J Reconstr Microsurg
DOI: 10.1055/s-0039-1701041
Special Topic Issue: Reconstruction of the Lower Extremity
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment

1  Department of Plastic and Reconstructive Surgery, VM Medical Park Florya Hospital, Istanbul Aydin University, Istanbul, Turkey
Ismail Karasoy
2  Department of Orthopedics and Traumatology, Gumushane State Hospital, Gumushane, Turkey
Yucel Genc
3  Department of Radiology, Gumushane State Hospital, Gumushane, Turkey
Ozgur Pilanci
4  Private Clinic, Istanbul, Turkey
› Author Affiliations
Funding None.
Further Information

Publication History

16 September 2019

02 December 2019

Publication Date:
28 January 2020 (online)


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.