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

Chihena H Banda; Pafitanis Georgios; Mitsunaga Narushima; Ryohei Ishiura; Minami Fujita; Jovic Goran

doi:10.1016/j.jpra.2019.01.009

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

JPRAS Open. 2019 Feb 4:20:19-26. doi: 10.1016/j.jpra.2019.01.009. eCollection 2019 Jun.

Authors

Chihena H Banda^{1

2}, Pafitanis Georgios³, Mitsunaga Narushima¹, Ryohei Ishiura¹, Minami Fujita¹, Jovic Goran⁴

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan.
² Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia.
³ Group for Academic Plastic Surgery, The Royal London Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK.
⁴ Department of Surgery, The University Teaching Hospital, Lusaka, Zambia.

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.