Bio

Publications


2015

Mutiso, VM, Khainga SO, AS Muoki, Kimeu MM.  2015.  Epidemiology of Burns in Patients Aged 0-13 Years at a Paediatric Hospital in Kenya. East and Central African Journal of Surgery. 19(3):12-21.
JI Adungo, Mutispo VM, Ngugi M, Khainga S, A Mouki, Kimeu M.  2015.  Analysis of Soft Tissue Injuries and Scarring Following Terrorist Bomb Explosion at the American Embassy in Nairobi, Kenya. East and Central African Journal of Surgery. Website
M Hussein, CKMAY, A Ruturi, Nangole FW, Khainga SO, Khainga SO.  2015.  Dual omental flap in obliterating post-pneumonectomy bronchopleural fistulae. KMA. Abstract

Background: Post-pneumonectomy bronchopleural fistulae is associated with high mortality and morbidity. The omental flap has been widely used to manage this condition either through laparoscopic or open surgery with varied degrees of success. We present a modification of the omental flap by using two flaps of the omentum in obliterating the bronchopleural fistulae. Objective: To evaluate the effectiveness of dual omental flap in obliteration of postpneumonectomy bronchopleural fistulae Design: A prospective clinical study. Setting: The cardiothoracic unit at the Kenyatta National Hospital between January 2010 and December 2013 . Subjects: Five patients with post-pneumonectomy bronchopleural fistulae managed in a period of four years. Results: Pneumonectomy were due to cancer of the lungs in two patients and tuberculosis in three patients. All the patients had previously attempted repair with a pleural patch without success. Dual omental flap was utilised to repair the fistulae. All patients had successful repair of the fistula and no recurrence was noted at one year of follow up. Conclusion: Dual omental flap offers an alternative technique in obliterating postpneumonectomy fistula. The two flap technique allows for one flap to completely seal the fistula while the second flap provides an additional airtight closure over the first flap and hence prevents any leakages. This ensures higher success rate with few recurrences.

Nangole, WF, Khainga S, Aswani J, Kahoro L, Vilembwa A.  2015.  Free Flaps in a Resource Constrained Environment: A Five-Year Experience-Outcomes and Lessons Learned., 2015. Plastic surgery international. 2015:194174. Abstract

Introduction. Free flap surgery is a routine procedure in many developed countries with good surgical outcomes. In many developing countries, however, these services are not available. In this paper, we audit free flaps done in a resource constrained hospital in Kenya. Objective. This is a five-year audit of free flaps done in a tertiary hospital in Kenya, between 2009 and 2014. Materials and Methods. This was a prospective study of patients operated on with free flaps between 2009 and 2014. Results. A total of one hundred and thirty-two free flaps in one hundred and twenty patients were performed during the five-year duration. The age range was eight to seventy-two years with a mean of 47.2. All the flaps were done under loupe magnification. The overall flap success rate was eighty-nine percent. Conclusion. Despite the many limitations, free flaps in our setup were successful in the majority of patients operated on. Flap salvage was noted to be low due to infrequent flap monitoring as well as unavailability of theatre space. One therefore has to be meticulous during surgery to reduce any possibilities of reexploration.

2014

Nangole, F, Biribwa P, Khainga S.  2014.  Pedicled anterior lateral thigh flap in managing a bilateral groin contracture., 2014. Case reports in surgery. 2014:451356. Abstract

A fifteen-year-old female patient presented with a severe bilateral groin contracture for the last 8 years. She had sustained burns at the age of seven years. Three attempts to release the contracture with split thickness skin grafts had been done without success. A pedicled anterior lateral thigh flap was raised and advanced into the defect after the contracture had been released. Postoperatively the patient healed well without any complications and was able to achieve hip abduction of about 130 degrees.

Nangole, FW, Khainga SO.  2014.  FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis., 2014. Plastic surgery international. 2014:276058. Abstract

Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx.

2013

Gisore, JO, Khainga SO.  2013.  NEGATIVE PRESSURE WOUND THERAPY (NPWT) FOR THE MANAGEMENT OF LAPAROSTOMY WOUNDS: CASE SERIES., 2013 Dec. East African medical journal. 90(12):409-12. Abstract

Laparostomy or the open abdomen can be a lifesaving intervention in surgical emergencies for abdominal compartment syndrome, wound dehiscence, trauma and intra-abdominal sepsis. However, the open abdomen imposes a significant burden on nursing staff caring for these critically ill patients due to the large volume of exudate and fluid loss.To achieve mechanical containment of abdominal viscera and active removal of exudate, we used NPWT to manage five patients with complex intra-abdominal sepsis laparostomy wounds. It took between 12 to 28 days to achieve full granulation for secondary closure of the wounds. The series shows that in the management of laparostomy wounds, NPWT provides an easier way to manage the large volumes of exudates and reduces the frequency of dressings changes required with traditional wound dressings.

Khainga, SO, Wasike RW, Biribwa PK.  2013.  Reduction mammoplasty using inferior pedicle in heavy breasts (macromastia). Abstract

Symptoms associated with heavy breasts are pain in the upper part of the body; back pains, poor body posture and headache. These patients also have difficulties in finding suitable clothes and experience poor self image and problems such as establishing sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia. In all the patients except three, good results were achieved. One patient suffered nipple necrosis of the right breast and the other two had superficial wound infection of T-junction and were appropriately treated. The patient who lost the nipples had nipple reconstruction three months later.

Nangole, FW, Khainga SO.  2013.  Retrospective Review of Patients Operated on with Bilateral Cleft Lip through Surgical Outreaches in Kenya. Abstract

This was a study to evaluate the characteristics and outcome of patients operated on with bilateral cleft lip through surgical outreach programs in Kenya between January 2006 and December 2011. Files for fifty-nine patients operated on during the study period were evaluated. The mean age for surgery was ten months with about forty-five percent of the patients more than one year of age. No presurgical orthopaedic devices were utilized on any of the patients. Mulliken surgical technique and the Manchester technique were the commonest surgical techniques in equal proportions. An overall complication rate of about 7.5 percent was noted. In conclusion we noted a delay in the surgical management of the majority of our patients. This resulted in a backlog of cases. There is thus a need to intensify more surgical outreach camps as well as training more surgeons to assist in the management of clefts. Cleft surgery is a relatively safe surgery that could be carried out in relatively remote centers through surgical outreach programs. This was evidenced by the low complication rates in our series.

2012

Ondieki, JG, Khainga SO, Owilla F, Nangole FW.  2012.  OUTCOME OF FOAM VERSUS GAUZE DRESSINGS IN NEGATIVE PRESSURE WOUND THERAPY FOR THE MANAGEMENT OF ACUTE TRAUMATIC WOUNDS WITH SOFT TISSUE LOSS AT KENYATTA NATIONAL HOSPITAL., 2012 Jul. East African medical journal. 89(7):230-40. Abstract

Wounds have provided a challenge to the clinicians for centuries and this scenario persists to the 21st century. Negative pressure wound therapy (NPWT) is one of the latest additions in wound management. It has been widely adopted in developed countries with foam as the default wound dressing although it has some limitations.

2011

Werunga, KP, Khainga SO, Musau P, Emarah M, Lumarai L.  2011.  Use of combined paracetamol and low dose ketamine in pain control during change of dressings in burn patients. Abstract

To determine the effectiveness of Paracetamol and low dose Ketamine in controlling burn pain during dressings. Setting: The burns ward of Moi Teaching and Referral Hospital, a 750 bed capacity tertiary centre in Western Kenya. Subjects: Consenting patients were recruited to the study on admission. Babies and minors had consent given by their parents or guardians. Results: Of the Fifty nine patients who were recruited into the study, seventy percent of them were children. Male to Female ratio was 1.2:1. There was statistically significant change in the pain score on both FLACC and VAS (both p<0.001) after the introduction of low dose Ketamine with Paracetamol. The patients and healthcare providers were satisfied with the new mode of pain management during change of dressings for burn wounds. Conclusion: The use of oral Paracetamol combined with the low dose intravenous Ketamine, is effective in controlling burn pains during change of dressings. It is a safe and cheap alternative, that can be applied in remote and resource limited medical facilities.

SO Khainga, RK Tenge, PWK.  2011.  Restoration of Anal Sphincter Tone by Graciloplasty: A Report of Five Cases . East African Medical Journal. 88(1) AbstractWebsite

Stool incontinence can be as a result of congenital or acquired anal sphincter problems. It is a devastating state for a patient not to be able to control stools resulting into continued feacal soiling. It reduces an individual to a dejected and depressed person who becomes a social misfit. Hence any procedure that can alleviate this state is normally highly appreciated. Various techniques have been quoted in literature and use of gracilis muscle to form a neosphincter is one of them. Dynamic graciloplasty, is a technique whereby electrodes have been implanted into gracilis muscle and is connected to an implantable pulse generator which provides progressive levels of stimulation to convert the fast twitch, fatigue prone muscle fibres to a slow twitch, fatigue resistant firbres over eight week training period (1,2,3). This has shown improved efficacy over the static graciloplasty (3). In this case report, five patients with stool incontinence from different aetiologies are presented, all having been managed by static graciloplasty and intense physiotherapy with good outcomes reported.

Wanjala, N, Khainga S.  2011.  An Outreach Experience With Cleft Lip/Palate Surgery in selected Hospitals in Kenya. Annals of African Surgery . 7 Abstract

Objective
To describe the presentation and surgical care of patients managed for cleft lips and palates during a surgical outreach program..
Study design
A five year retrospective chart study of the patients operated on between January 2005 to the 31st December 2009 in selected hospitals in Kenya.
Setting
Smile train-facilitated surgical outreach programs at the following hospitals: St Elizabeth Mission Hospital Mukumu, St Francis Mission Hospital, Mwiki, Embu Provincial General hospital , Isiolo District Hospital.and Alupe Subdistrict Hospital.
Subjects
One hundred and sixty three patients with cleft lips and palates.
Results
The male female ratio was 1.3 to 1. Left unilateral cleft lip was the most common malformation (34.6% of the patients) with modified Millards repair the most frequent surgical procedure. More than 30% of the patients operated on had attained their fifth birthday. There were eight complications for every 100 procedures. Palatal fistulae were the most common complications.
Conclusion
The overall pattern of deformity encountered and the morbidity profile correlate with other studies. There is need to intensify more outreach programs to capture younger patients and address the backlog of cleft cases in the community.

2009

Nangole, FW, Khainga SO, Kiboi J.  2009.  Pressure ulcers presentations and management at Kenyatta National Hospital and Spinal Injury Hospital. Abstract

To determine the presentation and management of patients with pressure ulcers. Design: A prospective study. Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital (NSIH). Subjects: One hundred and thirteen patients were evaluated. Ninety six patients from KNH and seventeen from NSIH. Patients admitted at Kenyatta National Hospital and National Spinal Injury Hospital with pressure ulcers during the study period. Results: Of the 113 patients, 77 (68.1%) were male and 36 (31.9%) were female. Mean age of the patients studied was 38.1 years while the range was between 12 and 74 years. Paraplegia was the main associated medical condition accounting for 35.4%, followed by HIV/AIDS with 27.4%. The most common anatomical site for pressure ulcers was tronchanteric region with 43% of the ulcers. Pressure ulcers of grade III and IV accounted for 66.4% of the ulcers. Two hourly turning was the most common method of pressure dispersion used. Gauze dressing was the most common method used in wound care while 67.3% of the patients had their wounds cleaned with povidoneiodine. Fasciocutaneous flaps were the most common surgical procedure performed (81.7%) for closure of pressure ulcers. Overall, 59.3% of surgical procedures had been successful at one month. This was, however, reduced to 48.1% at three months. Conclusion: Majority of patients with pressure ulcers were in a relatively young age group with a mean age of 38 years. Most of the ulcers were located along bony prominence points of the pelvic girdle and the proximal femur. Most of the ulcers in this study were treated conservatively, with only a few ulcers subjected to surgical interventions. For the ulcers treated with surgical interventions the early outcome was good, however studies need to be done to determine long term outcomes.

2008

Kaisha, WO, Khainga S.  2008.  Causes and pattern of unilateral hand injuries., 2008 Mar. East African medical journal. 85(3):123-8. Abstract

To assess the causes and pattern of hand injuries in patients with isolated unilateral acute hand injuries managed at the Kenyatta National Hospital (KNH).

2007

Khainga, SO.  2007.  "Graciloplasty" in treatment of recurrent complete rectal prolapse: case report., 2007 Aug. East African medical journal. 84(8):398-400. Abstract

Gracilis muscle flap was used to treat a seven year old boy with a one year history of recurrent rectal prolapse. Initial perineal surgery in form of Thiersch stitch resulted into failure to control rectal prolapse and damage to anal sphincter. Graciloplasty corrected both problems.

Khainga, SO, Githae B, Mutiso VM, Wasike R.  2007.  Reverse sural island flap in coverage of defects lower third of leg: a series of nine cases. Abstract

The distally based sural island flap was first described by Masquelet, et al., in 1992. It is a skin island flap supplied by the vascular axis of the sural nerve. The aim of this paper is to demonstrate that it can be applied in coverage of difficult wound in the lower third of the leg. We treated nine patients with nine distally based sural island flaps. All the flaps survived, most of the flaps had venous congestion. The largest flap was 10 x 8 cm and Doppler was used in only one flap. This technique is easy and quick to execute without sacrificing major arteries.

Khainga, KA.  2007.  The diagnostic role of ultrasonography in patients with thyroid gland enlargement at Kenyatta National Hospital, Nairobi, Kenya (E. Africa).. Abstract

Background
/\ prospective cross section study was carried out at the Department or Diagnostic
Imaging and Radiation Medicine of the University of Nairobi, the X-ray Department of
Kenyatta National Hospital (KNH), the Thyroid Clinic [TC] of KNll and the Department
of Pathology. University of Nairobi.
During the study in a period spannmg SIX months, 70 patients presenting with
goiter at KNH thyroid clinic and sent for ultrasound evaluation, were recruited into the
investigation using purposeful sampling technique. Demographic data was gathered for
each case before ultrasonography being carried out on the thyroid gland using real time
and Doppler modes in axial [transverse] and longitudinal [sagittal] planes. The
sonographic features of each thyroid nodule studied were size, internal consistency,
echogenicity relative to adjacent tissue. vascularity at CFI, margination and presence of
calcification and a sonoluscent peripheral halo.
lesions then underwent FNA for cytology or excision biopsy lor histology to
rule out malignancy. Data collection was done using a presorted questionnaire filled by
the researcher. It was analyzed by SPSS computer software and results presented in form
tables, charts and graphs.
Results: ()2.R(/'i) or patients with thyroid enlargement were female. The male: female
ratio was found to he I: I). The age range or patients with thyroid enlargement varied
from 18 to 77yrs. Goiter was most noticeable' in the 4th through to ih decades [from 21
to GO years J with 75% or the patients in this study falling in this age range.
The rate ofmalignancy in this study is 2.9(10 having registered only two cases.
The findings indicate that there exists a relationship between the cytological status and
the age 01' the patients, internal consistency. outline/margin, presence or the peripheral
halo. vascularity and presence of calcifications. There was no signi Iicant relationship
established between the cytological findings and the variables gender. number of nodules
and echogenicity.

W Kaisha, KS.  2007.  Hand injury: association of handedness with cause and site of injury. Annals of African Surgery. 1 Abstract

BACKGROUND: Most people have a dominant hand: right or left. The dominant hand for most purposes is that which is used for writing. The performance, reflex activity and exposure of
these hands differ. Due to this asymmetry, it is possible that handedness may influence the likely causes, the lateralization and pattern of injury.
OBJECTIVE: This study was designed to assess the association of hand dominance to the causes, lateralization and pattern of hand injuries.
SETTING: Kenyatta National Hospital, a national referral and teaching hospital in Nairobi, Kenya.
METHODOLOGY: A prospective analysis of consecutive patients who presented with unilateral hand injuries between May and
August 2006 at (KNH) was done. Data on hand dominance, hand injured, causes and pattern of injury were collected using a questionnaire. Associations were investigated using student’s
t-test and Chi square tests, with level of significance taken as < 0.05. Yates correction and Fischer’s exact tests were used where the cell value was less than 5.
RESULTS: A total of 99 patients with hand injuries were recruited. Ninety four were right handed, three left handed, with two ambidextrous. The dominant hand was injured
in 47 (48.5%), while the non-dominant hand was injured in 51.5% of the cases (p = 0.27). The most common causes of injury were occupational (31.3%) and assaults (30.3%).
Falls on the hand caused injury more on the dominant hand (p=0.03) than the non-dominant one. Hand dominance had no influence on the other causes, nor did it have influence on the
lateralization and pattern of injury.
CONCLUSION: With the exception of falls, hand dominance has no influence on causes, lateralization and pattern of hand injury.

2006

Khainga, SO.  2006.  Extended pedicle rectus abdominis myocutaneous flap for groin reconstruction: case report., 2006 Oct. East African medical journal. 83(10):575-9. Abstract

Reconstruction of left groin defect following a failed left femoral aneurysm bypass procedure. The defect was occasioned by excision of a saccular aneurysm of left femoral artery, and repair with PTFE graft for an ilio femoral bypass. On the second postoperative day, the wound became septic and the graft extruded with a resultant wound defect of about 20 x 10 cm. The graft was later removed and wound coverage achieved by an extended contralateral pedicled rectus abdominis myocutaneous flap.

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