Evolving Trends and Practice in Plastic Surgery in a Resource-constrained Setting: A 27-year Review From Nepal

Plastic surgery in low- and middle-income countries (LMICs) has expanded during the past decades, but data reflecting trends and practices in plastic surgery in LMICs are scarce. This study reviewed trends and practice patterns in an LMIC to identify evolving trends and practices in plastic surgery from the perspective of an LMIC.

A retrospective study was conducted reviewing data from patients admitted to the Department of Plastic Surgery and Burns at a major tertiary care referral center in Nepal from 1998 to 2024. Data on sociodemographics, clinical variables, and operative procedures were collected. For comparison, cases were divided into an early cohort (1998-2005) and a recent cohort (2021-2024). Average annual procedures were compared using unpaired Student t tests, with significance set at a P value of less than 0.05.

A total of 6482 procedures were performed, with an annual average of 240 (range, 128-438). The majority were men (61.2%) and had a mean age of 29.5 ± 18.8 years. Traumatic injuries (29.6%) and burns (17.4%) were the common diagnosis. Reconstructive procedures accounted for half (50.1%) of all procedures. Compared with the early cohort, reconstructive procedures increased by 306.2% (P < 0.0001), and breast procedures by 7600% (P = 0.03) in the recent cohort. The number of aesthetic, hand, and congenital procedures increased, although not to the point of statistical significance, whereas burn procedures declined.

In the past three decades, plastic surgery in Nepal has evolved with a rise in reconstructive and breast procedures, and a fall in burn procedures, reflecting shifting patient priorities, evolving specialty trends, and interdisciplinary collaboration.