Shyaka Ian, Nezerwa Yves, Mukagaju Francoise, Dang Rushil R, Furaha Charles, Ntirenganya Faustin
From the Department of Plastic Surgery, Rwanda Military Hospital, Kigali, Rwanda.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Taoyuan, Taiwan.
Plast Reconstr Surg Glob Open. 2023 Oct 11;11(10):e5332. doi: 10.1097/GOX.0000000000005332. eCollection 2023 Oct.
Reconstructive microsurgery practice has been well adopted in developed countries, but this has not been the same in low- and middle-income countries (LMICs). Injuries related to road traffic accidents are highest in these countries, with 93% of the world's fatalities on the roads occurring in LMICs. The objective of this study was to highlight the need for sustainable microsurgery in LMICs and share strategies undertaken in Rwanda.
We review the contemporary literature about the needs and challenges facing reconstructive microsurgery in LMICs. We describe the strategies undertaken in Rwanda towards developing microsurgery. We also report the outcomes of the first ever microsurgery visiting professorship organized in the country and the steps taken towards achieving sustainable microsurgery practice in Rwanda.
There is a huge unmet need for reconstructive microsurgery in LMICs. Most of the microsurgical operations in these countries are done in short term surgical mission setups. No data focusing on sustaining reconstructive microsurgery in LMICs has been described in the contemporary literature. There is a 2.5-fold increase in the number of trained plastic surgeons in Rwanda over the past 5 years, with increasing skills in microsurgery and opportunities for formal overseas fellowships.
With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable microsurgery services is possible in countries with limited resources. In our experience, the fly-in-fly-out microsurgical missions aimed at mainly providing surgical care to patients seem to have a limited long-term impact and sustainability. We recommend integrating these missions into planned microsurgical initiatives of pre-existing local plastic surgery training programs.
重建显微外科手术在发达国家已得到广泛应用，但在低收入和中等收入国家（LMICs）情况并非如此。这些国家与道路交通事故相关的伤害最为严重，全球93%的道路死亡事故发生在LMICs。本研究的目的是强调LMICs对可持续显微外科手术的需求，并分享卢旺达所采取的策略。
我们回顾了关于LMICs重建显微外科手术面临的需求和挑战的当代文献。我们描述了卢旺达为发展显微外科手术所采取的策略。我们还报告了该国首次组织的显微外科客座教授职位的成果以及为在卢旺达实现可持续显微外科手术实践所采取的步骤。
LMICs对重建显微外科手术存在巨大的未满足需求。这些国家的大多数显微外科手术是在短期外科手术任务设置中进行的。当代文献中没有描述专注于在LMICs维持重建显微外科手术的数据。在过去5年里，卢旺达受过培训的整形外科医生数量增加了2.5倍，显微外科手术技能不断提高，并有机会获得正式的海外奖学金。
有了敬业的当地倡导者、全面的方法和可靠的合作伙伴，在资源有限的国家建立可持续的显微外科手术服务是可能的。根据我们的经验，主要旨在为患者提供手术护理的往返式显微外科手术任务似乎长期影响和可持续性有限。我们建议将这些任务纳入现有当地整形外科培训计划的规划显微外科举措中。
