Surgical Management and Reconstruction Training (SMART) Course for International Orthopedic Surgeons

<p>Background</p><p>The burden of complex <a title="Learn more about Orthopedic Trauma" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/orthopedic-trauma">orthopedic trauma</a> in low- and middle-income countries (LMICs) is exacerba...

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Autores principales: Hao-Hua Wu, Kushal R. Patel, Amber M. Caldwell, R. Richard Coughlin, Scott L. Hansen, Joseph N. Carey
Formato: article
Lenguaje:EN
Publicado: Ubiquity Press 2016
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Acceso en línea:https://doaj.org/article/328ebd7c9bc74b3b8631f682bd43be04
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Sumario:<p>Background</p><p>The burden of complex <a title="Learn more about Orthopedic Trauma" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/orthopedic-trauma">orthopedic trauma</a> in low- and middle-income countries (LMICs) is exacerbated by <a title="Learn more about Soft Tissue Injury" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/soft-tissue-injury">soft-tissue injuries</a>, which can often lead to amputations. This study's purpose was to create and evaluate the <a title="Learn more about Surgical Management" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/surgical-management">Surgical Management</a> and Reconstruction Training (SMART) course to help <a title="Learn more about Orthopedic Surgeon" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/orthopedic-surgeon">orthopedic surgeons</a> from LMICs manage soft-tissue defects and reduce the rate of amputations.</p><p>Methods</p><p>In this prospective observational study, orthopedic surgeons from LMICs were recruited to attend a 2-day SMART course taught by plastic surgery faculty in San Francisco. Before the course, participants were asked to assess the burden of soft-tissue injury and amputation encountered at their respective sites of practice. A survey was then given immediately and 1-year postcourse to evaluate the quality of instructional materials and the course's effect in reducing the burden of amputation, respectively.</p><p>Results</p><p>Fifty-one practicing orthopedic surgeons from 25 countries attended the course. No participant reported previously attempting a flap reconstruction procedure to treat a soft-tissue defect. Before the course, participants cumulatively reported 580-970 amputations performed annually as a result of soft-tissue defects. Immediately after the course, participants rated the quality and effectiveness of training materials to be a mean of ≥4.4 on a Likert scale of 5 (Excellent) in all 14 instructional criteria. Of the 34 (66.7%) orthopedic surgeons who completed the 1-year postcourse survey, 34 (100%, 'P' < 0.01) reported performing flaps learned at the course to treat soft-tissue defects. Flap procedures prevented 116 patients from undergoing amputation; 554 (93.3%) of the cumulative 594 flaps performed by participants 1 year after the course were reported to be successful. Ninety-seven percent of course participants taught flap reconstruction techniques to colleagues or residents, and a self-reported estimate of 28 other surgeons undertook flap reconstruction as a result of information dissemination by 1 year postcourse.</p><p>Conclusion</p>The SMART Course can give orthopedic surgeons in LMICs the skills and knowledge to successfully perform flaps, reducing the self-reported incidence of amputations. Course participants were able to disseminate flap reconstructive techniques to colleagues at their home institution. While this course offers a collaborative, sustainable approach to reduce global surgical disparities in amputation, future investigation into the viability of teaching the SMART course in LMICs is warranted.