What is it about?

Low and middle-income countries have a high reconstructive surgery burden with several endemic diseases that may require microsurgery such as cancer, road traffic injuries, noma, lymphedema and burns, with children worst affected. We reviewed 1,376 microsurgery flaps in 1,327 patients performed in Africa from 1976 to 2020. Head and neck cancer made up 30% of cases while breast reconstruction comprised 2%. We found a 89% success rate, equivalent to reported outcomes in high income countries. However, the higher complication rate (51%) and lower salvage rate (45%) suggest need for improved perioperative care.

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Why is it important?

Perceived poor outcomes in Africa have raised pertinent ethical questions about the efficacy and safety of performing microsurgery in this setting. This has led some charities to instead transport patients abroad, at great expense, to undergo microsurgical reconstruction in high-income countries, following which they are returned to Africa. This study is the first large scale systematic review and meta-analysis investigating microsurgery outcomes in Low and middle-income countries. We found microsurgery is increasingly being used in Africa and the success rates are high and equivalent to high income countries. However, the comparatively higher complication rate and lower free flap salvage rate suggests a need for improved perioperative care.


Microsurgical reconstruction is the treatment of choice for a variety of complex tissue defects. However, the practice is underdeveloped in low and middle-income countries (LMIC) which account for 6.4 billion (83.1%) of the global population. This study provided an overview of the state of microsurgery in Africa. The high success rate found invalidates the perceived poor outcomes in LMIC, and the study provides a scientific evidence to guide the improved growth, education and practice of microsurgery in Africa and LMIC in general.

Dr Chihena Hansini Banda
Mie Daigaku

Read the Original

This page is a summary of: Clinical Application and Outcomes of Reconstructive Microsurgery in Africa: A Systematic Review and Meta-analysis, Journal of Plastic Reconstructive & Aesthetic Surgery, April 2022, Elsevier,
DOI: 10.1016/j.bjps.2022.04.028.
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