Introduction

Department of Plastic surgery and burns is one of the specialized departments run in Tribhuvan University Teaching Hospital, Kathmandu. Plastic surgery and burns services were started in this hospital in 1998. Initially these services were provided through Plastic Surgery and Burns unit under the Department of Surgery. With regular service, academics and research the work load of the unit gradually increased and Department of Plastic Surgery was established in 2016. During these 23 years, it has progressed significantly in terms of manpower, academics and clinical services. At present, the department provides wide range of clinical services to patients with Burn, trauma, cancer and congenital problems. It also performs various complex reconstructive surgeries and cosmetic surgeries regularly.

Faculties and members

1. Prof Dr Ishwar Lohani
2. Prof Dr Jayan Man Shrestha, Head of Department
3. Dr Sangam Rayamajhi, Lecturer
4. Dr Samit Sharma, Lecturer
5. Dr Himalaya Niraula, Clinical registrar
6. Dr Bikesh Rajbhandari, Clinical registrar

The following are the MCh residents in Department of Plastic Surgery and Burns

1. Dr Rohan Pradhan, MCh 3^rd year resident
2. Dr Sushant Rai, MCh 3^rd year resident
3. Dr Anup Thapa, MCh 1^st year resident
4. Dr Sudeep Pandit, MCh 1^st year resident

Academic activities

 Under the Institute of Medicine (Tribhuvan University), the department had started MCh plastic surgery in 2010, and has produced 7 plastic surgeons since then, and 4 MCh plastic surgeons are currently enrolled in this program. Besides training to MCh residents, the department is contributing in the training program of MS General Surgery (of Maharajgunj Medical Campus and Patan Academy of Health Sciences) and MBBS.

Following academic activities are routinely conducted in the department.

1. Morning conference daily in the morning. 9.00 am to 9.30 am.
2. Topic presentation/ journal club presentation/ mortality and morbidity presentation by MCh 2^nd year, MCh 1^st year and MS residents. 9.30 am to 10.00 am. Wednesday and Friday.
3. Case presentation by MCh 3^rd year and MCh 2^nd 9.30 am to 10.00 am. Wednesday and Friday.
4. Bedside teaching and discussion to MCh and MS residents in round everyday
5. Bedside Teaching and discussion to MBBS 3^rd year and junior interns by MCh residents
6. Case presentation and discussion in Plastic surgery OPD

Hospital and Clinical Services

The department is one of the oldest centers of the country for the treatment of plastic surgery and burn cases. Plastic surgery and hand surgery cases are being managed in Plastic surgery ward in the 4^th floor of the main building of TUTH. There is a separate burn ward consisting of 9 beds for the treatment of burn patients. Besides commonly performed procedures like management of acute burn and hand injury, reconstructive procedures for trauma, malignant diseases and congenital conditions, the department is recently performing various complex surgeries regularly that include Brachial plexus surgeries, free flap surgeries for oral cavity cancers, mandibular defects and lower limb trauma.

The followings are the list of services provided by the department:

1. Acute burn management and burn reconstruction surgeries
2. Cleft lip, cleft palate and craniofacial surgeries
3. Facial plastic surgery including ear and nasal reconstructive surgeries
4. Breast reconstruction surgeries after breast cancer and congenital disease
5. Plastic reconstructive surgery for trauma, malignant diseases and congenital conditions
6. Microsurgery (Free flap operations)
7. Skin cancer management
8. Head and Neck cancer surgery and reconstruction including oral cavity and mandibular reconstruction
9. Facial paralysis surgeries
10. Hand Surgery – hand trauma, tendon surgeries, peripheral nerve surgeries, congenital hand anomalies treatment, replantation, pollicization, toe transfer
11. Brachial plexus surgery
12. Cosmetic Surgery – blepharoplasty, rhinoplasty, facelift, browlift, breast augmentation and reduction, abdominoplasty, liposuction, fat grafting.

The department runs 4 OPD days a week. It has 4 operation days in a week for elective cases and performs all kinds of plastic surgery and Hand surgery emergency cases 24 hours a day. The department is working together with other departments including orthopedic surgery, Neurosurgery, ENT, maxillofacial surgery, Gynecology etc. to provide plastic reconstructive surgery services in combined operations.

The department has started free treatment to cleft lip and cleft palate patients in collaboration with Smile train which is a cleft focused international organization that provides funding and resources for treatment of cleft patients. The patients get free surgery cost, free bed charge and food during their stay in hospital. Burn Victim Survivors is an international organization which is helping burn patients of TU Teaching hospital by providing medical and surgical support and, nutritional support.

Currently there are six plastic surgeons in the department with 2 Professors. The department has 2 units headed by each professor. Consultants in Unit I are Prof Dr Ishwar Lohani, Dr Sangam Rayamajhi, Dr Bikesh Rajbhandari / Dr Himalaya Niraula. Consultants in Unit II are Prof Dr Jayan Man Shrestha, Dr Samit Sharma, Dr Bikesh Rajbhandari / Dr Himalaya Niraula.

OPD Schedule:

Unit I: Dr Ishwar Lohani, Dr Sangam Rayamajhi, Dr Bikesh Rajbhandari / Dr Himalaya Niraula.

Unit II: Prof Dr Jayan Man Shrestha, Dr Samit Sharma, Dr Bikesh Rajbhandari / Dr Himalaya Niraula

Research activities :

Following articles have bee, published in 2021-2022

1) Sharma, S., Pokhrel, B., Rayamajhi, S., Shrestha, J. M., & Lohani, I. Split Thickness Skin Grafting With and Without Surgical Removal of Granulation Tissue in Granulating Wounds: A Single Blinded, Randomized Controlled Trial. Journal of Institute of Medicine Nepal. 2021; 43(2), 1–6.

2) Sharma, S, Pokhrel, B, Khadka, N, Rayamajhi, S, Man Shrestha, J, Lohani, I. A 63-kg giant neurofibroma in the right lower extremity and gluteal region of a 22-year-old woman: A case report. Clin Case Rep. 2021; 9:e04152. 

3) Rajbhandari B, Niraula H, Devkota M, Sharma S, Rayamajhi S, Shrestha JM, Lohani I. Our experience of scalp reconstruction in a tertiary care center of Nepal. Journal of Society of Surgeons of Nepal. 2021 Dec 31;24(2):46-50.

4)  Niraula H, Rajbhandari B, Devkota M, Sharma S, Rayamajhi S, Shrestha JM, Lohani I. Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal.Journal of Institute of Medicine Nepal ( JIOM). 2021Dec1;43(3).

5) Sharma, S, Rayamajhi, A, Chapagain, A, Shrestha, JM. Management of an extensive form of verrucous hemangioma with staged skin grafting: A case report. Clin Case Rep. 2022; 10:e06724.  

6) Sharma, S, Rayamajhi, A, Shrestha, JM. A lymphatic malformation with a “Lympholith” and encasing neurovascular structures in the arm of a 2-year-old child: A case report. Clin Case Rep. 2022; 10:e06608.

7) Gautam P,Gyawali S, Mainali P, Niraula H, Shrestha JM, Lohani I. Mangled right hand: A case report.International journal of surgery case reports.2022 Dec 23: 107846.

8) A 5 kg giant breast lipoma in a 40-year old woman. A case report. Samit Sharma, Aadesh Rayamajhi, Jayan Man Shrestha. (Awaiting publication).