AI Article Synopsis

  • Microsurgical free tissue transfer is critical for repairing significant bone or soft tissue injuries but is often seen as unfeasible in low- and middle-income countries due to the need for specialized training and resources.
  • A program in Cambodia, supported by non-governmental organizations, successfully performed 56 free flap surgeries from 2004 to 2023, training local surgeons while treating various reconstruction needs.
  • Despite facing a higher failure rate compared to high-income countries, the majority (83.3%) of patients showed improvement or complete resolution of their original issues, highlighting the potential for better outcomes with targeted solutions in low-resource settings.*

Article 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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http://dx.doi.org/10.1016/j.bjps.2024.08.073DOI Listing

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