Development of reconstructive surgery services in the Gaza Strip, Palestine.

Plastic surgery involves the restoration, alteration or reconstruction of the human body. It includes reconstructive and aesthetic surgery. This paper discusses the authors' experience introducing new reconstructive, microsurgical and aesthetic surgeries in the Gaza Strip. We analyzed 192 cases of reconstruction carried out in the Al-Alamy Burns Center in Al-Shifa Hospital from August 2017 to July 2018 and at the European Gaza Hospital during a one-month delegation, as well as 38 aesthetic surgeries performed in the author's private clinic. We highlight challenges hindering the development of reconstructive and plastic practices in the Gaza Strip and propose solutions. Plastic surgeries have greatly evolved at Al-Shifa Hospital. Despite obstacles limiting the development of reconstructive surgery, we were able to treat complicated cases requiring microsurgical procedures. In one year we performed 192 reconstructive surgeries, in addition to 38 hair transplants. Overall success rate was 97.8%, with five failed flaps documented. Wound infection was the main cause of failure. However, the failed flaps were repaired by various approaches. The hair transplant patients went home the same day with no complications. Plastic surgeries have improved significantly and staff competencies have increased with frequent exposure to different cases. Moreover, the physicians' skills and knowledge have been imbedded in practice following the educational development of the authors. Establishing specialized training programs in plastic and reconstructive surgery is crucial to enhancing and reinforcing the physicians' skills and knowledge and guaranteeing high quality care.