One of a kind: Meet the only trained Reconstructive Microsurgery Surgeon in Kenya

Dr. Alex Okello is a Plastic, Aesthetic and Reconstructive Microsurgeon based at Kenyatta National Hospital. But guess what? He is the first and only fellowship-trained Reconstructive Microsurgeon in Kenya – Just one in a population of more than 50 million. He attained this stature following the completion of the International Fellowship in Microsurgery at Uppsala University Hospital, Sweden in February of this year. What a feat! He took time off his busy schedule for an interview with Newsline. Excerpts… What is microsurgery? Reconstructive microsurgery is a surgical discipline in which specialized operating microscopes and precision instrumentation are used to repair intricate structures such as blood vessels and nerves less than a few millimeters in diameter.

This field has made a major impact to restore form and function to individuals impaired by trauma, developmental abnormalities, birth defects, cancer, and congenital anomalies.

Microsurgery is a tool used by many plastic surgeons to perform specific procedures, including transferring tissue from one part of the body to another (free tissue transfer), reattachment of severed parts (replantation), and composite tissue transplantation.

For example; Microsurgery can be used to take tissue from the thigh or trunk to reconstruct a breast, reattach amputated fingers, repair or transfer nerves, or perform complex surgery of the head and neck region (reconstruction of ears, noses, mouth, tongue, and scalp); limb reconstruction (hands, fingers, toes, soft tissue repair that facilitates immediate/ early bone fracture fixation) and other small body parts.

What made you venture into this field?

This was after the successful hand re-implantation we did for Joseph Theuri a boy who had been accidentally severed by a chaff cutter machine here at KNH. I was involved with the team that did that first surgery. So, from there I kept thinking, for us it was the first one, but they have been doing this routinely for the rest of the world.

This made me want to gain more knowledge and skills on how to make such procedures a routine here in our hospital and in the country at large.

Fast forward; I went for training/ fellowship and in February this year I was certified by the Uppsala university hospital & Uppsala university. I then submitted my credentials to the World Society of Reconstructive Microsurgery (WSRM) and after evaluation, they confirmed me, and I became a member of the association.” How is microsurgery done?

Microsurgical procedures represent a wide range of highly individualized operations. The reconstruction is typically reserved for complex reconstructive surgery problems when other options (primary closure, skin grafting, local or regional flap transfer) are inadequate.

Tiny blood vessels and nerves are carefully dissected at the recipient site. Once a suitable donor site is selected, tissue can be isolated on its unique blood supply. The tissue is then disconnected from the body, and blood vessels are reattached at the recipient site using an operating microscope.

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Dr. Alex Okello during certificate presentation upon completion of the fellowship in Uppsala University, Sweden

“Microsurgery is a tool used by many plastic surgeons to perform specific procedures, including transferring tissue from one part of the body to another (free tissue transfer), reattachment of severed parts (replantation), and composite tissue transplantation.”

There are various procedures in microsurgery but the most common ones include; - Breast reconstruction - using free tissue transfer; For a free flap reconstruction surgery, your surgeon disconnects the tissue from your donor site and attaches it to the tissues near your chest. - Head and neck reconstruction using free tissue transfer; is typically performed to address aesthetic and functional abnormalities of the face, skull, jaws, and ears. - Vascularized bone flap transfer; is a joint-preserving procedure for early or middle-stage osteonecrosis of the femoral head in younger patients that removes the necrotic bone of the femoral head and restores the blood supply and provides new bone and mechanical support for the femoral head. - Complex wound reconstruction; is an orthopedic surgery performed to substantially repair a bone, joint, or prosthesis that is failing and significantly impacting the quality of life of an individual. - Nerve repair and grafting; Nerve grafts are generally portions of a sensory nerve that are harvested from another part of the body to be used as graft material. - Lymphatic reconstruction; is a procedure to rebuild damaged lymphatic vessels. This can help lymphatic fluid drain from an area.

ILR can lower your chance of getting lymphedema.

According to Dr. Okello, reconstructive plastic surgery is done to correct facial and body abnormalities caused by birth defects, injury, disease, or aging. Usually, the goal of reconstructive plastic surgery is to improve body function.

“More significantly is that we can do these procedures now in babies where they are required. This means that we can use a microscope and pinpoint even the tiniest parts of their bodies. If possible, we find some tissues around the baby, then we can reconstruct that particular area”, added Dr. Okello.

“When you start reading about what the world is doing, you get the sense as a country we are far behind in terms of what we providing the patient yet we have the largest population that requires this procedure.

“We were able to do the first free flap breast reconstruction here at KNH, which was very encouraging. I am currently involved in various multidisciplinary teams where we are able to discuss all available options with the patients and be able to provide these services to them. We actually have patients in line, as we speak, for breast reconstruction and complex mandibular reconstruction.

“It’s a field that works with everyone and can provide a lot when it is supported. It requires a lot of reorganization and dedication and people knowing that even in the end, it’s not always over. In Africa, Kenyatta National Hospital has the opportunity to be the first to set up a unit dedicated to reconstructive microsurgery which will open doors to numerous opportunities”, Dr Alex concluded.

Dr. Alex Okello and colleagues during a micro surgery procedure at Uppsala University

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Dr. Alex Okello and Colleague from Uppsala University in Sweden

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Dr. Alex Okello’s Journey

• Dr. Alex is the first and only trained plastic surgeon in reconstructive microsurgery in Kenya. He attained this after completing the International Fellowship in Microsurgery at Uppsala University Hospital, Sweden in February 2022.

• Dr. Alex attained his medical degree from the Moi University, School of Medicine, Kenya, completed a plastic surgery residency at the University of Nairobi, School of Medicine, Kenya and is a Fellow (Plastic Surgery) of College of Surgeons (ECSA)

• He is also an Associate Editor with the Annals of African Surgery.

• He joined KNH six years ago as Medical Officer (MO) in the Accident and Emergency before transitioning to the department of specialized surgery specifically plastic and reconstructive surgery for three years now.