Chuff cutter turns nightmare for top Kenya surgeons

The chuff cutter, a popular machine in local farms for shredding livestock feed (straw) has been cause for the most difficult surgeries in the country.

A review of limb re-implantation at the division of plastic and reconstructive surgery at Kenyatta National Hospital (KNH) shows many injuries are caused by the shredder. Almost all involving males.

“An interesting finding in our study was that more than 90 percent of patients were males. Other studies have shown male patients to be more prone to injuries leading to re-implantation than females,” says the new study.

The report is published this month (September2021) in the journal of Orthoplastic Surgery by a team of 10 top surgeons at the University of Nairobi, Kenya.

The division had received 21 patients with cut limbs (extremities) during the two year review period. Of these 12 patients were offered re-implantation as the treatment option.

These included 10 males and one woman. Among the men was a six-year-old boy, injured by a chuff cutter but successfully treated.

The woman, aged 39 had her left wrist crushed by a stone cutter but unfortunately was one of three re-implantation cases that failed.

About half of the injuries, five, had been caused by a chuff cutter and four by a sharp knife.

The team of Ferdinand Nangole, Stanley Khainga, Tom Mogire, John Paul Ogallo, Dorsi Jowi, Alex Wamalwa Okello, Martin Ajujo, Kenneth Aluora, Amanda Malunga and Francis Kenimak reports a 75 per cent success rate.

Of the 12 cases, nine were successful with only three failures, which literature shows to be an exceptional feat especially in a poor country.

“Our overall re-implantation success rate was 75 per cent with only three of the attempted 12 cases not successful,” wrote the surgeons.

One patient in the three failed cases, the doctors explain, had an infection three weeks after surgery and the arm could not be saved.

Of the remaining two patients, the amputated parts had not been stored properly which affected re-implantation hence the poor results, says the team. Some of the failed cases also had poor adherence to post surgery rehabilitation sessions.

Six of ten patients who had hand injuries, the report says, were able to return to original work with near normal sensory recovery and good movement.

Two patients were able to resume some sensible work with near complete sensibility and good muscle power. The remaining two patients were able to carry on daily life with partial recovery of sensibility.

“Our success rate compare favourably with others across the world but can be improved,” says the study.

The team says re-implantation is a major challenge especially in a resource poor country like Kenya. “But we have demonstrated it can be done successfully.”

“The most crucial factor in our experience was the determination and motivation of the surgical team to salvage the amputated extremity.”

Also crucial, the study says is massive availability of transfusion blood, big and highly trained team of varied experts and speed especially to transport the severed organ.

By Gatonye Gathura

The study is available here: https://doi.org/10.1016/j.orthop.2021.05.001

About Gatonye Gathura 142 Articles
Science Journalist

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