Kiran Nakarmi

Kiran Nakarmi
Kirtipur Hospital · Department of Burns, Plastic and Reconstructive Surgery

MS in General Surgery, MCh Plastic Surgery Fellowship in Plastic Surgery, Fellowship in Hand and Microsurgery

About

49
Publications
8,305
Reads
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142
Citations
Introduction
Head of Department. Department of Burns, Plastic and Reconstructive Surgery. Course coordinator, Hand and Microsurgery Fellowship. Director, ReSurge International Surgical Outreach Program Nepal
Additional affiliations
October 2018 - June 2021
Phect-NEPAL, Kirtipur Hospital
Position
  • Consultant
Description
  • Chief of the department Director, ReSurge International Surgical Outreach Program for Nepal Founding Life Member and General Secretary, Nepal Burn Foundation
Education
January 2013 - January 2016
April 2004 - March 2005
Liverpool Hospital
Field of study
  • Plastic surgery
July 2002 - July 2003
University of Utah
Field of study
  • Hand and Microsurgery

Publications

Publications (49)
Article
Full-text available
Background: Free tissue transfer is one of the most important and essential techniques in reconstructive surgery. The underlying complexity, steep learning curve, high cost, and fear of failure make it very difficult to establish as a regular service in developing countries such as Nepal. Methods: A retrospective cohort study design was used to...
Article
Full-text available
Thumb is very important for hand function. Many options are available to reconstruct injured thumb from simple dressing (pulp injury without bone exposure) to replantation and toe transfer (significant loss of thumb length). In chronic setting, where other fingers are intact, on-top plasty can be used to reconstruct injured thumb. In this study, a...
Article
Full-text available
IntroductIon: Most of the children in Nepal undergo palate repair at a later age than ideal and develop articulatory errors. Very few speech pathologists are available in the periphery where great majority of cleft children reside. ReSurge International Surgical Outreach Program-Nepal provides week-long speech therapy camps in peripheral sites for...
Article
Introduction Nepal is a low-income country where burn injury is a leading cause of preventable deaths and disabilities. A major burn center was established in 2013 to care for patients with acute injuries and reconstruction needs from local and from distant communities. We aimed to characterize the epidemiology of admissions and patterns of referra...
Article
It is known fact that adding adrenaline to local anesthetic gives many advantages but it is not practiced commonly in digital anaesthesia due to fear of ischemia due to resultant vasoconstriction. Total five cases were there. All patients received lignocaine with adrenaline in digital block. Recent literature and our findings both suggest use of ad...
Article
Full-text available
Burn injuries have decreased markedly in high-income counties while the incidence of burns remains high in Low- and Middle- Income Countries (LMICs) where over 90% of burns are thought to occur. However, the cause of burns in LMIC is poorly documented. The aim was to document the causes of severe burns and the changes over time. A cross-sectional s...
Article
Background: Speech therapy is important for ideal functional outcome after cleft palate surgery. Nationwide lockdown due to outbreak of COVID-19 in Nepal restricted the ability of patients to travel to nearby outreach centers for regular speech therapy. The objectives were to assess the feasibility and challenges of conducting online speech therap...
Article
Background Enterally based resuscitation for major burn injuries has been suggested as a simple, operationally superior, and effective resuscitation strategy for use in austere contexts. However, key information to support its implementation is lacking, including palatability and acceptability of widely available rehydration drinks. Methods We per...
Article
Introduction Protocolized burn resuscitation algorithms with hourly, closed loop feedback, have reduced instances of over- and under-resuscitation and improved outcomes in high income countries. However, a “know-do” gap exists as this practice has yet to be adopted in many low- and middle-income countries (LMIC). We aimed to describe the change man...
Article
Full-text available
Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objectiv...
Article
Full-text available
Surgical management of vaginal agenesis constitutes a significant technical challenge. The goal of vaginal reconstruction is to create a neovagina that is both functionally and aesthetically satisfactory using a simple and reliable technique applicable to most. Bilateral pudendal thigh flaps were used to reconstruct neovagina for a 13-y girl with c...
Article
Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally, but there are limited data on cooking behavior patterns to inform prevention and advocacy. Therefore, we aimed to describe the epidemiology, risk factors and outcomes of these injuries and highlight the potential of the World Health Organization (WHO)...
Article
Full-text available
Background Worldwide, different strategies have been chosen to face the COVID-19-patient surge, often affecting access to health care for other patients. This observational study aimed to investigate whether the standard of burn care changed globally during the pandemic, and whether country´s income, geographical location, COVID-19-transmission pat...
Article
Full-text available
Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objectiv...
Article
Full-text available
It's about the use of medical illustration by medical students in medical schools
Article
Full-text available
Introduction: The COVID 19 pandemic has adversely impacted all aspects of health care throughout the world. Burn care in lower and middle income countries has suffered the most. We aimed to compare burn care at Kirtipur Hospital before and during the pandemic and explore psychological issues and practice behaviour among burn care worker (BCW). Meth...
Article
Background: In Nepal's remote regions, challenging topography prevents patients with cleft lip and palate (CLP) from seeking care. Objective: To measure the effect of a mobile surgical scout program on CLP surgical care in remote regions of Nepal. Methods: Forty-four lay people were trained as mobile surgical scouts and over 5 months traversed remo...
Presentation
Full-text available
Access to burn care is very limited in Nepal due to difficult terrain and centralized location of tertiary burn care center. There is often delay in primary resuscitation due to this. This study proposes 3 or 5 burn stabilization centers outside Kathmandu to make primary burn care accessible to most of the people.
Article
In Nepal, preventable death and disability from burn injuries are common due to poor population-level spatial access to organized burn care. Most severe burns are referred to a single facility nationwide, often after suboptimal burn stabilization and/or significant care delay. Therefore, we aimed to identify existing first-level hospitals within Ne...
Article
Full-text available
Background: Plastic surgery varies in scope, especially in different settings. This study aimed to quantify the plastic surgery workforce in low-income countries (LICs), understand commonly treated conditions by plastic surgeons working in these settings, and assess the impact on reducing global disease burden. Methods: We queried national and i...
Article
Introduction Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally. A cookstove is any apparatus that provides heat and is used for cooking (e.g., three-stone fire, traditional or improved cookstove). There are limited data on patterns of cooking behaviors and CSBs to inform prevention initiatives and adv...
Article
Introduction The study country has a disproportionally high burn incidence rate compared to other low- and middle-income countries. Preventable death and disability are common due to poor population-level spatial access to organized burn care, including no organized system of ground or aeromedical transport. Currently, severe burns are referred to...
Article
Full-text available
Introduction The management of burns is costly and complex with inpatient burns accounting for a high proportion of the costs associated with burn care. We conducted a study to estimate the cost of inpatient burn management in Nepal. Our objectives were to identify the resource and cost components of the inpatient burn care pathways and to estimate...
Article
Full-text available
Background: This study assessed the lower limb reconstruction outcome so that it will provide a baseline evidence to enable data-driven decision making to improve outcome in the future. Methods: In this study, hospital records from 1st January to 31st December 2019 were collected retrospectively. Complete data of all patients' records treated fo...
Article
Full-text available
Introduction: Burn injury is an important cause of mortality and morbidity in children worldwide. Mortality is higher in developing countries than in developed ones. Most of them occur in predictable domestic settings and can be prevented. The objective of this study was to find out the prevalence of acute pediatric burns in a hospital setting. M...
Article
Full-text available
Introduction: Dental anomaly is one of the major problems in a child born with cleft lip and palate. These anomalies have deleterious effects on the dentition leading to aesthetic problems, impairment of mastication andimproper phonation. The aim of our study was to find out the prevalence of dental anomalies in patient with cleft lip and/or palate...
Article
Full-text available
Introduction: Dental anomaly is one of the major problems in a child born with cleft lip and palate. These anomalies have deleterious effects on the dentition leading to aesthetic problems, impairment of mastication andimproper phonation. The aim of our study was to find out the prevalence of dental anomalies in patient with cleft lip and/or palate...
Article
With a lot of uncertainty, unclear, and frequently changing management protocols, COVID-19 has significantly impacted the orthopaedic surgical practice during this pandemic crisis. Surgeons around the world needed closed introspection, contemplation, and prospective consensual recommendations for safe surgical practice and prevention of viral conta...
Article
Introduction Though access to surgical care for cleft lip/palate has expanded in low- and middle-income countries (LMICs), post-palatoplasty speech therapy is often lacking due to limited healthcare infrastructure and personnel. This mixed-methods study seeks to: 1) evaluate the impact of task-shifted speech therapy on a standardized speech score;...
Article
Full-text available
Introduction: Burn injury is an important cause of mortality and morbidity in children worldwide. Mortality is higher in developing countries than in developed ones. Most of them occur in predictable domestic settings and can be prevented. The objective of this study was to find out the prevalence of acute pediatric burns in a hospital setting.
Article
Full-text available
Background and Objectives: Patients with hand injuries and other conditions presenting to ER or office are usually given local anaesthesia to evaluate the case or perform a certain procedure. Lignocaine in various concentrations with or without adrenaline is used. Lignocaine with adrenaline is shown to be more acidic than plain lignocaine of simila...
Article
Full-text available
Background: Burn infections are the major causes of morbidity and mortality in burn patients. The infectious agent could be both Gram positive and Gram negative bacteria. The aim of this research was to study the bacteriological profile of burn patients and anti-microbial susceptibility pattern of their wound isolates. Methods: This cross-sectional...
Article
Full-text available
There is an evident need for Negative Pressure Wound Therapy (NPWT) systems specifically designed for use in resource-constrained settings to aid in the treatment of open wounds. Methods: Prospective single-arm interventional pilot study of 14 patients with complex wounds was conducted at Kirtipur Hospital in Kathmandu, Nepal. A novel NPWT device...
Article
Full-text available
In Nepal, burn is the third most common injury after falls and road traffic accidents. Infection is the leading cause of mortality in burn injury. A profile exploring predominant flora and antimicrobial sensitivity is important to facilitate treatment ahead of microbiology results and to aid prevention of multidrug-resistant organisms. The aim of t...
Poster
Full-text available
skin bank in Nepal
Article
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p> Background: There can be multiple hand problems with which patients can present. Such hand problems can be because of any kind of trauma, birth defects, tumours, infection or other conditions. Hand surgery is a special field of plastic surgery, which deals with these hand problems. The Department of Burns, Plastic & Reconstructive Surgery of Kir...
Presentation
Full-text available
It is about Nepalese experience on reconstructive surgery.
Article
Degloving injury involves shearing of the skin from the underlying tissue due to differential gliding in response to the tangential force applied to the surface of the body leading to disruption of all the blood vessels connected to skin. The flap of degloved skin has precarious blood supply making it almost impossible for the flap to survive. We d...
Article
Full-text available
Hand is a confined anatomical unit with different types of tissues. It translates to the fact that there are variety of tumors arising in this small area. Each tumor has unique presentation and different treatment modality. It is important to differentiate among them for proper management. This paper tries to present common types of tumors of hand...
Article
Full-text available
Background: Burn injury is a global health problem mainly occurring in developing countries. The Nepal Cleft and Burn Centre at Kirtipur Hospital, Kathmandu, has been providing the acute burn care since 2013 with 7 intensive care unit beds, 30 general beds, and 2 dedicated operating rooms. A similar descriptive study was performed in this center i...
Article
Full-text available
Background In Nepal, burn trauma causes more than 55,000 injuries each year. Burn-related mortality is high in Nepal, in part due to lack of allograft, leading to high infection rates. To address this challenge, our collaboration between Kirtipur Hospital, America Nepal Medical Foundation, Stanford University, and ReSurge International established...
Article
Full-text available
Objective: Telemedicine in outpatient burn care, particularly in burn scar management, may provide cost-effective care and comes highly rated by patients. However, an effective scar scale using both video and photographic elements has not been validated. The purpose of this study is to test the reliability of the Patient and Observer Scar Assessme...
Presentation
Full-text available
It is about briefing the US Congress about the impact of investment in global surgery.
Article
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we describe a case report of 27 year old male with progressive drooping of both upper eyelids for eight years, associated with inability to move eyes towards a particular direction. After thorough clinical evaluation, ocular investigations, various blood tests and cardiology evaluation, a diagnosis of Kearns-Sayre syndrome (KSS) was made. KSS is a...
Article
Full-text available
Nepal Cleft & Burn Center, Kirtipur Hospital, Kathmandu has been providing the acute burn care since 2013 with 10 ICU beds, 32 general beds and two operating rooms. This study analyses the demographics of and early outcome in the acute burn patients. This is a descriptive retrospective study of the clinical data of acute burn patients admitted from...
Article
Full-text available
Background: Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at Kathmandu Model Hospital in 2007 with the support from Interplast Australia and New Zealand. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free fla...
Article
Full-text available
Introduction: Timely repair of cleft lip and palate maximises the benefits of surgery. Developing countries have large number of adults with unrepaired clefts. The impact of a cleft program can be determined by observing the trends of lower age at surgery. Public Health Concern Trust, Nepal has been providing a comprehensive nationwide cleft servi...

Questions

Questions (3)
Question
Outcome of burns has improved in terms of saving lives but hands are often ignored leading to bad contracture deformities. I want to what has been done to look into this problem. Please help me with any research you all have done in this field. Thank you very much.
Question
What is the ideal age for speech assessment for the cleft children?
What are the measures of speech assessment that can be done in day to day practice?
How soon after cleft palate surgery should the speech assessment be done?
Question
I want to assess the nasality in two groups of children undergoing cleft palate surgery (2 different techniques) and compare the difference. Are there any simple ways of clinically assessing nasality?

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