Building a sustainable free flap program in a resource-limited setting: A 12-year humanitarian effort

BackgroundWe present a sustainable complex reconstructive program built through 12 years of surgical outreach work at Kijabe Hospital in Kenya.MethodsRetrospective chart review and anecdotal experiences.ResultsIn 2011, surgeons from a US-medical center performed Kijabe Hospital's first 3 successful free flap surgeries. Since then, they have returned 7 times, performing a total of 31 tumor excisions with microvascular reconstruction. One flap failure occurred that was reconstructed on a subsequent trip. In 2013, a US-trained missionary surgeon and a Kenyan-trained general surgeon began working with the visiting team with the goal of performing these surgeries independently. In 2016 they performed their first independent free flap reconstruction and have since performed 32 independent cases with only three flap losses. Establishing infrastructure, staff education, selective patient criteria, and continuous communication are the factors that enabled the success of this program.ConclusionsEstablishing a successful microvascular reconstruction program in a resource-limited setting is feasible.