Abstract
Background Microsurgical lower extremity reconstruction remains challenging, especially when
resources are limited such as lack of proper equipment, human resources, administrative
support, and located in a remote area far from tertiary care. Nevertheless, reconstructive
solutions are required, especially when in urgent trauma situations. In this article,
we evaluate ways of overcoming challenges and issues that should be considered in
a newly established unit by sharing our initial lower extremity reconstruction experience.
Methods We report a local hospital's initial lower extremity reconstruction experience in
February 2017 to January 2018. Through a total of seven patients, we tried to enhance
the environment, instruments, nurses' contribution, and perspective of the peers and
community in terms of factors related to the surgeon, hardware, environment, supporting
faculty, reimbursement, and patients.
Results Four patients underwent reconstruction with a freestyle propeller flap and three
with an anterolateral thigh flap; in one case, a superficial circumflex iliac artery
perforator flap was chosen to salvage partial flap necrosis. Increased experience
of the surgeon, new equipment, continuing nurse/patient education, and collaborating
with other departments allowed us to choose more challenging flaps and be more meticulous
while decreasing the operation time and hospital stay.
Conclusion To start a lower extremity reconstruction practice in a resource-poor environment,
the surgeon needs to evaluate the relevant factors; moreover, he or she should continuously
improve them until a working methodology is achieved. Despite all the challenges,
the adaptations learned at this center can be applied to other local hospitals around
the world to set up a lower extremity reconstruction practice and improve its outcomes.
Keywords
lower extremity reconstruction - constrained environment - microsurgery
