Reconstructive Surgery for the Neglected Tropical Diseases: Global Gaps and Future Directions

Abstract

Background: Several neglected tropical diseases (NTDs) are highly disfiguring, particularly those in resource-poor countries that lack access to basic surgery. There has been a push to integrate surgery into treatment programs for NTDs. In this article, we provide an overview of the major disfiguring NTDs and discuss the processes and barriers that impede access to reconstructive surgical treatments or their integration into health systems. Methods: A review of the literature was conducted using the online database PubMed, from 2008 to 2021 with the specific diseases listed as NTDs either on the World Health Organization or the PLoS Neglected Tropical Disease websites. Reference lists of identified articles and reviews were also searched, as were databases from the World Health Organization’s Weekly Epidemiological Record. Result: Success in the surgical treatment and postoperative care of disfiguring NTDs would benefit from standardization and harmonization of surgical approaches and procedures. In some settings, reconstructive surgery should be used cautiously, emphasizing appropriate use of antibiotics, partnerships with global and local surgical teams, and local capacity building. Preventative hygiene approaches remain paramount in resource-poor areas. Conclusions: Surgery is a promising treatment for NTDs that result in disfigurement and disability. The expansion of local capacity building, with medical trips and surgical training of local health workers, together with the development of universal surgical protocols remain essential cornerstones for NTD reconstructive surgery. Antibiotics and drug management should comprise key first steps before turning to surgery.

Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia

“…Noma can result in various sequela, including trismus, sequestration of the jaws, fibrous ankylosis of the temporomandibular joint, oro‐nasal fistula, damage to permanent tooth buds, premature loss of deciduous teeth, and maxilla and mandible hypoplasia 9,24,25 . Soft and hard tissue loss often leads to chewing difficulties for noma patients 26 .…”

“…Noma can result in various sequela, including trismus, sequestration of the jaws, fibrous ankylosis of the temporomandibular joint, oro‐nasal fistula, damage to permanent tooth buds, premature loss of deciduous teeth, and maxilla and mandible hypoplasia. 9 , 24 , 25 Soft and hard tissue loss often leads to chewing difficulties for noma patients. 26 While the surgical intervention for noma patients is primarily focused on treating the sequelae, it is important to note that complications can arise in certain cases.…”

Plastic Surgeons Critical to Surgical Care and Rehabilitation of Patients with Neglected Tropical Diseases

“…For example, the protocol for an international randomized controlled trial investigating peripheral nerve decompression in HD has been published and awaits funding, which the recent article may help create. 1,3 Plastic surgery missions for cleft lip/palate, burns, and other disfiguring conditions in underdeveloped nations have helped immensely with training and reducing the surgical burden. We suggest that such missions are still needed to help patients with HD.…”

“…We commend Pham et al for bringing attention to the role of plastic and reconstructive surgery for neglected tropical diseases, particularly leprosy or Hansen Disease (HD). 1 In 2016, we published the first article related to HD in Plastic and Reconstructive Surgery Global Open (PRS-GO). 2 We discussed the treatment of peripheral neuropathy in patients with HD.…”

“…For example, the protocol for an international randomized controlled trial investigating peripheral nerve decompression in HD has been published and awaits funding, which the recent article may help create. 1 , 3 …”