The global burden of surgical disease is substantially growing. Conditions that are treated using reconstructive and plastic procedures makes a huge portion of the global surgical disease. Unfortunately, these diseases affect those in the lower level of the economic spectrum.
This article reviews the role of plastic surgery in global health, the global need for reconstructive and plastic surgery and the efforts done to meet these needs.
Plastic Surgery and Global Health
Global health refers to an area of research, study and practice where achieving health equity and improving health for everyone worldwide is a priority. Approximately two billion people in the world cannot access basic surgical services and in the poorest parts of the world, the burden is higher.
Even when these services are accessed, their effectiveness, timeliness and safety are not optimal and, in the process, the patients may be affected financially.
To prevent disability and death in developing countries, an additional 143 million surgeries and 4 million health workers are needed annually.
Fortunately, plastic surgery is gaining global awareness with various conditions across the world needing the intervention of plastic surgery. These conditions mostly affect the poor and can be exacerbated by difficult social circumstances and poverty.
In low- and middle-income countries, the shortage of plastic surgeons is substantial.
The Unmet Plastic Surgery Need
It has been estimated that 66 percent of the measured surgical disease are caused by congenital anomalies, malignancy and injuries.
These conditions are often treated through plastic surgery intervention as explained by the Calgary Plastic Surgery Centre.
The greatest surgical burden includes trauma and injuries. Natural disasters, road traffic accidents and war can injure soft tissue, nerves, tendons and bones which if left untreated can cause disability. Plastic surgical intervention that is timely, simple and inexpensive for soft tissue protection and closure, wound debridement and fracture fixation, reduces complications such as non-union and osteomyelitis and enables effective healing.
Globally, burns make a significant percentage of acquired deformities that need reconstructive care. Each year, about 10.9 million people get severe burns. Burns are the 5th leading cause of childhood injury that is not fatal and the 11th cause of death in children.
In the poorest parts of the world, burns are overrepresented. This is because livewires are exposed, cooking is often done in open flames and fires are caused by destructive wars. Burns can compromise function and form as well as cause extensive scarring.
For optimal healing, most burns need plastic surgical expertise for skin grafting, burn excision, reconstructive surgeries and contracture release. To maintain function, splinting and physiotherapy are important.
Cleft lip and palate (CLP) are the most common congenital anomalies globally. Infants surviving CLP are at higher risk of infection, malnutrition and feeding and speech problems. Perinatal mortality is increased by CLP and children with CLP may be ostracized and stigmatized from their communities. They may even be denied employment and education opportunities.
Meeting the Need
Action to improve health equity and health in general is important to global health. Reconstructive and plastic surgery has a tradition of international service and currently, its humanitarian importance is very strong.
Over 100 non-profit associations for plastic surgery have been formed to increase the services for plastic surgery to people in developing countries. Examples include Smile Train, Operation Smile and ReSurg, and they target providing effective and safe CLP care.
For decades, humanitarian organizations have organized outreach programs where hundreds of reconstructive and plastic surgery missions are done in developing countries. These missions provide surgeries for trauma, burns, congenital defects such as CLP repair and craniofacial deformities.
The ‘mission model’ has ensured timely, safe and high-quality delivery of surgeries to patients in need of reconstructive treatment. For these missions to be successful, they need effective communication and teams of nurses, technicians, anesthetists, occupational therapists, administrators as well as partnerships between governments, local medical personnel and health ministries.
This article has shown the role of plastic surgery in global health. Global surgical care that is sustainable is important for the future, even though finances and policy are the major difficulties encountered in this discipline.
Better surgical care needs continuous support from the entire plastic surgery community and research to ensure better interventions are developed.
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