Developing Orthoplastic Capacity for Soft-tissue Defects via Short-term Training: A Case Series in Samburu County, Kenya

Background: Orthopedic surgeons frequently encounter soft-tissue defects in the management of extremity trauma. Timely soft-tissue coverage is essential to minimize infection, avoid osteomyelitis, and reduce the risk of amputation. In many low- and middle-income countries, the collaborative effort between orthopedic and plastic surgeons is impractical due to a shortage of plastic and reconstructive surgeons. This study presents a retrospective case series of lower extremity soft-tissue flap reconstruction in an austere environment. Methods: The case series included 15 consecutive cases of 13 patients who underwent lower extremity soft-tissue flap procedures between 2018 and 2024. These flaps were performed by a single orthopedic surgeon following participation in a short-term soft-tissue coverage training course. Demographics, injury mechanism, Gustilo-Anderson classification, wound size, flap type, fixation method, follow-up duration, time to wound healing and bony union, functional outcomes, and postoperative complications were collected. Results: The most frequent indication for flap coverage was Gustilo-Anderson type IIIB open tibia fractures, which accounted for 43.8% of cases, followed by postoperative wound breakdown with exposed orthopedic hardware. The reverse sural artery flap was the most common flap type, performed on 37.5% of cases, followed by transposition flaps (25%) and gastrocnemius muscle flaps (18.6%). The overall flap success rate was 86.7%. Conclusions: The results demonstrate the importance of hands-on surgical training courses and reinforce the value of orthoplastic skill-building as a scalable and sustainable approach to addressing the gap in reconstructive care in austere environments.