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Microsurgery in low- and middle-income countries: Results of 20 years of experience in Cambodia.
Lupon, Elise; Chaput, Benoît; Kim, Yong-June; Pogn, Sopheap; Andre, Aymeric; Lauwers, Frédéric.
Afiliación
  • Lupon E; Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France; Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical Schoo
  • Chaput B; Department of Plastic Surgery, University Toulouse III Paul Sabatier, Toulouse, France.
  • Kim YJ; Department of Surgery, Children's Surgical Centre, Phnom Penh, Cambodia.
  • Pogn S; Department of Surgery, Children's Surgical Centre, Phnom Penh, Cambodia.
  • Andre A; Clinique MEDIPOLE Garonne, Toulouse, France.
  • Lauwers F; Plastic and Maxillo-Facial Surgery Department, University Hospital Center of Toulouse, Toulouse, France.
J Plast Reconstr Aesthet Surg ; 98: 161-169, 2024 Nov.
Article en En | MEDLINE | ID: mdl-39260035
ABSTRACT

BACKGROUND:

Microsurgical free tissue transfer is the gold standard for reconstructing major bone or soft tissue defects but requires complex training, and specific resources. Therefore, some authors have stated that microsurgery is impossible in low- and middle-income countries.

METHODS:

Patients from Khmer underwent free flap surgery at the Children's Surgical Centre in Phnom Penh between 2004 and 2023. Two non-governmental organizations facilitated the program Rose Charities Cambodia provided the facilities, patients and local staff, and Doctors of the World provided the surgeons, and anesthetists. At least one Khmer surgeon was trained during these operations. Digital data were collected retrospectively, and analyzed in June 2023.

RESULTS:

Fifty-six free flaps in 54 patients have been performed since 2004. The most frequent sites requiring reconstruction were the head and neck (35.7%), lower limbs (30.4%), and upper limbs (21.4%). The most frequent free flaps were free fibula (44.6%), gracilis (19.6%), and anterolateral thigh (16.1%). Among the 56 flaps, 41 (= 73.2%) were viable long-term and 15 (26.7%) were microsurgical failures. Sixteen flaps underwent revision in the operating room. Twenty-three flap-related complications were reported in 21 patients with mostly vascular thrombosis (n = 12), hematoma (n = 3) and infections (3). However, 83.3% had improved or were cured of their initial pathology after final surgical management.

CONCLUSIONS:

Free flaps performed in our series as part of international surgical collaborations in a low-income country are feasible, but we experienced higher failure rates, and later revisions compared to the results in high-income countries. We identified several solutions to improve the microsurgery outcomes in low-income settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos de Cirugía Plástica / Países en Desarrollo / Colgajos Tisulares Libres / Microcirugia Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: J Plast Reconstr Aesthet Surg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimientos de Cirugía Plástica / Países en Desarrollo / Colgajos Tisulares Libres / Microcirugia Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: J Plast Reconstr Aesthet Surg Año: 2024 Tipo del documento: Article Pais de publicación: Países Bajos