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

Banda, Chihena H.; Pafitanis, Georgios; Narushima, Mitsunaga; Ishiura, Ryohei; Fujita, M.; Jovic, Goran

doi:10.1016/j.jpra.2019.01.009

Cited by 31 publications

(40 citation statements)

References 11 publications

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“…Huge abdominal defects, more than 150 cm 2 have traditionally been covered by free flaps [ 3 , 5 ]. Commonly used free flaps have been anterior lateral thigh flap and latissimus dorsi muscle flap.…”

Section: Discussionmentioning

confidence: 99%

“…Commonly used free flaps have been anterior lateral thigh flap and latissimus dorsi muscle flap. However, free flaps may not be available in many settings [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Local and regional flaps have traditionally been limited to smaller defects. Bigger defects have been managed by free flaps [ 4 , 5 ]. However, free flaps are not universally available [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Bigger defects have been managed by free flaps [ 4 , 5 ]. However, free flaps are not universally available [ 5 ]. They are technically demanding, require long operative hours and are prone to complications leading to flap failures.…”

Section: Introductionmentioning

confidence: 99%

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Local/regional flaps for extensive abdominal wall defects: Case series

Wanjala

Dan

2020

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…Commonly used free flaps have been anterior lateral thigh flap and latissimus dorsi muscle flap. However, free flaps may not be available in many settings [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Local/regional flaps for extensive abdominal wall defects: Case series

Wanjala

Dan

2020

International Journal of Surgery Case Reports

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“…Even further, free flap surgeries are not universally available at many centers in the middle and developing countries without such services. 10 Paraumbilical perforator flaps are raised on the perforators of the deep inferior epigastric vessels. The perforator is located two to three centimetres lateral to the umbilicus.…”

Section: Discussionmentioning

confidence: 99%

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction

Shahryari

Seyedoshohadaee

Rafii

et al. 2020

wjps

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BACKGROUND Complex defects of the forearm and arm are best reconstructed with free flaps. Free flaps are however not universally available. They require long operative time and may be contraindicated in patients with extensive injuries due to a lack of good recipient vessels. The alternatives to free flaps are distant flaps such as groin flaps, random abdominal flaps, thoracoepigastric flaps and paraumbilical perforator flaps. These are axial flaps that are limited by the angiosomes supplied by a given perforator or blood vessel. To improve the extent and reliabilities of the paraumbilical flaps, we incorporated two perforators in the flap. METHODS A total of 17 patients with extensive forearm defects were managed by two vessel paraumbilical perforator flaps between January 2013 and December 2018. The perforators were identified by a hand-held Doppler and the flap was fashioned with the perforators at the base. RESULTS The mean length of the flap raised was 19.5 cm and width was 8.3 cm. The median age was 39 years. All the flaps were successful with no incidence of flap necrosis and no dehiscence. CONCLUSION Two vessel perforator flaps improved the reliability of the paraumbilical perforator flap, allowing for a bigger flap to be harvested and thus ensuring a cover of larger defects. The flaps were easy to raise and were easily tolerated by the patients.

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Achieving microsurgery missions in Kenya—a 6-year experience of a non-governmental organization

et al. 2021

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Background Microsurgery has enormously expanded the possibilities of reconstructive plastic surgery in the modern era. However, there is a vast difference in its spreading and utilization between developed and developing countries. Microsurgery missions can play a significant role in the evolution of reconstructive microsurgery in developing countries. We present our 6-year experience in a rural hospital in Kenya. Methods The humanitarian missions consisted of 19 consecutive visits to North Kinangop Catholic Hospital (Kenya) between 2014 and 2020. Every mission team consisted of a plastic surgery specialist with more than 10 years of experience and a final-year plastic surgery resident. All missions were organized and coordinated by a nonprofit organization alongside the Clinic of Plastic and Reconstructive Surgery of the University of Padova, Italy. Results During all missions, our plastic surgery teams evaluated a total of 749 patients, performed a total of 595 outpatient visits, and gave a total of 83 inpatient consultations. Among all surgical procedures performed, 17 were microsurgeries: six free flaps, one hand replantation, and ten propeller flaps. We experienced few complications and a success rate of 82%. Conclusions Our 6-year experience demonstrates that it is possible to safely carry out microsurgery procedures with local staff help and coordination. We believe that our missions are a real practical example of how foreign expertise can make local surgery evolve to perform safe microsurgery, even in a low-experience setting such as that of most developing countries. The education of local staff is crucial for the outcome of such missions. Level of Evidence: Level IV, risk / prognostic study Keywords Microsurgery • Free tissue flaps • Medical mission • Nonprofit organization • Eastern Africa

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

Cited by 31 publications

References 11 publications

Local/regional flaps for extensive abdominal wall defects: Case series

Local/regional flaps for extensive abdominal wall defects: Case series

Two Perforators Improve the Extent and Reliability of Paraumbilical Flaps for Upper Limb Reconstruction

Achieving microsurgery missions in Kenya—a 6-year experience of a non-governmental organization

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