Plastic and reconstructive surgery in Zambia: epidemiology of 16 years of practice

The epidemiology of surgical conditions in developing countries is not well studied, but plastic and reconstructive surgery can play a significant role in meeting the need for surgical care. Knowledge of the conditions treated by a plastic surgeon in a low-income country would inform the development of surgical services.

The surgical log of the lead author from 1993 to 2008 was reviewed. The cases were performed in 33 surgical facilities in Zambia, and name, gender, age, diagnosis, procedure, and hospital were prospectively recorded. Data were analyzed for the number and distribution of cases and for patterns related to age and gender.

Between 1993 and 2008, 5,740 operations were performed, and complete data were available for 5,735 (99.9%) patients. There were 5,774 surgical diagnoses. Of these, 3,885 (67.2%) were acquired conditions. These included 1,985 (34.3%) burns, 514 (9.0%) keloids, 448 (7.8%) nonburn traumas, 410 (7.1%) deep tissue infections, and 343 (5.9%) tumors. The 1,889 (32.7%) congenital conditions included 1,322 (22.9%) craniofacial defects and 354 (6.1%) limb defects. Children accounted for 78.2% of burns. Trauma cases were predominantly male (273, 60.9%). Congenital conditions were repaired after 5 years of age in 355 (18.8%) cases.

Based on a 16-year case log from one developing country, more than half of conditions related to plastic surgery comprised injuries and congenital anomalies. Age- and gender-related patterns were evident. These findings may inform the provision of resources for injury prevention, surgical training, and delivery of surgical services.