of cleft palate, dental treatment etc. There are still a lot of people in rural Nepal who are not able to get the services. We can even see very old people with the untreated cleft lip and palate in the villages.

A lot numbers of Cancer patients are not getting proper treatment for their big Defective Wound. The need of proper Plastic and Reconstructive Surgical services is obvious in this area. Removal of huge tumor from the body is sometimes challenging which may always need reconstructive surgery for the closure of the secondary defects. Treatment of such tumor occupies a big space in Plastic Surgery.

Simple Skin Grafting of the open wounds can save the life of many and can decrease the morbidity. The closure of the various Open Wounds due to emerging serious Road Traffic Accident with the fasciocutaneous, muscle and musculocutaneous Flaps of Plastic Surgery Technique is changing the conservative and traditional approach of other Surgical Technique with the excellent Functional and Aesthetic results.

The lack of awareness of the people about the disease and deformity which can be treated, the poor socio-economic status, the difficult access, limited service motivate us to establish the  PLASTIC SURGERY hospital in the country.

BHIM BAHADUR’S STORY

Bhim Bahadur Khadka, 25yrs old is a nice family man happily living with his family in western Nepal.  Like many other young nepali man he decided to work in Dubai to earn more money to help his family and to support his daughter’s education. He had  worked in Dubai for several years and send money to his family on and off. Unfortunately one day he fell down from the roof while working in the construction site. He got the fracture of his cervical vertebra (C6) and became quadriplegic. The primary operation with the anterior fusion of the vertebra has done.

Bhim Bahadur returned back to Nepal and admitted to one of the hospitals in Kathmandu. He developed fourth degree pressure ulcer in the sacral region meaning by that there is a big defect in the sacral area with the exposure of the sacral bone and presence of infection with the discharge of pus.
The patient was admitted in Nepal Plastic Surgery Hospital. Patient’s general conditions were improved. Regular positioning of the patient was done by the hospital’s staffs and also by the family member. Psychological support from the hospital staffs and also by his wife and other family members  makes his stay at ease in the hospital.

With the regular dressing wounds become much clean. Repeated debridement was done. The wound was closed with Bilateral V-Y Advancement Gluteal Muscle Flap.

The overall condition of the patient was improved and with some rehabilitation the patient was discharged from the hospital. Mr Bhim Bahadur was returned back home safely.

Many Nepalese are leaving the country to find the job elsewhere because of the less job opportunity inside the country due to disturbed political situations. There are many young Nepalese people who sustained injuries while working in countries like India, Dubai, Malaysia, Qatar, Saudi Arabia and so on. Many youngsters became paralysed and lost their jobs and returned back home.  Paraplegic patients can easily develop pressure sores. Pressure sores are more common in Sacral, Trochanteric and Ischiatic area. Prevention is always better than cure. It applies to pressure sore also. Regular positioning of the patient can easily prevent the bed sore to occur. The pressure ulcer is treated with the regular dressing, debridement and closure of the wounds with the Flaps.