BURNS, PLASTIC AND RECONSTRUCTION SURGERY DEPARTMENT IN KIRUDDU NATIONAL REFERRAL HOSPITAL. PREAMBLE

Burns, Plastic and Reconstructive Surgery Department currently in Kiruddu National Referral Hospital is the only established National Burns and Plastic Surgery centre in Uganda. The Department is located on the fourth floor of Kiruddu Hospital main building in Buziga along Salaama road. It was set up in 2003 to support Mulago Hospital complex in its efforts to respond to an Identified need in specialised Burn care, Plastic and Reconstructive Surgery and re-located to Kiruddu Hospital in 2016 to enable the renovation of Mulago Hospital.

Since then, the Burns and Plastic Surgery Unit has made tremendous strides in the treatment and management of burn injuries and Plastic Surgery cases not only in Uganda but as far as East and Central Africa. The Unit collaborates with super specialized units of Mulago Hospital Complex like Uganda Cancer Institute, General Surgery, Neurosurgery, Pediatric Surgery, Orthopedic surgery, among others to offer holistic health care to meet patients and client’s needs. We are the Centre of reference for breast and reconstructive surgery in Uganda.

The outlook of the Department

Staffing

The department has several staff of various medical qualifications that include 5 Consultant Plastic Surgeons, 5 Fellow Plastic surgeons, 3 Medical Officers, 4 Medical Clinical Officers, 18 Nurses, 5 Anesthetists, 4 Theatre Assistants, 1 Dispenser, 2 Nutritionists, 1 Physiotherapist, 1 Occupation Therapist, one Records Assistant, 2 Cooks.

Fig. 1: Some of the Burns and Plastic Surgery department staff

The Burns and Plastic Surgery Department comprises an Intensive Care Unit (ICU) which handles critically ill and extensively burnt patients with a 14-bed capacity, a Plastic Surgery Ward with 16 admission beds taking care of in-patient plastic surgery cases, a Burns ward aka Holland with 22 admission beds for patients with severe or extensive burn injury that need admission and close monitoring. The department also has an Out-patient Unit for patients with minor cases that can be seen as they commute from home, there is a theatre with two operating rooms for all surgical operations, a physiotherapy and occupational therapy unit, a pharmacy with essential drugs, a drug and sundries store, a library/study/conference room and finally a kitchen that prepares specialized meals necessary to facilitate burn wound healing.

BURNS THEATRE

Fig. 2: Part of the theatre staff operating on a Burns patient in one of the theatre rooms

Fig. 3: OPD recently partitioned to create an admission dressing room, a consultation room and a nurses’ changing room

ICU

Fig. 4: One of our staff attending to severely burnt patients in one of the two ICU rooms

The objectives of the department:

1. To contribute to the reduction of morbidity and mortality from burns injuries in Uganda in order for individuals to attain full productivity, and reduce on foreign exchange expenditure incurred in treatments abroad.

2. To introduce methods of treatment which will decrease the level of disabilities and deformities resulting from burns, injuries and congenital birth defects.

3. To provide optimal medical and surgical treatment, care, and rehabilitation of Burns patients and plastic surgically correctable afflictions to all patients that need it.

4. To educate and train Health professionals in the best practices of treatment, care, reconstructive surgery and rehabilitation of patients with burns and related afflictions.

5. To train nursing staff in the various levels of health care in the country in burns and wounds management and prevention.

6. To develop treatment protocols for Burns and Reconstructive Surgery. 7. To develop and disseminate Educational programmes on Prevention, and first Aid

care of burn injuries 8. 8. To carry out Burn injury prevention campaigns all over the country to reduce

on the incidences of Burn.

SURGICAL CONDITIONS HANDLED IN THE DEPARTMENT

We handle all Burn injuries that may have been caused by flames, hot liquids, chemicals like Acids and Bases, electricity and/or lightening, radiation, etc through the Burns Unit.

Fig. 5: Shows a patient who recovered from severe flame burns

Before After

We also handle a wide range of Plastic Surgery conditions among which are listed below;

• Craniofacial anomalies 1. Cleft lip and Palate

Fig. 6: A baby with cleft lip had his lip repaired.

2. Hemangioma 3. Vascular malformation

• Wounds/ulcers 1. Vascular ulcers 2. Diabetic ulcers 3. Sickle cell disease ulcers 4. Necrotising fasciitis 5. Buruli ulcer, Tuberculus ulcer 6. Tropical ulcers

• Tumors 1. Breast tumors both Benign and Malignant 2. Squamous and Basal cell carcinomas 3. Melanomas 4. Rhabdomyosarcoma 5. Dermatofibrosarcomas 6. Neurofibromas 7. Marjolin’s ulcer

• Congenital deformities 1. Syndactly, Polydactly, Camptodactly 2. Hypospadius 3. Epispadius 4. Vaginal Atresia i.e imperforate hymen, vaginal hypoplasia and vaginal

septum • Other deformities

1. Post Burn Contractures 2. Duputyrens Contracture

• Hand Surgery • Aesthetic Surgery

1. Rhinoplasty (Nose Job) 2. Breast Aesthetics

• Breast Augmentation • Breast Reduction • Mastopexy • Breast Augmentation with Fat Injection • Gynaecomatsia

Fig. 5: A man with Gynaecomatsia had breast reduction and reconstruction successfully done to correct the excessively grown developed breast

Before After

3. Abdominal Aesthetics • Tummy Tuck

Before After

• Mini Abdominoplasty • Lipoabdominoplasty

4. Face Aesthetics • Profiloplasty • Aesthetic Eyelid Surgery • Prominent Ear Surgery • Fat Injection to the face • Lip Augmentation

• Permanent Lip Augmentation • Genioplasty – Chin Augmentation • Brow lift and Forehead lift • Face lift with sutures • Face lift • Neck lift

5. Body Aesthetics • Post Bariatric Surgery • Genital Aesthetics • Liposuction • Buttock Aesthetics

Buttock Augmentation Buttock Lift (without implants) Buttock lift (with implants)

• Arm/Thigh Lift

ACHIEVEMENTS IN 2019-2020

ü Our fellowship program has expanded to attracting people from East and Central Africa including countries like Zimbabwe, Tanzania, DR Congo, Ethiopia, Rwanda. We currently have 5 Fellows specializing in Plastic Surgery.

ü Two successful surgical camps were conducted in November and December ü We acquired new surgical instruments and equipment like an Electric

dermatome, and a patient monitoring equipment. ü Extension of wall oxygen and suction devices in all the wards ü Part of the waiting area was partitioned into an In-patient dressing room, nurses’

changing room and an Out-patient clinic.

Electric Dermatome (left) and a Battery Dermatome (Right) used to harvest split thickness skin to cover granulated wounds.

Electric Dermatome Battery Dermatome