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Reconstructive considerations in low and middle-income countries

Cervenka, Briana; Trudeau, Stephenb; Fagan, Johanc; Zender, Chadd

Current Opinion in Otolaryngology & Head and Neck Surgery: October 2018 - Volume 26 - Issue 5 - p 340–346
doi: 10.1097/MOO.0000000000000484

Purpose of review Surgical mission trips in head and neck surgery are common. There are an increasing number of surgical groups performing complex reconstructions in low and middle-income countries (LMIC). Consideration of reconstructive options that are location and patient specific are critical for optimum patient care and local physician education.

Recent findings The pectoralis muscle regional flap is a versatile and reliable option and has been shown to reconstruct defects in nearly every head and neck subsite. Additional regional flap options described are the supraclavicular island flap and submental island flap. There are 15 published case series describing experience with performing microvascular reconstructions in LMIC. The average success rate was 87.1%. Both loupe and microscope magnification are used.

Summary Complex reconstructions are successfully being performed in LMIC. Although microvascular reconstruction is being utilized by some groups, local and patient-specific factors should be carefully considered, as many regional and local flap options available provide the same reconstruction benefit while minimizing operating room time, resources, and postoperative care needs.

aDepartment of Otolaryngology-Head and Neck Surgery, University of California at Davis, Davis, Sacramento, California

bCase Western Reserve MC, Cleveland, Ohio, USA

cDepartment of Otolaryngology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

dDepartment of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland MC, Cleveland, Ohio, USA

Correspondence to Chad Zender, MD, University Hospitals Ear, Nose and Throat Institute, 11100 Euclid Ave, Cleveland, OH 44106, USA. Tel: +1 216 844 5307; fax: +1 216 201 5157; e-mail:

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