Plastic and Reconstructive Surgery

Introduction In most parts of the African continent, plastic and reconstructive surgery remains among the least developed surgical specialties, with training opportunities available only abroad. As a result, this specialty still depends largely on the abilities of nongovernmental organisations (NGOs), philanthropic individuals, and organised surgical safaris/ camps to meet the reconstructive needs of the majority of the populace. Because of the overwhelming needs for this service, general surgeons and the few paediatric surgeons provide this care. It is therefore essential that the surgeon managing paediatric reconstructive surgical problems be well informed on the spectrum of presenting pathologies, as well as the available options and resources for their treatment. This chapter highlights the most common reconstructive topics peculiar to Africa. It is not intended to be a comprehensive text, and the reader is referred to appropriate texts, including those mentioned at the end of this chapter. Illiteracy, superstition, poverty, and armed conflicts continue to hamper the evolution of health care for all in Africa into the 21st century. In addition, children with disabilities or deformities are still hidden away from school and society. Most public transport, health, and education systems remain disability-unfriendly. Surgeons can become agents of change; by providing quality surgical care and educating the relatives and community, children with disabilities or deformities can become socially acceptable. Educational opportunities will give them the vehicles to self-actualisation. A good understanding of embryology and anatomy are indispensable for the management of paediatric plastic and reconstructive surgical problems. Embryology is important because congenital aberrations and malformations form the majority of these problems; surgical restoration of form depends on a good knowledge of normal anatomy. As a caution to the surgeon, the patient and relatives of the patient, an appreciation of the limitations of current surgical techniques in achieving desired results is essential. Patients and their relatives must be involved in the decisionmaking process and informed on available options. Realistic goal-setting is a crucial part of reconstructive surgery. The physician must also gently inform the patient and relatives of the need for long-term follow-up and/ or therapy. The surgeon seeks to restore form, function, and cosmesis, but this is not always possible, and part of the process of goal-setting must include agreeing on which of these aspects are the most feasible and most important to achieve. Staged procedures and their results should also be carefully relayed to the patients and relatives. Whenever a congenital malformation is presented to the clinician, the history taken must include, amongst others: • prenatal and postnatal history;