Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment.

Area of Science:

• Microsurgery
• Reconstructive Surgery
• Limb Reconstruction

Background:

• Microsurgical lower extremity reconstruction presents significant challenges in resource-limited environments.
• Lack of equipment, personnel, and proximity to tertiary care complicate urgent trauma reconstructions.

Purpose of the Study:

• To evaluate strategies for overcoming challenges in establishing a new microsurgical lower extremity reconstruction unit.
• To share initial experiences and lessons learned in a resource-poor setting.

Main Methods:

• A retrospective review of seven patients undergoing lower extremity reconstruction from February 2017 to January 2018.
• Focus on enhancing surgeon, hardware, environment, faculty support, reimbursement, and patient factors.

Main Results:

• Successful reconstructions using freestyle propeller and anterolateral thigh flaps; one case required salvage with a superficial circumflex iliac artery perforator flap.
• Improvements in surgeon experience, equipment, nursing education, and interdepartmental collaboration led to reduced operation time and hospital stay.

Conclusions:

• Surgeons must critically assess and continuously improve relevant factors to establish microsurgical reconstruction in resource-poor areas.
• Adaptable strategies from this experience can guide other centers in setting up similar practices and improving patient outcomes.