Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb 4:20:19-26.
doi: 10.1016/j.jpra.2019.01.009. eCollection 2019 Jun.

Challenges in global reconstructive microsurgery: The sub-Saharan african surgeons' perspective

Chihena H Banda  1   2 , Pafitanis Georgios  3 , Mitsunaga Narushima  1 , Ryohei Ishiura  1 , Minami Fujita  1 , Jovic Goran  4
Affiliations

Challenges in global reconstructive microsurgery: The sub-Saharan african surgeons' perspective

Chihena H Banda et al. JPRAS Open. .

Abstract

Background: Microsurgery is an essential element of plastic surgery practice. However, it remains unavailable or rudimentary in several developing countries, especially in sub-Saharan Africa. This study presents the local plastic surgeons experience, while focusing on specific challenges encountered and methods to improve the sub-Saharan global microsurgery practice.

Methodology: An online survey was sent to all plastic surgeons registered with the College of Surgeons East Central and Southern Africa and respective national plastic surgical societies in the east central and southern Africa regional community. A total of 57 questionnaires were sent. Surgeons' country of practice, years of experience and rate of performing microsurgical procedures were considered.

Results: The survey response rate was 56% (n = 32). Most participants believed microsurgery was essential in the region. The leading challenge was inadequate perioperative care, mainly attributed to shortage of support staff (n = 29, 91%). Others were lack of surgical expertise and resources. Interestingly, public unawareness of the benefits of microsurgery was also noted as a critical hindrance. The foremost suggestion on improvement (n = 19, 59%) was to enhance training with a multidisciplinary team-building approach. Others included increased advocacy, publications and funding.

Conclusion: The Plastic surgeons' perspective recognizes the needs of Global Reconstructive Microsurgery in sub-Saharan Africa. However, inadequate perioperative care, insufficient expertise, lack of equipment and lack of public awareness were major hindrances. Finally, there is a need to improve microsurgery in the region through advocacy, training and multidisciplinary team building.

Keywords: Africa; Challenges; Free tissue transfer; Global surgery; Microsurgery; Training.

PubMed Disclaimer

Figures

Figure 1.
Figure 1
Participants by Country.
Figure 2.
Figure 2
Participants by Years of Experience.
Figure 3.
Figure 3
Number of Reconstructive Microsurgical Procedures Performed (5-Year Experience).
Figure 4.
Figure 4
Comparison of Opinions on Shortage of Surgical Expertise by Surgeon Level of Experience.
Figure 5.
Figure 5
Comparison of Opinions on Adequacy of Local Microsurgery Training by Country Group.
See this image and copyright information in PMC

References

    1. Kakarala K., Emerick S.K., Lin D.T., Rocco J.W., Deschler D.G. Free flap reconstruction in 1999 and 2009: changing case characteristics and outcomes. Laryngoscope. 2012;122(10):2160–2163. - PubMed
    1. Suh J.D., Sercarz J.A., Abemayor E. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Neck Surg. 2004;130(8):962–966. doi: 10.1001/archotol.130.8.962. - DOI - PubMed
    1. Nangole W.F., Khainga S., Aswani J., Kahoro L., Vilembwa A. Free flaps in a resource constrained environment: a five-year experience—outcomes and lessons learned. Plast Surg Int. 2015;2015:6. 194174. - PMC - PubMed
    1. Rodgers W., Lloyd T., Mizen K. Microvascular reconstruction of facial defects in settings where resources are limited. Br J Oral Maxillofac Surg. 2016;54(1):51–56. - PubMed
    1. Giessler G.A., Fieger A., Cornelius C.-P., Schmidt A.B. Microsurgical reconstruction of noma-related facial defects with folded free flaps: an overview of 31 cases. Ann Plast Surg. 2005;55(2) https://journals.lww.com/annalsplasticsurgery/Fulltext/2005/08000/Micros... - PubMed

LinkOut - more resources