What is Global Reconstructive Surgery?

Written By,

Aimee Wilkinson, Bristol Medical School

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For the month of October, we are casting a spotlight on global plastic and reconstructive surgery! In this blog post, we give a brief introduction to global reconstructive surgery and what it means to be a global surgeon.

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Published in 2016, the World Bank’s Disease Control Priorities Publication [1] lists 44 distinct surgical procedures that are essential for health promotion in the global population. After consideration of the cost­effectiveness and feasibility of implementing different surgeries, as well as the global burden of conditions for which each surgery is indicated, the report concludes that reconstructive treatment of burns, wounds and congenital malformations constitutes “essential surgery”.

Despite the importance of these interventions, 5 billion of the world’s 7 billion population do not currently have access to safe or affordable surgical care [2]. Untreated surgical disease represents a significant proportion of disease burden globally [3,4] and places great strain on local and regional economies [9]. Low and middle­income countries (LMICs) are most significantly affected by this disparity. These countries represent 48% of the global population but have the greatest burden of untreated surgical disease [2] and access to only 20% of the global surgical workforce [5].

The field of global reconstructive surgery recognises that surgeons possess knowledge and skills that can benefit the wider global community. Propelled by the establishment of the Lancet Commission on Global Surgery in 2015 [6], the field ensures equitable access to surgical care worldwide by supporting areas of greatest need, namely LMICs and populations suffering the consequences of conflict, displacement and disaster [7].

In practice, the work of global surgical initiatives has shifted in recent years from sending surgeons from high­income countries to operate in LMICs, towards more sustainable actions such as training of local surgeons and promoting the exchange of experience between countries [8]. There may still be circumstances such as natural disaster and conflict, wherein plastic surgeons from developed countries provide trauma care or operative reconstruction acutely in harsh or resource­poor environments [7]. However, global surgical interventions are now typically longer­term and are tailored specifically to a population’s culture, customs and needs [9].

The challenges that face global reconstructive surgeons are continually evolving. Reconstructive surgery is of incredible social and economic benefit, providing substantial health benefit for relatively little money [8]. However, against the backdrop of a rapidly growing population, an increasing incidence of chronic health conditions particularly in LMICs [3] and growing uncertainty surrounding travel in light of the recent coronavirus pandemic, it is clear that more innovative solutions to the disparities in surgical care provision are needed.

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References

[1] Mock C, Donkor P, Gawande A, et al. (2015). Essential surgery: key messages from disease control priorities, 3rd edition. Lancet, 385:2209–2219.

[2] Čebron U, Zuo K, Kasrai L. (2019). A Bibliometric Analysis of the Most Cited Articles in Global Reconstructive Surgery. Annals of Plastic Surgery, 83(3):334–339.

[3] Meara J, Leather A, Hagander L, Alkire B, Alonso N, Ameh E, et al. (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993):569–624.

[4] Sue G, Covington W, Chang J. (2018). The ReSurge Global Training Program. Annals of Plastic Surgery, 81(3):250–256.

[5] Holmer H, Lantz A, Kunjumen T, Finlayson S, Hoyler M, Siyam A, et al. (2015). Global distribution of surgeons, anaesthesiologists, and obstetricians. The Lancet Global Health, 23:S9–S11.

[6] The Lancet. (2015). The Lancet Commission of Global Surgery [Online]. Available at: https://www.lancetglobalsurgery.org/ (Accessed 7th October 2020)

[7] British Foundation for International Reconstructive Surgery and Training. (2017) What is Global Reconstructive Surgery? [Online]. Available at: http://www.bfirst.org.uk/get­involved/trainees/what­is­globalreconstructive­surgery/ (Accessed 7th October 2020)

[8] Hughes C, Alkire B, Martin C, et al. (2012) American plastic surgery and global health. Annals of Plastic Surgery, 68:222–225.

[9] Goodacre T. Commentary on “Plastic surgery and global health: How plastic surgery impacts the global burden of surgical disease.” (2010). Journal of Plastic, Reconstructive & Aesthetic Surgery, 63(8), 1249–1250.