Plastic and Reconstructive Surgery Global Open最新文献

Background: Plastic surgery is a fairly new discipline in Kenya; like other surgical disciplines, it has experienced years of neglect. The surgical burden of disease that can be addressed by plastic surgeons is extensive, but it requires a systematic approach to sustainably address it.

Methods: The authors reviewed data on the number of plastic surgeons and their distribution across the country. The projected county populations were used to calculate the ratio of plastic surgeons to the population served.

Results: With a population of 53 million and 41 plastic surgeons, 1 plastic surgeon serves 1.3 million Kenyans. However, only 16 counties have at least 1 plastic surgeon; the majority are to be found in the cities of Nairobi, Mombasa, and Eldoret; 28 million Kenyans live in counties without a plastic surgeon.

Conclusions: Plastic surgery in Kenya needs international collaboration to grow. Research, training, and sustainable healthcare financing were identified as the primary drivers of equitable access to plastic surgery in Kenya.

Background: Despite the rapid evolution of plastic and reconstructive surgery in India, access to these services remains inaccessible to large portions of the population. A variety of cultural, socioeconomic, and geographic factors persist as barriers to equitable surgical access. Although free governmental healthcare is available through national insurance programs, use remains low, leaving many families to bear the financial burden of out-of-pocket costs when medical care becomes necessary.

Methods: To understand and address these issues, this article reviewed the current deficits and potential solutions to increase plastic and reconstructive surgery access and delivery in India.

Results: Current challenges include an imbalanced surgeon distribution, limited infrastructure outside large urban areas, and inadequate incentives to promote a service-oriented practice in light of the lifestyle and compensation advantages associated with aesthetic plastic surgery. Strategies such as the increased adoption of emerging technology, international partnerships, and telemedicine show promise in expanding surgical access to underserved areas. Additionally, improving the use of public insurance programs by increasing trust in national healthcare, adjusting workforce distribution, and leveraging global partnerships may improve reconstructive access.

Conclusions: Addressing inequities in plastic surgery delivery within India requires a multifaceted approach. The strategies explored in this article aim to strengthen local healthcare systems, expand reconstructive access in rural regions, and enhance surgical training across India.

Background: Peru, an upper-middle-income country with approximately 500 plastic surgeons, equivalent to approximately 1.5 plastic surgeons per 100,000 population, faces substantial gaps in reconstructive surgical care. Critical areas of unmet need include congenital anomalies, burn care, trauma management, and postoncological reconstruction.

Methods: This perspective analysis draws upon the experiences of 2 plastic surgeons working within the Peruvian healthcare system in Arequipa and Lima, combined with a review of relevant literature on reconstructive surgery in Latin America.

Results: Key challenges for reconstructive surgery in Peru include a fragmented healthcare system, disparities between rural and urban areas, and a growing focus on cosmetic procedures driven by higher financial returns and medical tourism. Domestic strategies to address these gaps include increasing government funding, advocating for the inclusion of reconstructive surgery in national health insurance schemes, and promoting specialization in reconstructive surgery through improved residency programs and government incentives. International solutions emphasize sustainable collaborations with nonprofits and nongovernmental organizations that use diagonal service delivery models and low-cost, reproducible training opportunities that prioritize knowledge transfer, capacity building, and alignment with national health priorities, guided by principles of equity, respect, and the empowerment of local professionals.

Conclusions: Peru must address gaps in reconstructive surgery through improved training, government incentives, and professional recognition, supported by sustainable international collaborations. These efforts can build local capacity, rebalance plastic surgery toward national health needs, and reduce disparities in access to essential surgical care.

Background: Uganda, an East African country with a population of approximately 46 million, has 72.62% of its people living in rural areas. Plastic and reconstructive surgery was historically delivered by visiting surgical teams, which, although impactful, faced limitations in follow-up and patient reach. Uganda has only 22 trained local plastic surgeons, mostly in urban private practice. Few work in public hospitals, limiting access to reconstructive care for the country's largely rural population.

Methods: A cross-sectional survey of 35 participants (plastic surgeons and trainees) was conducted using self-administered questionnaires across teaching and nonteaching hospitals in Uganda. The study examines the current gaps in reconstructive surgical care and possible solutions specific to Uganda.

Results: Among 17 practicing surgeons, most were men (76.5%) and based in urban areas (94.1%). Nearly half (41.2%) had 6-10 years of posttraining experience, and all (100%) reported a mixed reconstructive and aesthetic practice. There is a high reconstructive burden due to acute burn and burn complications, congenital anomalies, road traffic accidents, commonly from commercial motorcycles known as boda bodas, and an increasing rate of cancer. Despite the small number of surgeons and their desire to train more, a whole 53% are working in nonteaching hospitals. Of the 18 senior plastic surgery residents, 72.2% were men, with the majority in their fourth year of training.

Conclusions: Establishing training hubs and implementing retention strategies for plastic surgeons, while strengthening regional hospital infrastructure, is essential for improving equitable access to quality plastic surgical care in Uganda.

Background: Ethiopia, the second-most populous country in Africa, faces a growing demand for plastic and reconstructive surgery amid significant limitations in infrastructure, workforce, and healthcare financing. This article outlines the historical development of the specialty, key areas of need, and systemic barriers, while also exploring how global partnerships and advocacy can address these disparities. Input from local and visiting surgeons emphasizes opportunities for collaborative learning and durable capacity building.

Methods: The authors reviewed both scientific and gray literature to examine key themes addressed in the miniseries.

Results: Ethiopia has a severe shortage of plastic and reconstructive surgeons, with services largely confined to urban centers and limited access for rural populations. Inadequate workforce capacity, infrastructure, training, and financing restrict the delivery of complex reconstructive care, although international partnerships have begun to support early capacity building.

Conclusions: Plastic and reconstructive surgery in Ethiopia faces significant unmet needs that require investment in infrastructure, workforce development, and research. Equitable international partnerships and sustained advocacy are crucial for enhancing access, training, and surgical outcomes.

Background: Ghana is a low- and middle-income country, and providing universal health coverage for its population of more than 30 million is a significant challenge. The predominantly rural population lacks access to essential reconstructive surgery services. In urban areas, where reconstructive services are available, they are not affordable for most patients.

Methods: This article identified the challenges faced by plastic surgeons in Ghana and proposed potential solutions.

Results: Ghana's National Health Insurance Scheme, although a significant step toward universal health coverage, does not cover the cost of most essential reconstructive procedures. This places a significant financial burden on patients and their families, often leading to delayed or foregone treatments. The number of plastic surgeons in Ghana is small and is disproportionately located in Accra and Kumasi, 2 of the biggest cities. The lack of financial compensation models to encourage plastic surgeons to provide reconstructive services in rural settings means that most plastic surgeons will continue to be based in urban areas, where opportunities to engage in financially rewarding cosmetic procedures exist. The infrastructural and logistical challenges also deter plastic surgeons from leaving urban centers, as most regional and district hospitals are not equipped for reconstructive services.

Conclusions: Challenges affecting essential reconstructive services in Ghana include the uneven distribution of plastic surgeons and the lack of effective financial compensation models. Potential solutions include the need for a more equitable distribution of plastic surgeons, the development of financial compensation models for rural service, and the enhancement of regional hospital infrastructure.

Background: Vietnam's plastic surgery landscape is evolving amid rapid development and persistent systemic challenges. Major disparities in reconstructive care arise from limited infrastructure, an insufficient number of trained specialists, and unequal access between urban and rural regions.

Methods: This article drew on insights from Vietnamese plastic and reconstructive surgeons to examine the country's current reconstructive capacity and barriers to care.

Results: Although Vietnam has 3 institutions with accredited plastic surgery residency programs and additional master's tracks for plastic surgery training, the workforce remains inadequate to meet demand. More than 65% of the population lives in rural provinces with minimal access to reconstructive services, whereas surgical services are concentrated in Hanoi and Ho Chi Minh City. High-volume needs include burns, oncological reconstruction, and congenital anomalies such as cleft lip and palate. Systemic barriers further constrain surgical capacity, including insufficient infrastructure, scarce surgical materials, and a lack of multidisciplinary support. Financial incentives and disparities in work conditions also reduce the availability of reconstructive services in the public sector.

Conclusions: Although international partnerships and short-term missions have bolstered training in advanced techniques, their long-term impact is limited without sustainable collaboration. Scalable, locally adaptable solutions, including government-sponsored rural incentives, expanding training opportunities, virtual education platforms, and train-the-trainer models, are urgently needed. Coordinated investment in education, infrastructure, and policy reform could enable Vietnam to deliver equitable, life-changing reconstructive care that restores function, dignity, and quality of life nationwide.

Background: In sub-Saharan Africa (SSA), there is a significant burden of surgical disease that necessitates expanded plastic surgery (PS) training and infrastructure. There has been no recent comprehensive comparison of the available training programs and regional disparities in training opportunities.

Methods: The websites of PS training paradigms were reviewed, and information regarding program requirements and structure was obtained. Data were supplemented by contributions from current and past PS trainees.

Results: Surgical care within SSA is organized through (1) the College of Surgeons of East, Central, and Southern Africa (COSECSA), through which 14 accredited PS programs in 19 countries serve 38.8% of the SSA population; (2) the West African College of Surgeons, through which 32 accredited PS programs in 15 countries serve 41.2% of the population; (3) the Colleges of Medicine of South Africa, through which 9 accredited PS programs serve 4.9% of the population. The Master of Medicine PS training program in Kenya serves 4.5% of the population. Examinations taken for certification include a preresidency, a general surgery assessment, and a final examination at the end of residency. In 2022, 14 PS trainees were certified through COSECSA, and 5 were certified through the West African College of Surgeons. Both Master of Medicine and COSECSA trainees can sit for the certifying examination administered by COSECSA.

Conclusions: PS training prerequisites, curriculum, and examination structure are comparable across SSA, although regional disparities exist. This suggests the strong possibility of success for initiatives that would be directed toward standardizing the qualifications to practice PS in SSA and increasing opportunities for intraregional training.

Background: Ecuador faces a considerable public health burden from congenital anomalies, trauma, and burns, creating a high demand for reconstructive surgery. However, this need is largely unmet despite the presence of a skilled local surgical workforce. This article aims to analyze the systemic barriers that prevent qualified plastic surgeons in Ecuador from providing essential reconstructive care and understand the role of colleagues from high-income countries.

Methods: This perspective analysis is based on a review of regional health data and literature, combined with direct expert experience from surgeons practicing within the Ecuadorian healthcare system.

Results: Ecuador faces a scarcity of high-technology equipment for specialties such as craniofacial surgery and microsurgery due to their cost. The reimbursement structure within the Ecuadorian healthcare system disincentivizes plastic surgeons from providing reconstructive care, as it is not usually a financially sustainable option. International partnerships may benefit Ecuadorian surgeons by modernizing educational frameworks, creating equipment donation programs, and building sustainable local capacity rather than relying on temporary mission trips from abroad.

Conclusions: The failure to provide reconstructive surgery in Ecuador represents a systems failure, not a skills gap. Overcoming this requires a multistakeholder approach focused on policy reform to make reconstructive care financially sustainable, strategic investment in technology, and the development of equitable, locally led partnerships.

Background: Breast reshaping is a common request after massive weight loss, yet implant use in this population remains controversial due to higher complication risks and limited comparative data on implant types.

Methods: This retrospective study, conducted from January 2016 to December 2022 at a public hospital, included adult female patients who underwent breast reshaping with implants. Exclusion criteria were weight loss through diet/exercise alone, a history of breast cancer, poorly managed comorbidities, and significant psychiatric disorders. The procedures were performed by a consistent surgical team, with implant selection tailored to each patient based on preoperative assessments of breast ptosis and individual expectations. Data analysis included patient demographics, surgical specifics, and postoperative complications.

Results: Among the 56 patients studied, 38 received polyurethane implants and 18 received textured implants. The study found no significant differences between these groups regarding age, initial weight, body mass index, weight loss, return to normal activities, patient satisfaction, implant positioning, or complication rates. The overall complication rate was 37.5%, with no significant variation between the 2 implant types.

Conclusions: The study underscores the challenges of achieving optimal results in post-massive weight loss breast reshaping due to unique deformities and a higher risk of complications. Despite ongoing debate over the ideal implant type, this research indicated no clear superiority between polyurethane and textured implants. Future research directions should explore newer ultra-light implants and compare implant-based techniques with autologous tissue approaches to further refine outcomes in this patient population.